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Wisconsin Governor Scott Walker’s rejection of federal Medicaid money and his “hands-off approach to rate regulation” has lead to higher than average health insurance premiums in the Badger State.

How high? Up to 99 percent higher than in its neighbor (and longtime rival in all things) Minnesota.

Robert Kraig, the executive director of Citizen Action of Wisconsin, said a report he co-authored shows that “rates are much higher in Wisconsin than in Minnesota, despite having similar geographies and similar underlying medical costs.”

Kraig said Wisconsin insurance exchange premiums for a single person are an average of 79 percent to 99 percent higher than premiums in Minnesota, before tax credits are applied. He said the average Wisconsinite will pay $1,800 more annually for health care.

Wisconsin is one of the more than two dozen states whose governors or legislators have blocked federally funded Medicaid expansion.

As part of the Affordable Care Act, the federal government is assisting states with expanding Medicaid coverage to 133 percent of the federal poverty line, closing the gap between those who qualify for traditional Medicaid coverage and those who can buy health insurance on the state exchanges. Many states, including Minnesota, have accepted the expansion as a no-brainer.

But as part of the Supreme Court’s decision last June, states cannot be required to accept these federal funds, leading many governors like Texas Gov. Perry, Virginia’s Bob McDonnell, and Wisconsin’s Walker to “stand up to Obamacare” by saying no to these funds.

So in states like Wisconsin, the coverage gap persists, pushing about 92,000 low-income Wisconsinites onto the health exchanges. Low-income people, on average, have more medical needs, so adding thousands of them to the exchange pool leads to higher premiums -- for everyone.

In Milwaukee, average cost of health insurance is 112 percent higher than Minnesota’s average; in La Crosse, WI, it’s 136 percent higher. Yikes.

It’s not just the Medicaid expansion. Under Gov. Walker, Wisconsin’s Office of the Commissioner of Insurance has been very laissez-faire about challenging insurance rates, while Minnesota has “exercised a rigorous rate of review,” according to the Cap Times. Kraig’s study found that such reviews have lowered Minnesota’s rates by up to 37 percent. “We have taken in Wisconsin a clearinghouse approach,” Kraig said, “The insurance company says, ‘Here’s our rate in the exchange’ and the state of Wisconsin says ,’OK.’”

Back to Scott Walker. Not only is Walker up for reelection next year, he’s also laying groundwork for a presidential campaign. Accepting Medicaid expansion through Obamacare would be an anathema to Walker’s Tea Party base and his corporate backers; he can’t say that out loud, which is why his explanation for rejecting the funds has been vague and elusive.

By rejecting Medicaid for ideological and political reasons, Walker is continuing the pattern he’s held since taking office: it doesn’t matter if it makes life worse for Wisconsinites, it only matters that he holds onto power.

Tell Gov. Walker to end the games: accept federal funds for Medicaid now.

Originally posted to Working America on Fri Oct 25, 2013 at 07:49 AM PDT.

Also republished by Badger State Progressive.

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Comment Preferences

  •  Now How to Inform Wisconsonians of This nt (17+ / 0-)

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Fri Oct 25, 2013 at 07:51:18 AM PDT

  •  Walker up for re-election next year (8+ / 0-)

    and has some explaining to do about a lot of things.  He is a royal screw up.

    Also, saw this
    about Wisconsin woman.  It appears her fetus had a lawyer, but one was denied to her in court of law.  Really, just plain freaky.  

    Hope Walker gets the boot 2014.

    1. What does it mean? 2. And then what?

    by alwaysquestion on Fri Oct 25, 2013 at 07:58:37 AM PDT

  •  so ACA for the poor is the issue, it did not have (2+ / 0-)
    Recommended by:
    Sherri in TX, alwaysquestion

    anything to do with basic rates being higher as that was always the case in WI?

