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>> My name is Martin Rudd, and
I serve as the campus executive
officer and dean
and professor of chemistry.
Our conference is taking place
in the Communication Arts
Center, completed in 2008, and
the first academic building in
the UW System that's recognized
as LEED gold certified for its
use of sustainable materials in
its construction and energy
saving features.
Central to our mission is to
bring resources of the
university to the people of the
state and the communities that
support its campuses.
This type of engaged learning
conference is exactly the type
of facilitation that we can
provide for our citizens.
Support to maintain and improve
facilities on the UW Fox campus
is provided by a unique
partnership with Outagamie and
Winnebago Counties, and that
included contributions of more
than $10 million to build the
Communication Arts Center in
2008.
For that ongoing support to keep
and to grow UW Fox as a vibrant
university in the community,
we remain very thankful to our
county partners.
It is my pleasure tonight
to introduce our conference
organizer, Dr. Corina Norrbom.
You need to know three things
about her.
First, she is a practicing
physician at the Aspirus
Walk-In Clinic in Wausau.
Before that, she spent 12 years
as a family physician in Antigo.
Secondly, she is serving as the
inaugural community fellow at
the Wisconsin Institute for
Public Policy and Service, also
known as WIPPS.
Thirdly, she's exhibited an
unstoppable drive to help
educate the citizens of
Wisconsin about the
opportunities and challenges of
the Affordable Care Act.
Since June, she has crisscrossed
the state finding sponsors and
lining up an incredible slate of
speakers, both for tonight's
public event and tomorrow's
professional conference.
I have been in awe at her
ability to connect pieces of the
rapidly changing world of
healthcare.
Please join me in welcoming and
thanking Dr. Norrbom for her
role in putting this event
together.
[APPLAUSE]
>> Good evening.
Thank you, Dean Rudd.
On behalf of the Wisconsin
Institute for Public Policy and
Service, let me again welcome
you.
This evening's session,
"Putting Politics Aside:
The Realities of Obamacare,"
is the opening of our
two-day conference related to
the Health Insurance
Marketplace.
I have a couple of thank yous.
First of all, we're grateful to
all of our generous sponsors.
And I would especially like to
thank our major sponsors:
Affinity Health, ThedaCare,
and Bellin Health.
Thanks, too, to our planning
committee.
If anybody from the planning
committee is here, if you could
stand up so that we could
acknowledge you.
[APPLAUSE]
And several of them are
backstage, too.
I'd also like to thank the
UW Fox Valley facility staff,
especially Megan Mudge.
And also, thank you to the
student ambassadors who
volunteered their time tonight.
I'd also like to thank the
speakers, the panelists, and the
moderator for this evening.
And finally, we'd like to thank
Wisconsin Public Television for
recording and live streaming
this evening's program.
And also a big thank you to them
for the video clips that we're
going to be using as part of our
discussions.
So I do have a couple of ground
rules too.
One, silence your cell phones
and electronic devices.
We'd also like for you to keep
your questions limited and
focused so that as many people
as possible can ask questions.
As as far as with questions,
there are microphones on either
side of the theater.
So if you have a question,
you're welcome to go to the
microphone at the appropriate
time.
And above all, we ask that you
be courteous and respectful of
each other and the speakers
because, after all, this is a
public forum that's dedicated to
civil dialog.
I have a quick reminder.
Oops, was I advancing somebody's
slides?
Registration is still open for
our professional conference
tomorrow.
I'd invite you to please visit
our table outside the theater if
you're interested,
or go to WIPPS.org.
That's W-I-P-P-S.org.
So, why are we here?
We may have different reasons
for being here.
I'm here because I'm a
physician, and every day that I
see patients I encounter people
who are suffering because they
don't have health insurance.
I'm also here because I want to
be informed.
The Health Insurance Marketplace
and the individual mandate for
insurance are at the heart of
the Affordable Care Act.
And we also want you to be
informed.
So that's why I'm here.
And why are you?
Are you a young person coming
off of your parent's insurance?
