Wisconsin Would Start Health Insurance Marketplace, Public Option Under Budget

Feb. 17—Wisconsin would create a state-based health insurance marketplace and a public option plan in which people likely could buy into BadgerCare, the state's main Medicaid program, under Gov. Tony Evers' proposed budget.

The moves could save the state money and provide insurance for many who might lose coverage if the Affordable Care Act is struck down, the governor's office said. Twenty-one states have state-based marketplaces and at least two — Colorado and Washington — are known to be pursuing public option programs.

"A public option will provide an affordable alternative for many Wisconsinites who struggle to pay their medical bills and cannot afford the copayments, deductibles and other cost-sharing requirements of plans offered on the marketplace," according to a summary of Evers' budget.

The proposals are in addition to Medicaid expansion, which would save the state $634 million by tapping additional federal funds and cover 90,900 additional people while expanding benefits such as addiction treatment and enabling more payments to providers such as hospitals and nursing homes, Evers said. That measure is likely to be rejected by the Republican-controlled Legislature, as it was in Evers' 2019 budget.

Instead of using the health law's federal marketplace to provide insurance to people who don't get coverage through jobs or government plans, Wisconsin would spend $2.1 million to start its own marketplace, initially on the federal platform in 2023 and fully state-based in 2024.

Premiums would likely be cheaper and the state could set its own enrollment periods and assistance efforts, according to Evers' budget, which includes more premium assistance for those with low incomes.

Fifteen states operate state-based marketplaces and six have their own marketplaces on the federal platform, according to the Kaiser Family Foundation. Many of the states are led by Democrats but some have Republican governors or divided governments, including Idaho, Maryland, Massachusetts, Vermont and Pennsylvania.

The budget would provide $1.8 million to the state Office of the Commissioner of Insurance and the state Department of Health Services to study forming a public option by 2025 or earlier if the Affordable Care Act goes away.

The U.S. Supreme Court in November heard arguments in a case brought by Republican state officials who alleged the law's mandate requiring insurance was made unconstitutional in 2017 when Congress eliminated the penalty for failing to have coverage. Even if the mandate falls, other parts of the law could be upheld. A ruling is expected in June.

Under a public option, people who make too much to qualify for BadgerCare likely could buy coverage by paying full price. In a 2017 proposal, the amount was $7,224 a year, according to the Legislative Fiscal Bureau.

The idea, which could incorporate private insurance carriers, generally involves governments leveraging their authority to reduce health care prices, according to the Public Option Institute in Washington, D.C.

"A public option will also foster greater competition in the marketplace and ultimately benefit all consumers," Evers' budget summary said.

Wisconsin is one of 12 states that haven't expanded Medicaid as allowed under the federal health law, as Evers' budget calls for again. It's the only one of the states with no gap in coverage for residents below the poverty level. Republicans say the move would amount to expanding welfare and the federal government could stop reimbursing states at higher rates.

Other health proposals in the budget would:

Create a $500 tax credit for caregivers of family members with conditions such as Alzheimer's disease, with income limits between $75,000 and $85,000 per person. The cost: $203 million, part of some $600 million proposed for caregivers and long-term care

—.

Limit insulin copays to $50 and create an Insulin Safety Net Program, among other measures to reduce prescription drug costs

—, including spending $3.2 million to establish an Office of Prescription Drug Affordability.

—Provide $14 million for public health workers to sustain the state's COVID-19 response and prepare for future outbreaks.

—Spend $35.7 million to increase dental care payments to Medicaid providers, and begin to license dental therapists.

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