    "The poor can never be made to suffer enough." Jimmy Breslin

    by merrywidow on Fri Oct 25, 2013 at 08:43:54 AM PDT

  •  This story is based on a hard-hitting report (21+ / 0-)

    from Citizen Action of Wisconsin:
    A Tale of Two States: Why Wisconsin’s Health Insurance Individual Marketplace Premiums are Dramatically Higher than Minnesota’s

    Two images from that page really bring the story home:

    If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality. - Bishop Desmond Tutu

    by AnnieJo on Fri Oct 25, 2013 at 08:51:38 AM PDT

  •  It is really pissing me off (15+ / 0-)

    I am self-employed in Wisconsin and was looking forward to getting a better policy for less. I currently have a crappy high deductible policy.

    It turns out that my premium for an exchange policy would cost more than my current policy. Now the coverage would be better and the deductible would be lower, but I'm in fairly good health and rarely go to the doctor. So I might try to skate by one more year with my current policy.

    I have a business associate in Minnesota who enrolled in his state exchange. We are about the same age and his premium will be much lower than mine. Happy for him, but it fills me with rage! Because Walker is an obstructionist, an ideological zealot, a dick!

    There are things I absolutely love about Wisconsin, but I can work from anywhere. If Governor Goofy Eyes is re-elected I might just make a run for the border.

    •  I signed in for the first time in months (10+ / 0-)

      to comment and rec this diary.  I am also self-employed and have been waiting for 4 years to get some relief on insurance costs.  I just did a baseline check on a platinum plan (I have good insurance now) in Madison versus Mpls.  The Mpls plans are $150-$200/mo cheaper and the deductibles are lower.  I  will not be eligible for a subsidy.

      I just sent an inquiry/ compliant to our insurance commissioner on this.  I am absolutely livid.

      No African American president has ever failed to be reelected. (h/t XKCD via Balloon Juice)

      by Ophelia on Fri Oct 25, 2013 at 09:56:48 AM PDT

      [ Parent ]

  •  Tell me again why Wisconsinites shouldn't be (2+ / 0-)
    Recommended by:
    scribeboy, WisVoter

    allowed to buy insurance in Minnesota?

    This is the most perfect example I've seen yet of how terrible that rule is.

    Bookmarking this diary for the next time someone argues that buying insurance across state lines won't lower costs.

    •  Race to the bottom. (10+ / 0-)

      When you let insurers cross state lines and offer insurance based on their own state's laws, you undercut any state insurance mandates that may be in effect.  In the case of Wisconsin, the mandate I was involved in fighting for was regarding autism insurance coverage.  If you let a state WITHOUT such a mandate sell insurance in Wisconsin, then you have to let Wisconsin insurers "compete," and boom goes your mandate.

      ALEC is a big fan of this idea.

      If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality. - Bishop Desmond Tutu

      by AnnieJo on Fri Oct 25, 2013 at 10:54:48 AM PDT

      [ Parent ]

      •  I thought ACA fixed that? (1+ / 0-)
        Recommended by:

        ACA got rid of junk insurance plans, right?

        Also, the mandate doesn't go away. People who want to be covered for whatever is mandated can just buy their insurance in-state and be covered.

        •  In the scenario they tried to pull in WI in 2011, (1+ / 0-)
          Recommended by:

          the mandates would indeed have gone away -- the ALEC legislation they proposed would have given Wisconsin insurers the "freedom" to follow the out-of-state insurers' rules as soon as an out-of-state insurer set up to sell to Wisconsinites.  Must be able to compete on an even playing field, after all.

          The ACA does not have a national autism insurance mandate...

          Any legislation that would let out-of-state insurers sell here but NOT give the WI insurers an even playing field would never pass -- you think the WI insurers are going to let that happen?

          Even if the legislation did pass though and let the out-of-staters sell in Wisconsin under out-of-state rules, the mandates would still be toast, just in slow motion.  Insurance mandates rely on the large pool of shared risk.  What happens to the cost to insure for autism when families that don't have autism rush for the exits?

