Healthcare for $120 a month, self funded? A lesson for Obamacare...

[WhiskeyGirl]

BadgerCare Basic would be entirely funded through individual $130 monthly premiums, unlike the Plus plan that is state-funded.

Those with health insurance available through their employers within the last year would not be eligible for the state program, with the exception of those who have been laid off.

http://badgerherald.com/news/2010/02/15/senate_committee_pas.php

Doesn't pay for routine care, no maternity...

Dougherty said that in the past, the state has mandated that certain benefits must be required in certain health insurance plans, driving up the costs for many people. With the BadgerCare Basic program, these benefits are not required, which has caused some concerns for commercial insurers.

“They’re admittedly saying, we’re not going to cover all insurance mandates covered by the state, we’re not going to not follow all insurance regulation — we’re going to play a different game,” Dougherty said. “For insurers, that’s a bit frustrating.”

http://badgerherald.com/news/2010/02/12/senate_holds_hearing.php

How cheap would basic insurance be if insurance companies didn't have to follow state mandates?

[WhiskeyGirl]

BadgerCare Basic members will have access to catastrophe coverage; 10 physician visits per year; first inpatient hospital stay and five outpatient hospital visits; subsequent hospital stays after a $7,500 deductible; up to five emergency room visits per year; some generic medications; and the Badger Rx Gold discount drug membership.

“Having this sort of basic coverage means a person can see a doctor for a treatable condition and avoid a costly trip to the emergency room,” Robson said.  “When a person is struggling to get by on a modest income in a job that doesn’t provide health insurance, this type of coverage can keep them healthy and avoid bankruptcy due to mammoth medical bills.”

http://www.legis.wi.gov/senate/sen15/news/Press/2010/pr2010-001.asp

Insurance companies have to price their products with state mandates in mind.

[WhiskeyGirl]

Time to audit BadgerCare?

There’s more. At a meeting last month of the state Senate Health Committee that I serve on, DHS announced three options being explored to expand BadgerCare Basic.

Option 1 covers emergency room (ER) visits and applies a Medicaid standard plan cost sharing. Generic drugs have a $3 copayment per script. Total cost: $100.05.

Option 2 limits inpatient hospital to two visits. ER visits are unlimited. There is a $15 copayment for outpatient non-ER services and professional services and $60 for ER visits. Inpatient hospital has a $100 co-payment per visit and generic drugs have a $5 copayment per script. Total cost: $131.66

Option 3 has a $7,500 deductible on all hospital services including ER visits. Once the deductible is reached, all hospital services are covered generic drugs carry a $5 copayment per script, and modest Medicaid standard plan cost sharing applies. Total cost: $106.89.

No matter the option (s) chosen by DHS, problems are sure to follow. Each option would result in another expansion of membership, pressuring an already strained system. Option 2 with its unlimited ER visits would attract applicants in droves. The high deductible provision arguably makes Option 3 the most cost-effective; however an unaffordable increase in members is likely.

The fiscally irresponsible pattern starts with the mantra that people need coverage followed by the argument that people are under-covered. Programs keep getting bloated, never getting smaller. Government falls further and further behind in its attempts to keep promises and then makes the injudicious decision to make more promises, create more programs, and spend more money it does not have.

http://www.mymuskegonow.com/blogs/communityblogs/79612787.html

What is the actuarial basis for this program?

[WhiskeyGirl]

    * Doyle proposes BadgerCare Plus Basic Plan to help uninsured, By Jason Stein, January 21, 2010, Wisconsin State Journal: “With federal health care reform hitting obstacles, Gov. Jim Doyle on Thursday proposed a stripped-down health plan to cover tens of thousands of financially struggling state residents. But a Republican lawmaker immediately attacked the proposal aimed at 21,000 childless adults, saying the state was backing into a government-run health plan similar to the controversial public option being debated at the federal level. The proposed BadgerCare Plus Basic Plan would serve as a stopgap for qualifying childless adults in the state on a waiting list to enroll in the state’s swamped Core Plan, Doyle said. The new plan would be funded by a $130 monthly premium paid by participants, not taxpayers, the Democratic governor said. It will require lawmakers’ approval but could be up and running by April…”

    * Experts express doubts about BadgerCare Basic health insurance proposal, By Jake Miller, January 22, 2010, Wisconsin Rapids Daily Tribune: “Some health care directors who work with low-income patients are skeptical of whether the state’s proposed new health insurance program is affordable for the people it targets. The new BadgerCare Basic plan that Gov. Jim Doyle unveiled Thursday is expected to cost nearly $1,600 a year, or $130 a month. It’s targeted at the nearly 21,000 poor, childless adults who are currently on a waiting list for the popular BadgerCare Core plan…”

http://www.irp.wisc.edu/dispatch/tags/health-insurance-coverage/

Another reason to attract people to Wisconsin?  State subsidy insurance benefits?

Welfare tourism?

[WhiskeyGirl]

Republicans said a plan to offer health insurance coverage to individuals on the waiting list for the state BadgerCare Plus Core plan raise the cost of health insurance for everyone else, and end up costing taxpayers money when federal subsidies run dry.

Medicaid rates are lower than private insurance.  How much in costs will be shifted to private insurance?

The plan, BadgerCare Plus Basic, would be paid for entirely by a $130 monthly premium paid by enrollees.

Rep. Robin Vos, R-Caledonia, said the program is another example of a "brand new taxpayer entitlement" that "someone in the future will have to figure out how to pay for."

But Sen. Judy Robson, D-Beloit, countered that the program is merely meant as a stopgap for the 25,000 people on the waiting list for the Core plan, and that because it is paid for via premiums "it is not subsidized by the taxpayers."

How long before taxpayers pay everything?  Some programs never end.  Who's going to keep track of premiums? 

Is it possible that folks will pay one month and never get cancelled?  Who's keeping track of sending out premium notices and notices of cancellation due to non payment of premiums?

Rep. Phil Montgomery, R-Ashwaubenon, said the reason the plan is able to provide service at the rate is because the plan excludes government mandates like coverage of autism treatment or mental health conditions. He said given a level playing field, private sector insurance companies could provide a better service for cheaper.

http://blogs.wispolitics.com/budget/

Is the program limited to citizens and those here legally?  Will they allow illegal aliens to sign up?  Who will verify immigration status?  E-Verify?

[WhiskeyGirl]

Public input, existing Medicaid shortfalls...

http://www.legis.state.wi.us/lc/comtmats/files/ab0697_20100211133404.pdf