Just trying to figure out
whether or not you should
purchase insurance?
Did you receive a letter from
HIRSP or BadgerCare saying that
you now have to transition into
the Marketplace?
Maybe you're a small business
owner and you're trying to wade
through all of the material,
trying to decide what's best for
your business, you employees.
Are you a union worker who's
concerned about the health plan
that you bargained for?
You may be a large employer
trying to think about the
changes that are going to be
happening in 2015.
Or perhaps you're someone who's
uninsurable or can't afford
healthcare, and you're just
hoping that affordable coverage
will be available to you now.
Even if you're not one of those
people, you certainly know
someone who is.
The Affordable Care Act may seem
overly complex, and it's
certainly politically charged,
but tonight let's focus on
putting politics aside and talk
about the realities of the
Affordable Care Act,
particularly how it relates to
us here in Wisconsin.
So it's now my pleasure to
introduce our next speaker,
Outagamie County Executive
Thomas Nelson.
[APPLAUSE]
>> Welcome.
Since the creation of Medicare
in 1966 no federal healthcare
legislation has attracted as
much scrutiny and generated as
much publicity as the Patient
Protection and Affordable Care
Act, commonly called Obamacare.
And, for as much attention as
this new law as earned, there
has been an equal measure of
misinformation and confusion
surrounding it.
In some ways that's
understandable given its
complexity.
Under its provisions, healthcare
providers, private insurers, and
government programs intersect at
different points and serve
different populations.
Moreover, healthcare is a deeply
personal issue.
Many of us have strong feelings
about it, and sometimes emotions
can be a barrier to effective
communication.
Clarification is the purpose of
today's gathering.
Organizers deserve ample credit
for this and for their
dedication to the civic good.
Thanks to the Wisconsin
Institute for Public Policy and
Service for coordinating this
event, and thanks to all the
sponsors, contributors,
speakers, volunteers, and media
partners for your participation
and for your contribution to the
common good.
The Affordable Care Act is the
law of the land.
Implementation is underway, and
this forum represents a step
toward more fully understanding
what that means to all of us.
To the extent that this exercise
will answer questions and
elevate public awareness, I
thank everyone in attendance for
working to foster progress.
You may wonder why a local
county executive, like me, is
addressing a conference
pertaining to federal
legislation.
The answer is simple: service is
our business.
It's worth noting that Health
and Human Services comprise the
largest segment of the Outagamie
County budget levy, that is
roughly one-third.
Every day our staff engage the
leading edge of social services.
Whether you're talking about
BadgerCare, WIC, FoodShare,
public health, mental health, or
family care, public
administration happens right
here at the county level.
To that end, in anticipation of
the roughly 9,000 individuals in
our county who will be
transitioning from BadgerCare to
the Marketplace, Outagamie
County has dedicated four staff,
established an equal number of
consumer kiosks, and allocated
more than half a million dollars
to facilitate that transition.
On behalf of our constituents,
we are invested in the success
of this landmark law.
As a success will in no small
way depend on the public's
enhanced understanding of it,
let us do our part here to add
to that understanding.
Welcome and thank you for
attending.
And now, please allow me to
introduce this evening's keynote
speaker.
Donovan Slack
is a Washington correspondent -
for USA Today Gannett.
She has been closely covering
the roll-out of the Affordable
Care Act.
Before joining the staff at
Gannett, she worked as a White
House reporter for Politico.
Her resume also includes a
nine-year stint with the -
Boston Globe where she earned
national recognition for her
coverage of children and family
issues.
Please welcome Donovan Slack.
[APPLAUSE]
>> We're going to have a couple
folks, I think, come up.
This is our panel.
Greetings from Washington.
[laughs]
I've got to tell you, I flew in
today and it was good to get out
of that city for a little bit.
I'll tell ya.
And one of the main reasons,
I can tell you, is because of
this law.
And one would have thought that
three years after it passed that
some of the politics and the
politically charged statements
would have abated.
But, of course, now we know they
seem to be taking on a new life
even as we speak every day.