          If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality. - Bishop Desmond Tutu

          by AnnieJo on Fri Oct 25, 2013 at 01:02:46 PM PDT

          [ Parent ]

    •  because Minn insurance will be by Wis rules. (4+ / 0-)
      Recommended by:
      WisVoter, falconer520, Fonsia, Pilotshark

      No insurance company will sell Minnesota insurance anywhere if they can sell Wisconsin insurance everywhere.

      There was a time when all credit cards were sold from South Dakota until Delaware regained the position.

    •  In addition to what AnnieJo said... (2+ / 0-)
      Recommended by:
      AnnieJo, 3goldens

      The Republicans that advocate allowing to buy across state lines want to implement that without any of the protections included in the ACA, like minimum standards of coverage, not excluding people because of pre-existing conditions, etc.

      Their whole plan is A) tort reform, B) allow to buy across state lines. Oh, and privatize Medicare... but that is a somewhat separate issue.

      It would definitely be a "race to the bottom," as AJ said.

      •  Well we've got the new protections under ACA, (1+ / 0-)
        Recommended by:

        so no prob there.

        How would it be a race to the bottom with protections in place?

        •  It would depend on the details... (1+ / 0-)
          Recommended by:

          Assuming the ACA protections stand, then the issue that AnnieJo brought up might still be a problem.

          It would really depend on how it was written.

          But, the original intent (IMO) of allowing to buy/sell across state lines was so that purveyors of crap insurance would be free to sell it anywhere. This would put downward pressure on both quality and price in the marketplace.

    •  I believe the issue isn't just lower costs, but (1+ / 0-)
      Recommended by:

      rushing to the bottom for care and quality.  Yes, there are some guidelines from ACA that mandate what coverage has to be in the plans at minimum levels for bronze, silver, etc, but selling insurance across state lines has issues from ensuring doctors are in those plan service areas, ensuring the doctors are properly licensed and overseen - I mean, if your insurance company is in Montana and your doctor is next door, how do you appeal a ruling that a procedure is not necessary and reasonable?  That's not just for you - that's also for the doctor who might face problems being paid for the procedure they performed.

      The ACA can help with some standardization, but I don't think it does much to enforce national standards on states - the goal was to pretty much leave health care decisions and control at the state level.  

      •  I'm sorry, but these are pretty weak arguments. (0+ / 0-)

        Ensuring the doctor is licensed? States handle licensing, so we're good there.

        You appeal exactly the same way you would do it now. Why would it be any different?

        Tell me this: do any of these potential "issues" justify Wisconsinites paying 112% higher premiums than people in Minnesota?

        •  A Minnesota agency would have problems (0+ / 0-)

          certifying a Wisconsin doctor, due to distance, probably different requirements and difficulties in visiting their practice to verify what the doctor claims.  They could rely upon Wisconsin to oversee the doctor, but given the differences highlighted in this diary, will Minnesota trust that the Wisconsin doctor is actually up to the standards required of Minnesota doctors, and if he's not, can Minnesota do anything about it?  Would Minnesota want to have different standards for each state where their companies are selling insurance?  

          As for how appeals might be handled, the appeal might have to happen in the state where the insurance company is based, which would mean travel to a different state, maybe overnight, maybe multiple days.  It would be hard for a lower-income person to do, whereas in the past they could appeal to the state capitol or HQ which might be in the largest city within the state.

          •  These are non-issues. Seriously. (0+ / 0-)

            Minnesota would have problems certifying a Wisconsin doctor due to distance?

            Oh come on. Distance? Do they not have internet or telephone or mail in Minnesota? This argument about distance is just silly. Background checks take place in an office.

            My state uses Wisconsin-based NCBEX for character and fitness investigations for admission to the state bar. NCBEX is on the other side of the country and it works with no problems. Why couldn't that work for doctors?

