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.

(11) comments


America- please. Its well known that we're ranked 38th in the world in affordable healthcare. 38th. Us, the USA! We are an international embarrassment- and something has to be done about it.

america as founded
america as founded

The democrat voters did this to America. Not only are they ruining the best health care in the world, they are destroying America financially.

Call Ron Kind and ask how his family is affected. Hint; they're not. Ron voted for Obama care, knowing full well he would never have to live by the rules he imposed upon the rest of us.

America is over and your democrat neighbor is why.

When the country collapses, and it will, the democrats will be crying for someone to save their sorry butts as they always do.


That is correct! Obamacare is bad, has been bad since the words came out of his mouth, but his voters heard FREE so they voted! and here we sit! and you who said Walker did wrong? No, he is trying to keep that trash out of WI and keep the quality of care that we have. that exchange? it is coming, READ the article.


@Spirit. I believe you have a fundamental misunderstanding of both the 80/20 rule and how insurance works. Insurance companies do not have to pay back money to each individual if they didn't spend the money on their own personal health expenses but only to all insured parties if they don't spend at least 80 percent of the premiums they taken in the aggregate on healthcare. Think about it. If a health or car or house in sure had to pay back 80 percent off all premiums to every single person who didn't make a claim in any given year and only had to pay out very large amounts of money to a small number individuals who had a catastrophic loss such a bad car crash, house burning down, or catastrophic illness, they'd be bankrupt within the year. for example, if insurer A takes in $1 billion in premiums but only spends $750 million on claims, it would have to send out an equal amount of money to all insureds totaling $50 million on the theory that it charged each person a little too much for the insurance that year.


Obama care is NOT good. My husband and I have had excellent insurance. Now our deductible will increase to 2400 dollars per person. Last year (2012) our deductible was only 500 per person 1500 per family.
We are also losing most coverage. The company says this is because we have what the government considers a Cadillac plan and we will pay penalties if they don't change.
This is not a good thing.
Yes everyone should be able to have good affordable healthcare but DON'T TAKE MY EXCELLENT INSURANCE COVERAGE AWAY FROM ME.


Please take the time to take names/date/time from any insurance company who calls you about rasing your rates and file a complaint to the Wisconsin state insurance commission. Another FYI, California just released the rates on the health insurance pool and the rates are a lot lower than what the GOP/Tea Party has been spreading lies about.


Actually what a lot of insurance companies have figured out how they can circumvent the new rule enacted by ACA (Obama care). They will try to trick you with a "cheaper" increase (higher deductible), to try to lock you for another year and keep you from getting the benefits from Obamacare for another year! Say no to their "better" deal. We have two laws that protect us against their abuses and lies:

1- the 80/20 rule that states: Your insurance company must spend 80% of the premiums you pay every year, in your medical bills you incur or refund you that money. Example: If your premiums are $5,000 /year and you did not have any doctor visits or medical procedures, then your insurance company has to reimburse you $4,000 Yes! Four thousand dollars! And course the amount will vary if you had medical expenses.
2- Starting on September 1, 2011, health insurers must justify any rate increase of 10% or more before the increase takes effect.


The 80/20 rule went into effect in 2011, the health insurance company has to spend 80% of your premium towards your healthcare or issue a refund. Recently a friend of mine received a phone call from his insurance company, this is his note about the experience: Aetna just called me and told me my rates will go up because of Obama Care (ACA). So I asked them to tell me exactly which part of the ACA would make their rates increase and they did not have an answer, even though they transferred me to the "expert". I added that hey had been raising my rates every 6 months, even before the ACA was enacted, so not to lie and blame their increase now on the ACA.


the only reason this won't be effective in Wisconsin is because of Walkers ignorance in turning down the federal money and refusal to setup state exchanges.


Your increases next year are the tip of the iceberg. This bill does nothing to fix our catastrophic medical problem within this country. It only adds a devastatingly inefficient middle man (aka big government) to further increase price and decrease productivity.


Our insurance will be going up about 16% next year we're told. Where is the provision to prevent price gouging?

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