As a journalist, I have to
constantly vet every single
statement, every single piece of
information that I get.
Who's saying it?
Why are they saying it?
What is their motivation?
And how are they skewing the
data to back up their argument.
And I can say with Obamacare
there has been an inordinate
number of statements, as you can
imagine, to vet.
The rhetoric from both sides has
been heated and misleading.
Both sides.
I can tell you, as you know,
conservatives have said the law
would "literally kill people."
That's Michele Bachmann.
Others have called for President
Obama's impeachment because they
said he has usurped the
Constitution and done things
illegally in implementing the
law and passing it.
Conservatives also claim it is a
job killing government takeover
of healthcare.
On the democratic side,
President Obama and his
administration has said over and
over if you like your insurance
plan, you can keep it.
Oh, and if you like you're
doctor, you don't have to
switch.
Well, this is, of course, the
statement that's in the news
right now, and, really, it's not
true on a lot of levels as
hundreds of thousands of people
across the country are
discovering right now when they
receive cancellation notices.
HHS, the Department of Health
and Human Services, released a
glowing report, saying that
premiums across the country are
lower than they predicted.
Of course, they didn't compare
them against what they were
before.
And then, of course, the White
House yesterday just issued
another statement, what they
call a fact sheet, which says
that states refusing to expand
Medicaid, including Wisconsin,
are deliberately putting
politics over people and leaving
5.4 million of their own
citizens uninsured.
The rhetoric obviously has not
been isolated to Washington.
I'm sure you have heard it here
in Wisconsin.
The insurance commissioner here
came under withering criticism
for issuing a report saying
that, in fact, premiums were
going up across the state.
Governor Scott Walker has called
the new law a "ticking time
bomb."
Mary Burke, his democratic
challenger, said his decision
not to expand Medicaid is,
"it defies common sense."
But through all of this, cutting
through all of the rhetoric on
both sides, there is one thing
that I can tell you with almost
complete confidence, and that is
it's not going anywhere.
The House has voted to repeal it
40 times.
As long as this president is in
office, we will have Obamacare
and it will be implemented.
And I think the recent
government shutdown really
demonstrated that, certainly to
me if it didn't to the rest of
the country.
He is digging in his heels.
This is not going anywhere.
It is his legacy.
So, it is up to all of us to
become our own journalists, in a
certain sense, and to start to
vet and really understand what
this law means to you and to
your community regardless of
what the politicians are saying.
And that's hard to do.
But it's important because it
will affect every single
American.
Every single one.
As you know by now, you will
have to pay a penalty if you
don't have health insurance.
Many people, as I said, are
receiving cancellation notices.
You're going to have to shop
around for new policies.
Others will be looking at
different types of choices.
High deductible plans that maybe
have a lower premium but will
costs thousands of dollars
out of pocket.
I know tonight we're going to
hear from some people who are
deeply involved and have very
different perspectives on how
this is rolling out.
I know we have a doctor, a human
resources professional.
We have some business owners.
Before they start, I thought I
would sweep aside, right off the
bat, some of the most common
politicized statements that I
myself have had to cut apart and
get to the truth of.
The first one is if you like
your plan, you can keep it.
This, of course, President Obama
said this, or some version of
this, 37 times during his
campaign.
That's according to PolitiFact,
which earlier this week gave him
a "pants on fire" rating for
trying to change what he said. -
And then the Washington Post
today gave him three Pinocchios.
The truth is hundreds of
thousands of people are
receiving cancellation notices.
In some cases it's because their
previous plans didn't include
the new benefits required under
the law, such as no lifetime
cap, not refusal based on
preexisting conditions.
In other cases it's because
insurers are dropping out of
offering individual insurance or
dropping out of their market
because of the law.
But these cancellations, for the
most part, are affecting people
purchasing individual insurance
on the individual market.
So, to be fair, that's about
roughly 14 million Americans,
only about 5%, and that's a
relatively small minority, but I
can bet you we're going to be
hearing a lot about them and
from them.
