Health Care For All

1. Health Care For All Governor Doyle’s Roadmap to Universal Access to Health Insurance for all Wisconsinites July, 2009

2. Overview • Governor Doyle’s Health Care Vision • Wisconsin’s Health Care Challenges • Wisconsin’s Uninsured Population • Governor Doyle’s Seven Point Plan for Health Care Reform

3. Governor Doyle’s Health Care Vision • Every Wisconsin resident will have access to affordable health insurance. • Every child will have access to high-quality health care services. • The state must lead the way in meeting these goals.

4. Governor Doyle’s Health Care Vision • Sound health policy – grounded in research and data – will drive implementation of solutions. • Business community and health care providers work in partnership with the state to improve quality and reduce costs. • Health care costs are lowered and are no longer a drag on Wisconsin’s economy. • Health care programs must be simple and easy to access.

5. Wisconsin’s Health Care Challenges • Access – While progress has been made, some Wisconsin residents do not have access to affordable health insurance. • Cost – Costs are increasing, both for health care and for insurance coverage. • Quality – Lack of easily accessible information about the quality of care and medical errors are far too common. • Medicaid Financial Stability – State must maintain sustainable financing for Medicaid.

6. Wisconsin’s Uninsured Population • In 2007, 6 percent of Wisconsin residents were currently uninsured and 5 percent had been without insurance for the entire past year. • The percentage uninsured part of the past year shows a significant decrease from 2006 (5%) to 2007 (4%). • The proportion of children (ages 0-17) uninsured all year decreased from 4 percent in 2006 to 2 percent in 2007. The proportion of children uninsured during part of the year also significantly decreased (from 4% to 3%). • The percent currently uninsured decreased significantly between 2006 (8%) and 2007 (6%). • Wisconsin has the 2nd lowest uninsured rate in the country.

7. On WisconsinGovernor Doyle’s Seven Point Plan for Health Care Reform

8. Point #1: Universal Access Ensure that 98% of Wisconsin residents have access to affordable health insurance – including all kids

9. Universal Access: Implementation Wisconsin continues to expand access to health care during difficult economic times • Phase One: Implemented BadgerCare Plus for children and families in February 2008 • In one year, more than 100,000 individuals enrolled, including 70,000 kids. • Made the program simple and easy to access. • Streamlined eligibility requirements so more pregnant women, parents and caretakers were able to become members. • 30% of applications received online.

10. Universal Access: Implementation Wisconsin continues to expand access to health care during difficult economic times • Phase Two: Implemented BadgerCare Plus Core Plan for adults with no dependent • Transitioned General Assistance/General Relief medical program into the BadgerCare Plus Core Plan on January 1, 2009 (12,500 members). • Implemented the BadgerCare Plus Core Plan statewide on July 15, 2009. • Received more than 20,000 applications in three weeks. • 82 percent of applications received via online application process. • Innovative benefit/program design that will serve as a national model. • Requires members to receive a physical exam during the first year of the program. • This requirement is unique among state Medicaid Programs.

11. Universal Access: Easy Enrollment • Wisconsin leads nation in simplifying enrollment for health care programs. • Medicaid programs will be simple to understand, to enroll in and to administer. • Implement one-page application form. • Apply online via ACCESS, in person, by phone or through the mail. • Non-traditional points of entry: Community-based organizations like WIC clinics, faith-based organizations, Head Start, etc. • 200 partner organizations statewide.

12. Previous Medicaid Eligibility System Medicaid/BadgerCare/Healthy Start

13. Current Medicaid Program Medicaid/BadgerCare/Healthy Start

14. Point #2: Family Care • Reform of long-term care system. • Utilize managed care principles and community-based settings to control cost, expand access. • Ensures access to community-based long-term care services for 11,000 Wisconsin seniors and individuals with disabilities. • State is more than half way to statewide implementation. • By the end of 09-11 biennium, Family Care will be operating in 59 counties that include 90% of the state’s population.

15. Point #3: SeniorCare Asking Federal Government to extend SeniorCare through December 31, 2011 • Highly cost-effective drug program for 90,000 Wisconsin seniors. • Easy-to-understand program. • $30 annual enrollment fee and participants are enrolled for 12 months. • No donut hole. • Most drugs are covered and SeniorCare is accepted at all pharmacies. • Co-pays are based upon income and have remained unchanged since September 2002. • Wisconsin negotiates drug prices to save money for members.

16. Point #4: Health Care Quality Reform Wisconsin is transforming its Medicaid program Active purchaser of quality health care • Holding Medicaid and BadgerCare Plus HMOs accountable for health outcomes (P4P). • Implementing new quality measurement system (HEDIS). • Implementing innovative benefit/program design linked to quality improvement (Core Plan). • Increased oversight of HMO network capacity and utilization control procedures. • Performance-based RFP for managed care in Milwaukee/SE Wisconsin. • Goal to significantly improve quality, lower costs.

17. Point #5: Decrease Smoking Raised the cigarette tax per pack by $1.00 in 07-09 budget. Raised the cigarette tax by per pack $0.75 in 09-11 budget. • Increase taxes on other tobacco products. • Use new revenue to enhance funding for health care, including tobacco control programs. • For each 10% increase in the price of cigarettes, youth smoking rates decline by 6.5% and adult rates by 2%.

18. Point #6:Hospital Assessment • Reforms hospital rates to reward hospitals providing high-quality services to Medicaid members. • Substantially increases hospital rates. • Almost triples the average fee-for-service outpatient rate. • Inpatient rates will also substantially increase. • Net gain for Wisconsin hospitals is approximately $200 million per year. • Revenue state gains support Medicaid program and will allowed statewide implementation of the BadgerCare Plus Core Plan.

19. Point #7:BadgerChoice • Proposal to reform health care for small businesses. • Creates a connector for businesses to purchase insurance. • Creates a pool of more than 300,000 employees giving small businesses big business bargaining power. • Anticipated Outcomes: • Significantly lowers annual health care costs through insurance market changes and subsidy. • Reduces volatility in the market. • Makes small group insurance market more transparent. • Not included in Governor Doyle’s 09-11 biennial budget. • Wisconsin positioned well for national health care reform options.

20. Governor Doyle’s Seven Point Plan for Health Care Reform Summary • Wisconsin has a historic opportunity to ensure that every resident—especially every child—has access to affordable health insurance. • Governor Doyle’s plan builds on past successes, leads the nation in health care innovation. • Working together, we can ensure that every individual in Wisconsin has access to affordable health insurance and high quality care. • National reform efforts will have an impact on Wisconsin - Hopefully a positive impact.

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