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1/22/2010
Stripped down health insurance – it’s about time
Governor Doyle announced a new “self-funded” state health insurance plan meant for low income childless adults not covered by health insurance. About 20,000 adults were placed on a waiting list when Wisconsin couldn’t afford to serve all those applying for the newly expanded BadgerCare program last fall.
So, let’s look at the positives. First, when the money ran out, the state stopped accepting beneficiaries (as required by the federal waiver). Imagine.
Then, Wisconsin looked for a second plan - affordable, and for which low-income beneficiaries pay their own way.
For a monthly premium of $130, a [Badger Care]Plus Basic member has up to 10 physician visits, limited hospitalization, five emergency room visits annually, as well as generic medication and Badger Gold RX discount drug membership.
Another positive: Look at it - it’s a stripped down plan! Basic coverage. No mandates to include (see below). Yes, it is very basic coverage – and missing catastrophic coverage. But it’s what the state can afford and what most of those who need it can afford.
“This will meet about 95 percent of the basic medical needs of most people in the state;” says the Governor who concedes the coverage is not ideal for [those] used to more expansive coverage.
Doyle calls the new program a “bridge” to either a job with medical insurance or a slot opening up on the Plus Core Plan.
Though no private insurer is allowed to sell such a plan, the state exempted itself from the countless mandates that must be included in privately sold health insurance.
Rep. John Nygren (R-Marinette) details the negatives of this whole deal, calling “BadgerCare Plus Basic “a clunker.”
Governor Doyle’s government health care plan is quoted by him as costing $130 per month for those struggling to find affordable health insurance. This is an initial estimate and may end up being much higher. There are private plans already in existence that cost as low as $104 per month with comparable or stronger coverage than that which was laid out by Governor Doyle.
Additionally, without government mandates and regulations private plans could be offered at lower rates. In Florida a basic plan is offered as low as $23.70 a month. The governor’s Basic plan can unfairly function outside of state mandates and regulations placed on private insurers. As well, government reimburses pennies on the dollar for care shifting cost to hospitals and patients.
Why would government offer a sub-standard plan at an inflated price when cheaper and comparable or stronger plans exist? This leads me to believe ... it is about advancing government control of health care.
Nygren’s answer?
Make the health insurers compete for those on the waiting list. This would offer the lowest cost plan to consumers with the most generous benefits.
Exactly. Compete under the same rules as the government. Waive many of the more costly mandates. And set the market to work.
Here’s a great piece comparing cost and pervasiveness of mandates state to state. Wisconsin’s in about the middle of the pack.
The Impact of Mandates. While mandates make health insurance more comprehensive, they also make it more expensive because mandates require insurers to pay for care consumers previously funded out of their own pockets. We estimate that mandated benefits currently increase the cost of basic health coverage from a little less than 20% to perhaps 50%, depending on the number of mandates, the benefit design and the cost of the initial premium. Mandating benefits is like saying to someone in the market for a new car, if you can’t afford a Cadillac loaded with options, you have to walk. Having that Cadillac would be nice, as would having a health insurance policy that covers everything one might want. But drivers with less money can find many other affordable car options; whereas when the price of health insurance soars, few other options exist.
Why Is the Number of Mandates Growing? Elected representatives find it difficult to oppose any legislation that promises enhanced care to potentially motivated voters. The sponsors of mandates know this fact of political life. As a result, government interference in and control of the health care system is steadily increasing. So too is the cost of health insurance.
FL handles their BadgerCare Plus Basic (Cover Florida) by qualifying a number of private insurers to provide different levels of basic coverage. You’ll find the $23.70 premium rate Nygren references on p. 2 – (Note - no hospital inpatient or outpatient services or emergency care.)
Allow private insurers to offer basic health plans and let them compete. Basic health coverage can be affordable.
Jo Egelhoff, FoxPolitics.net
COMMENTS
No free lunch. You get what you pay for. Without in-patient coverage and coverage for other items that bankrupt people these stripped down plans don't do anything. Unless the unit costs come down there won't be significant changes. Maybe a few people will be kept out of the emergency room but that is about it.

dave allen (Fri Jan 22 06:42:46 2010)
I agree Dave, one gets what one pays for. That's the point of basic health care coverage. Look at the Florida health insurers' options. A wide variety of them. Yes, you get what you pay for. Must consider affordability for us all, and that gets back to the cost control discussion. Look also at the discussion of mandates. Helpful in addressing the cost/benefit discussion.

Jo (Fri Jan 22 07:06:15 2010)
I did look at the FL plan (or at least summaries) and I am not impressed. In other words the fundamentals aren't being addressed in any of these plans. They can't be since the health care "system" isn't affected one bit by these plans. bankruptcy, emergency room visits, chronic health issues will not change, it can't change under these plans.

dave allen (Fri Jan 22 17:19:31 2010)
I don't understand what you're saying Dave.What fundamentals aren't being addressed? The plans provide various levels of coverage at various levels of cost. Several providers make plans available so they must compete among each other. One way the health care system is affected is that more people are taking responsibility for basic health care, more people, if you will, are "covered by health insurance." Perhaps you can explain what you mean by bankruptcy, emergency room visits, chronic health issues? Emergency room visits are covered to a certain extent under many of the plans. Chronic health issues are covered via a varying level of office visits, varying levels of copays. It's my understanding as well that these policies are guaranteed issue, i.e., that pre-existing conditions cannot prevent someone from getting a policy and paying the same premium as someone else in their age category. Bankruptcy? Not sure what you mean here, but when a family is no longer at a certain minimum income, I believe a Medicaid program is available.

Jo (Fri Jan 22 19:54:15 2010)
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