Here's the second one.
If you like your doctor,
you don't have to switch.
Again, this will be different
for different people, but if
your doctor no longer accepts
your insurance, you may have to
switch.
If your new plan doesn't have
one or more of your doctors in
its network, you may have to
switch.
It really comes down to you,
where you live, and how the
insurance companies and
providers in you county, in your
area are implementing this law.
Here's another one.
Obamacare is a government
takeover of healthcare.
Obviously the law is not a
single payer universal
government-run system, and,
therefore, this is not true.
I can say, though, that the law
does expand government spending
on healthcare by at least 5%.
Before the law, the government
accounted for 43.6% of total
spending on healthcare.
After the law, and by 2020, it
will account for 49.2%.
So, in that way, it is expanding
government involvement.
And the government did decide
what health plans were required
to cover, what are these
so-called essential benefits.
And that's everything from the
preventive care, the mammograms,
the trips to the emergency room,
all of these various things that
each plan is required to
include.
And it also reserved the right
to approve or disapprove the
plans that are going to be
offered or that are being
offered in the health exchanges.
So, in that way, it is expanding
government involvement in
healthcare, but, once again,
it's not quite what the
republicans say it's doing.
And the other one, premiums are
going up everywhere.
And the converse, premiums are
going down everywhere.
And my favorite response to this
was from the California
Association of Health Plans,
which said the whole idea behind
the law is to spread the costs.
So while some consumers will see
their premiums drop, others will
see them rise no matter what the
people in Washington say.
There will be stories on both
sides.
And I think that at the end of
the day, when you do cut through
the politics and the reason it's
so difficult to understand this
is because it is gray.
It is different for every
person, every community.
I know here in Wisconsin some
insurance carriers have upped
their premiums on the individual
market in order to be able to
meet those essential benefits.
Others have contracted with
narrow networks, providers only
within a very limited geographic
area.
So people that buy into that
plan may have to drive 30-40
miles to go see a doctor when
they used to be able to drive
10 minutes down the street.
But each person, each community,
as I said, is going to be
different.
And time will tell, again, how
it will all shake out as people
receive cancellation notices and
they have to shop around.
Obviously, if and when people
can actually log into
healthcare.gov and shop around,
we will all have a better idea
of where everybody's going to
end up.
And here's the most interesting
part of this which is it's
really not a political decision.
At the end of the day this is
each one of you in you living
room, whether you are covered by
an employer plan or whether
you're looking for insurance for
your small business for you
employees or whether you're
looking for insurance just for
yourself and your children, it's
going to be dependent on what
you and your wallet and what
your needs and your healthcare
need.
And so there is no, it doesn't
matter what John Boehner says or
what President Obama says or
what anybody, Governor Scott
Walker for that matter, it
really doesn't matter because at
the end of the day it's going to
be you just like purchasing car
insurance.
You're going to decide what's
the best policy for your car.
And that's what we get to when
we cut through all the politics.
So, I don't know if anybody has
questions.
If you have a question for me,
please feel free to go up to the
microphone.
>> I would like to know why in
the world they didn't migrate
100% of the people on HIRSP into
the exchange?
And why didn't they migrate the
92,000 people losing BadgerCare
directly into the exchange?
I've been in the insurance
business, health insurance
marketing for 25 years, and one
of the characteristics through
this experience is that groups
migrate from one company to
another.
When one goes out of business,
we transfer clients to another
company.
This would have insured 130,000
people without having to have
anybody do anything except to
adjust their situation to
account for their individual
family and everything else.
That is a terrible error.
>> I think it's absolutely a
valid question, and I think it's
a question for Governor Walker.
He made those decisions.
The state obviously decided to
dissolve that high-risk pool,
and Scott Walker decided to take
the 92,000, although I think
it's 77,000 now, of people off
of BadgerCare and have them shop
around on the exchange.
And I don't know why they didn't
do it as a group except that
it's an individual exchange,
and I think the idea was to
allow them to shop around.