            Would Minnesota want to have different standards for each state where their companies are selling insurance?
            Of course not. Why would they even do that?
            As for how appeals might be handled, the appeal might have to happen in the state where the insurance company is based
            How about a rule that appeals occur in the state in which the individual lives? This is simple.

            We don't even need a federal rule -- states can implement the rule on their own. A state court would unquestionably have personal jurisdiction over an insurance company which sells insurance to residents of the state.

            I mean, premiums are 112% higher in Wisconsin, and this is seriously the problem that's standing in the way?

            •  I don't know what goes into medical certification. (0+ / 0-)

              I'm sure most is just checking degrees and certifications, but there may also be questions of the medical facilities for who's in-network and who isn't.  I don't know if states would be willing to join a compact for joint certification the way that licenses in some states are accepted in others that are part of the compact - that seems to be the most likely way it would happen.  Still, if Minnesota has higher quality standards than Wisconsin, they may not wish to accept Wisconsin practitioners at something of a lesser standard.

              I'm sure it can all be worked out.  I'm just not ready to force states to accept doctors and plans when there are reasons why differences exist.  And I'm sure the doctors, pharmacists, and health care providers can provide a lengthy list of how and why things are done differently in the two states.  I highly doubt, however, that it's as simple as charging twice as much for the exact same test performed by the same practitioner in the exact same quality clinic and pocketing the markup.

              •  Not sure I get why you're talking about doctors? (0+ / 0-)

                Or rather, why you seem focused on medical licenses and quality standards?

                If two states have different regulations for practicing medicine, that has no bearing on an insurance company in one state selling coverage to residents of the other.

                Every state has laws that govern practicing medicine. Doctors would still be subject to the laws of their own states. Nothing about having an out of state insurer would have any impact on that.

                I want you to read this article:

                In regions with less competition among insurers, premiums are higher.

                That's an absurd result. There is no reason why premiums should be drastically different for two people with identical circumstances, with the sole exception of which state they live in.

                I mean, do you disagree with that?

        •  There could be a myriad of reasons (0+ / 0-)

          for current complications with having insurance in one state and your medica providerl in another. With each state have their own sets of eligibility and coverage regulations, for both medical providers and insurance providers, the legalities would very likely present conflicts of responsibility and accountability.
          I know that in my state, Wisconsin, if you are on Medicaid, you must either be in a state HMO (managed care), or be pay for service, where you can see any Wi. state certified Medicaid provider, and, except in emergency situations for out of state medical care, the provider must be willing to accept your insurance coverage.  Private, commercial insurances very likely will have their own set of rules, possibly differing from state to state.
          Of course single payer would wash away all of this crap; ACA gives us a smorgasbord of insurances, providers within your state.  The problem is the restaurant to which we are currently consigned-that's all that's on the menu.

    •  Insurance Networks (2+ / 0-)
      Recommended by:
      Iberian, 3goldens

      If you could/were to buy a Minnesota policy your 'in network' coverage would require visiting a physician/clinic/hospital in the Minnesota network.  While this might be possible for border residents - it would likely not help those in Madison or other interior cities.

      The little research I have done on a plan for me in MN also shows that out of network coverage is with either steep ($10,000+) deductibles, large coinsurance (50% or more) and large or 'unlimited' out of pocket limits - making it unreasonable for all but emergency use.  (And for emergencies, out of network is treated as in network - so that at least is a good thing.)

      Better brace yourselves for a whole lotta ugly comin' at you from a never-ending parade of stupid - "Hairspray"

      by polaris2 on Fri Oct 25, 2013 at 11:53:40 AM PDT

      [ Parent ]

      •  No, the point of removing the invisible walls (0+ / 0-)

        at state borders is to go to doctors in your own state using the insurance that you bought out of state.

        The whole idea is to remove these invisible concrete barriers that drive up costs.

        I mean, set everything aside and ask yourself this -- doesn't it seem absurd that people in Wisconsin pay 112% more than people in Minnesota?

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