MADISON — Though the Legislature last week approved Gov. Scott Walker’s rejection of an optional Medicaid expansion under federal health care reform, the next steps in carrying out the rest of the law are expected to unfold this summer.
“Navigators” will be hired to help people enroll in coverage for next year, and details of the private insurance plans to be offered will be released.
Outreach campaigns will pick up, including a “Get Covered America” effort launched last week by former campaign staffers for President Barack Obama and “Time for Affordability,” organized by America’s Health Insurance Plans.
“The idea is to inform as many people as possible and make sure they get to the right avenue” for buying insurance, said Lisa Olson, director of policy and programs for the Wisconsin Primary Health Care Association, the state’s lead organization preparing to hire navigators.
The developments are expected to take place before online marketplaces, known as exchanges, open Oct. 1 and offer coverage beginning Jan. 1. That’s when most Americans will have to be insured or pay a penalty.
Wisconsin’s exchange, along with its partial Medicaid expansion for childless adults, will insure about half of the nearly 500,000 residents who lack coverage today, state officials say.
Critics say some lower-income people won’t be able to afford insurance on the exchange, even though they will qualify for subsidies.
Under Walker’s plan, almost 90,000 parents on Medicaid who make more than the poverty level will be shifted to the exchange.
The state’s exchange, to be run by the federal government, will offer a variety of private insurance plans. It is designed for people who have no access to employer-based coverage.
Some of those people currently buy insurance on the individual market or through a special plan for people with high-risk medical conditions.
The vast majority of people who get insurance through their jobs won’t use the exchange or see major changes to their coverage next year, said Barbara Zabawa, a health care attorney in Madison with Whyte Hirschboeck Dudek.
Some companies might decide to direct workers to the exchange, however, and the cost of employer coverage likely will increase because of new requirements, Zabawa said.
The Wisconsin Primary Health Care Association applied this month for $829,000 the federal government allocated to the state for navigators.
The association is leading a statewide coalition of 72 health care groups — called Enrollment for Health Wisconsin — which will learn by Aug. 15 if it will receive the money, Olson said.
The association represents the state’s 17 community health centers, including Access Community Health Centers in Madison, which mostly serve low-income people. The centers have collectively applied for another $1.7 million to help sign up people for insurance.
The $829,000 would be used to hire six full-time navigators, who would be able to enroll about 6,000 people in coverage, the coalition estimates.
“It’s barely scratching the surface” of the need, Olson said.
But the coalition plans to organize enrollment fairs and find other ways to reach large numbers of people, she said.
The state budget also includes two pots of state and federal money to hire workers to help implement the law: $10.3 million to hire 88 people for Medicaid enrollment, mostly in Milwaukee; and $38.1 million to help counties assist consumers, including $1.4 million in Dane County to hire 34 economic support workers.
Details about the plans to be offered on the exchange — such as premiums, co-payment amounts and levels of coverage — are expected to be released in late July, said J.P. Wieske, spokeswoman for the Wisconsin Office of the Commissioner of Insurance.
The information should be available on the exchange’s website by Sept. 15, according to the federal government.
Most Madison-area health insurance companies applied by early May to participate in Wisconsin’s exchange, though none has released details of what coverage they will offer.
Dean Health Plan, Group Health Cooperative of South Central Wisconsin, Physicians Plus and Unity applied to be on the exchange next year.
WEA Trust doesn’t plan to participate. Neither does WPS Health Insurance, except for its Green Bay-based subsidiary, Arise Health Plan.