>> Well, as a marketer and as an
insurance agent that gets paid
on commission, that's 130,000
prospects that I'll get paid on
a percent of them.
[LAUGHTER]
>> Someone will let the governor
know.
[LAUGHTER]
>> Thank you.
>> The question I have, when
this got passed, why didn't they
all put a brake on it, gave
everybody the same health
insurance as congressmen,
the president, senators, and
everybody would pay a certain
percentage, like 20% let's say,
toward the healthcare.
If I earned $100,000,
I would pay $20,000.
If I made $100 million,
I would pay $20 million.
No loopholes.
No nothing.
Simple.
See, I'm from the old school.
I have got gray hair, and we did
things simpler.
Now it's so complex.
Nobody knows anything.
That's all I have to say.
Do you have any comments.
>> That's true.
It's very complex.
It is.
And this is the result of a
political compromise because, I
think, when democrats first set
out to make this law, they
wanted to make a universal
payer.
If they had their way, Medicare
would be, all Americans would
have health insurance paid for
by the government.
But, of course, then you have
the republicans, and they want a
free market.
So what we end up with is a
hybrid.
And that's part of what makes it
confusing but also part of what
makes America America.
>> Yeah.
But I mean simple.
Everybody would pay, like I
said, and there wouldn't be all
this fighting.
That's what I'm saying.
Instead of buying everybody off
to vote for the healthcare, like
they did, they should have just
put a brake on it.
>> Are you going to run for
congress?
>> Well, no because they
wouldn't want me because I would
say it the way it is.
[LAUGHTER]
[APPLAUSE]
>> Thank you very much.
>> Can you answer certain
questions regarding healthcare
in this area?
>> I hope so.
>> What hospitals in this area
are going to be accepting the
Affordable Care Act?
All of them?
Or are there limited ones?
>> This is where it's not my
expertise because I actually
live in Washington, DC.
>> Okay.
Second one, for preexisting
conditions, I already have
health insurance right now, and
if I have high blood pressure,
if I signed up for the
Affordable Care Act would the
high blood pressure be covered
or do you have to wait a year?
I heard there was an exception
for that.
>> As far as I know, there is
zero underwriting allowed,
meaning they cannot deny you
for your preexisting condition
at all.
And that's a major part of the
law.
There are many other people here
who are much more qualified than
me to talk about that, but that
is one of the issues with the
law, is that you cannot be
denied.
>> Last question, is it very
area specific?
I travel to Florida in the
winter and I also do extensive
travels internationally,
will that be covered?
>> Well, that's a really
interesting question, and it's
one that I don't know, because
I don't know the individual
peculiarities of travel
insurance, and that kind of
thing.
But maybe one of our panelists
coming up can answer that.
I know we have a human resources
person and some other small
business owners and people that
are really involved with how
this is rolling out.
So hopefully they can answer
that.
I appreciate it.
[APPLAUSE]
>> Okay, it is now my pleasure
to introduce the moderator
for this distinguished panel.
Carol Koby is the executive
producer and host of All About
Living, radio with Midwest
Family Broadcasting.
She is a communications
consultant and has extensive
experience in moderating panels
such as this.
So please give Carol Koby
a welcome.
[APPLAUSE]
>> Thank you very much,
and it's a pleasure to be here.
Listening to the questions,
there is a lot of confusion, and
this was really a big deal.
We are living in a major moment
in history.
And if passing federal health
reform were so easy, one of the
administrations over the past
100 years would have already
accomplished it, something that
several of them tried to do.
But some things did happen, as
Tom Nelson mentioned.
We have Medicare that was passed
during the Johnson
Administration, and then during
the Reagan Administration COBRA
was passed.
And a provision in COBRA
included that no person needing
medical attention can be denied
healthcare in an emergency room.
So, as many people say, you can
always go to the emergency room.
Well, that is our form, in this
country, of universal
healthcare.
And now we have the Patient
Protection and Affordable Care
Act, shortened formally to the
Affordable Care Act and
informally known as Obamacare.
