More than a decade has passed since the Affordable Care Act (ACA) was signed into law, expanding Medicaid eligibility and ensuring quality, affordable health care coverage for millions across the nation. But in Wisconsin, 91,000 people are still waiting for access to such care.
This group consists of low-wage earners — many of whom are the essential workers keeping our state running amid the COVID-19 pandemic. Many make too much to qualify for BadgerCare and too little to afford private insurance costs or subsidies through the ACA marketplace, leaving them without health care.
Wisconsin is one of 12 states that refuses to expand Medicaid eligibility. Research has shown people without health care access are less likely to receive preventive care, increasing their chances of chronic disease and mortality, contributing to rising health care costs.
Wisconsinites deserve better. We need to expand Medicaid to ensure everyone has access to affordable health care coverage — including the 91,000 people our lawmakers have neglected for far too long.
Breaking down the coverage gapWhen state lawmakers partially expanded BadgerCare in 2014, they included adults making up to 100% of the federal poverty level (FPL) — roughly $12,800 per year — well below the ACA’s allowance of incomes up to 138% of the FPL — roughly $17,700 per year. They also slashed eligibility for parents from 200% to 100% of the FPL, resulting in more than 60,000 parents losing coverage. These conditions, and others, created today’s coverage gap and launched a debate over what’s considered “affordable” for low-wage workers.
People are also reading…
Wisconsin’s coverage gap includes people who don’t qualify for BadgerCare, but can’t afford the costs on insurance plans available through the ACA Marketplace. That includes:
- Low-wage earners who can afford the monthly premium but not the out-of-pocket costs on a Marketplace insurance plan.
- Low-wage earners who can’t afford their job-based insurance plan, but are ineligible for subsidies on the Marketplace because their job-based plan is deemed “affordable.”
- Low-wage earning households caught in the “family glitch” — if one earner has a job-based insurance plan that’s deemed “affordable” then no one in the household is eligible for subsidies through the Marketplace.
Take, for example, a full-time working single mother who makes $9 per hour. Because she makes more than $8.38 per hour, she doesn’t qualify for BadgerCare and must get insurance through her job or the Marketplace.
Because the Marketplace deems her job-offered insurance affordable, she doesn’t qualify for subsidies on Marketplace options. But on top of childcare, rent, food, clothing, and other basic monthly costs, she can’t afford the deductible and monthly premium on her job-offered coverage. As a result, she forgoes health insurance.
For adults and families in similar situations, scenarios like this are all too familiar.
Improving the state’s health and economic outcomesUnder the ACA, states that raise their Medicaid income eligibility to 138% of the FPL receive additional federal funding. Because Wisconsin has only partially expanded its income eligibility, it does not qualify for that funding.
Instead, Wisconsin pays about $300 million more each year to cover roughly 90,000 fewer people. With expansion, state taxpayers would have saved billions in healthcare costs over the years.
Medicaid expansion also has important health benefits, especially among lung disease patients.One study linked expansion with an increase in early stage cancer diagnoses — patients’five-year survival rate for a late-stage lung cancer diagnosis is only 6%, but if it’s caught early, that rate increases to 57%.
Statewide polling shows 7 in 10 residents support Medicaid expansion. Given intransigence in Wisconsin and the other 11 non-expansion states, support is growing for a federal solution. The case for expansion is crystal clear — it’s time we make it a reality.
William Parke-Sutherland is the health policy analyst at Kids Forward, where he leads in Medicaid policy, immigration-related health issues, and the Affordable Care Act. Dr. Todd A. Mahr is an allergist-immunologist in La Crosse and is affiliated with Gundersen Lutheran Medical Center. He received his medical degree from University of Wisconsin School of Medicine and Public Health and has been in practice for more than 20 years.
IN PHOTOS: Gov. Tony Evers visits vaccination site at UWL
Here are scenes from Gov. Tony Evers' visit to UWL’s Cleary Alumni & Friends Center, open for vaccinations Tuesdays through Saturdays from 11 a.m. to 7 p.m. Initially, the La Crosse County Health Department will prioritize people 65 and older.
Evers at UWL
Gov. Tony Evers, center, is accompanied by numerous officials Tuesday, including UW-La Crosse Chancellor Joe Gow, UW System President Tommy Th…
Gov. Evers at UWL
Gov. Tony Evers, right, is accompanied by numerous officials including UW System President Tommy Thompson, center, during a tour of the new CO…
Gov. Evers at UWL
Gov. Tony Evers tours the new COVID-19 vaccination clinic Tuesday at the Cleary Alumni & Friends Center on the UW-La Crosse campus.
Evers at UWL
Gov. Tony Evers speaks at the opening of La Crosse County's COVID-19 vaccination clinic at UW-La Crosse on Tuesday. Initially, the clinic will…
Tour of site
Aron Newberry, vaccine lead for the La Crosse County Health Department, leads Gov. Evers and other state officials on a tour of the site.