And I have followed and reported
on this law of the land since it
was passed and signed into law
in March of 2010.
And so when I happened to be
sitting at my computer late in
the evening of September 30th
and the hand was creeping
towards midnight and it got to
be one minute after midnight and
I thought to myself, I wonder,
because I had been logging into
healthcare.gov regularly.
And sure enough, there it was.
Instead of coming soon, which
was the words right under the
pretty girl smiling, there was
the word "open".
Well, at the moment, of course
I had an adrenaline rush because
I had been following it and
building up to this, and of
course that was quickly
dissipated when I found out that
it may be open but it wasn't
working.
[LAUGHTER]
Yet.
But that's only one part of the
Affordable Care Act.
While it is probably the
signature part of the act,
there's a lot more to it.
And that part, healthcare.gov,
will be and is being fixed, and
many people are having
successful experience on it
already.
And that will continue to
improve.
So where are we with the law,
with the Affordable Care Act
really, and what does it mean to
us?
Well, that's why we're gathered
here tonight to strip away the
politics, the political pundits,
opinions, and they're striving
to beat one another for ratings,
and get down to the nuts and
bolts and present to you the
realities of Obamacare.
And to do this, let me introduce
to you this very distinguished
panel who has many of the
answers to the questions
you have already expressed.
And they are, starting from the
far left, your left,
is Bill Hanna, Kerry Arent,
John Meurer, Lori Compass,
and Jose Araujo.
How did I do, Jose?
>> Good.
>> Thank you.
I practiced.
And you will meet them a little
bit more in just a moment, and I
will give you a little bit of
their backgrounds.
But before I do, you recall
seeing the Young Invincibles
video as you gathered in the
room this evening talking about
these young people who seem to
have more of a pension for
taking the risk of not
purchasing insurance, either
because they think that they're
not going to get sick or it's
one of the expenses that they
don't feel they can afford at
the moment.
So as we watched that, they
really encompass the fact that
we are all 100% at risk of
needing healthcare.
And now, before we hear from our
panelists, let's watch a short
segment from Wisconsin Public
Television on some of the recent
changes to BadgerCare and the
way they're affecting the people
of our state.
Let's watch.
>> I just was blind sided by
Nathaniel being taken off of
BadgerCare.
>> Becky McElhaney received a
letter from the state that her
two children, including her
14-year-old disabled son, could
be losing BadgerCare coverage
because of eligibility changes.
She says calls to her county
Medicaid office in Wausau
confirmed they'd be dropped
as of next year.
>> I think it's horrible.
I mean, we need that help in
this family due to the fact that
his therapies are very, very
expensive.
>> McElhaney was among more than
90,000 people in Wisconsin that
received this type of letter
from the state in September.
Kathleen Goff got the same
letter in Kenosha.
>> I was disappointed that
I was going to be taken off,
but I was hopeful that I could
find another policy through
Obamacare.
I'm hopeful that I can, that's
as good as BadgerCare is.
>> The letter said this: "Due to
changes in state law, adult
members with household income
above 100% of the federal
poverty level and children with
household income above 300% FPL
will no longer be eligible for
BadgerCare Plus.
You or someone in your household
may be above these limits."
The letters told people to apply
for insurance through the
Healthcare Marketplace,
but that hasn't been easy.
>> It always gives me this.
"Your account couldn't be
created at this time."
>> The Deputy Secretary of the
Department of Health Services
explains the BadgerCare changes.
>> As part of Governor Walker's
2013-2015 state budget, he
initiated an entitlement reform
plan to really create a Medicaid
program for individuals that are
truly in poverty and also to
take advantage of that fact that
with the changes in the
Affordable Care Act that people
will have access to affordable
health insurance through the
exchanges.
>> In McElhaney's situation,
her son, with autism,
and her daughter were covered
under BadgerCare.
She was covered under the
state's high risk insurance
plan, or HIRSP, because she had
previously been denied insurance
due to a chronic medical
condition.
The Affordable Care Act
prohibits such denial and so the
state program is ending.
A complicated case that got more
complicated when she couldn't
access the healthcare.gov
website and took to the phone.
>> Right, but can you give me
any plan information right now?
I need, you know, I need, I've
been waiting and I'd like to
know if you can give me any
numbers or plan information
about what I'm going to be
looking at.
>> Consumer healthcare advocates
say it's crazy out there.
>> We're getting calls.
I'm talking to people who are
confused, uncertain about
whether this is going to affect
them or not yet.
They're getting letters.
They realize that change is
coming, and I think that some
have tried the Marketplace and
not been able to get in.
So it's a situation where it
hasn't reached the panic point
yet, at least people that have
called us, but I think people
are very concerned.
>> According to the state Health
Department, new letters will be
going out at the end of this
month confirming for BadgerCare
recipients whether or not
they're definitely out of the
plan.
>> You're kind of in limbo, and
you don't know what is your
future as far as healthcare.
>> Just this week, McElhaney
learned that because of new
changes in how child support
income is counted, her kids
will be eligible for BadgerCare
after all.
It's a roller coaster and still
leaves her own insurance to
consider.
>> I have to make sure that I
have planning in for my
financial ability to purchase
these plans.
>> McElhaney says she pays $544
in monthly premiums for the
state high risk plan, plus
deductibles and drug co-pays.
Totally, she says,
about $10,600 a year.
Bypassing the website and going
directly to a private
marketplace insurer, she's found
a mid-tier plan putting her
premium at about $445 a month
after a subsidy with additional
deductibles and co-pays.
But under the law it cannot
exceed the out of pocket maximum
of $6350 a year after premiums.
So, she figures the Marketplace
plan will cost her about
$11,600.
>> I was hoping it was going to
be affordable.
I was really actually very
excited because I thought, okay,
now we all can get into a big
group, and we all can help
minimize the risk for everybody.
>> In the end, McElhaney says
she's relieved her new plan
would only cost $1,000 more
next year.
>> We're going to hear from each
of our panelists now, and I'm
going to have each of them give
their short presentations and
then at the conclusion we will
take your questions and address
those issues of concern to you.
And please, panelists, feel free
to address any of the issues in
either of the videos regarding
the Young Invincibles or
BadgerCare or anything that's
already been brought up from the
audience.
And I'm going to begin with you
John Meurer.
Let me introduce John Meurer
to you.
He is a professor and director
of the Institute for Health and
Society, the Medical College of
Wisconsin Department of
Population Health Sciences.
John studied liberal arts and
sciences at Marquette, attended
UW Med School, and trained in
pediatrics at Baylor in Houston.
He earned an MBA
in Health Systems Management
at Northwestern.
You've been all over the place.
My goodness.
In 1994, you joined the MCW
pediatric faculty as a clinician
educator and outcomes
researcher.
You served on Governor Doyle's
Public Health Council and as a
PI of a Healthier Wisconsin
Partnership Program Initiative
with covering kids and families
of Wisconsin.
John is a volunteer for the
nonprofit Common Ground
Healthcare Cooperative.
A warm welcome, please,
to John Meurer.
[APPLAUSE]
>> I'm going to present the
four goals of our healthcare
system.
Improving access, improving
quality, containing costs, and
improving population health.
First, the Affordable Care Act
will eventually improve access
to affordable health insurance
coverage for millions in the
United States.
These are some ambitious
national coverage goals for
2014.
To have Marketplace as fully
operational by mid December so
every eligible person can enroll
To have the uninsured and those
with high out of pocket costs
down by five million.
To have seven million people
enroll in private plans and
nine million in Medicaid.
And to have the uninsured
decrease by 13 million.
Particular challenges in the
southern part of our country
where 18%-24% of people are
uninsured, and most of those
southern states are not
expanding Medicaid coverage.
This is a list of the 10
essential health benefits in the
federal facilitated marketplace.
No matter what plan you enroll
in, those are guaranteed.
Many current individual and
small business health plans lack
coverage of these benefits, and
in particular the red
highlighted areas.
Behavioral health and substance
abuse, rehab therapies,
preventive and chronic care
condition treatment, and for
children dental and vision
coverage.
These are additional services
that many people currently can't
get but will get through the
exchange.
The Affordable Care Act premiums
and cost sharing, the cost
sharing, the premium benefits
are really with the silver plan.
So, you can see in the blue
line, the first column is
household, then annual income,
federal poverty level, premium
as percent of income, the ACA
monthly premium, and the maximum
out of pocket cost.
It varies whether it's an
individual or a family I want to
highlight in particular that
121.
If a premium is $440, that's
actually the second lowest
silver plan for a 50-year-old
in Milwaukee.
It depends on age, gender, and
location.
That's the actual amount.
The individual at that income
level of $23,000 per year will
actually pay $121 monthly.
The fed will pay a $319 subsidy
to cover that $440,
and the fed will pay
directly to the insurer.
There's 550,000 or about 10% of
our population in Wisconsin who
are uninsured.
300,000 in Wisconsin will be
eligible for a premium tax
credit.
It will depend on their income.
But the law is a compromise.
For some uninsured, the premium
is still too high and
unaffordable, but for some
taxpayers, that subsidy is too
high and unaffordable.
It's a compromise.
Second, I want to talk a bit
about quality of care.
When you get health insurance,
what service do you get of high
quality?
The Institute of Medicine came
out a report with a six list of
domains.
These are really the
responsibility of us physicians,
nurses, hospitals, and other
healthcare professionals to
ensure you get quality care.
Third, I want to spend a good
deal of time on cost because the
greatest challenge we face is
the cost escalation for
healthcare services.
I'll summarize the
recommendations that are common
to these seven proposals from
diverse groups across our
country.
Multiple approaches are much
more likely to succeed in
containing cost than any single
one of these recommendations.
First is payment improvements
and realigned incentives to
contain costs.
And some good examples are the
Medicare sustainable growth rate
and getting that closer to the
increase in consumer price
index.
Maybe a percent or two above
that.
Medicare advantage, private
advantage care plans.
Alternatives to fee for service
payments, which is incentive to
do more.
Supporting more primary care.
The majority of practitioners in
Europe are primary care; the
majority in the US are
specialists.
And promoting high quality care.
A second approach is delivery
and other health system reforms.
These are things like medical
homes and teen-based care and
care coordination and case
management.
Accountable care organizations
where hospitals, doctors, and
sometimes health plans work
together to coordinate services.
State innovation to improve
quality and reducing costs,
using electronic medical
records, administrative
simplification of forms, and
medical malpractice reform.
All of these are things
recommended as cost containment
measures.
And finally, improving quality,
promoting market competition,
and setting targets.
You can see the trend over the
last decade in cost increases.
Patient and consumer engagement,
price and quality transparency,
new Medicare options for
beneficiaries, affordable cost
sharing and premiums, high
quality low cost health plans in
state marketplaces, and spending
targets are a number of
proposals to try to get at cost.
All of these things together are
strategies to try to get cost
under control in our country.
I want to finish with focusing
on the triple aim.
This is about population health.
We all want an excellent
experience of patient care.
That's part of good quality, but
a second important part is
having good population health
outcomes.
For the county in this community
to have obesity rates going
down, not only for individuals
and families, and at the same
time controlling per capita
costs, this is really the
responsibility of integrated
organizations thinking about how
to think about individuals and
populations in cost management.
The Center for Disease Control
using this health pyramid to
help us understand.
Clinical and educational
counseling at the very top of
the pyramid requires motivation
and effort by individual
patients to change their
lifestyle.
Lifestyle is the biggest impact
on our health.
More than medical care.
That means healthy nutrition,
physical activity, no smoking.
Social policies, on the other
hand, make it a lot easier to
achieve population health goals.
Things like Head Start
education, more bike paths for
safe moving around, smoke-free
buildings, and health insurance
tax credits and subsidies make
it more affordable for citizens
to have access to care.
These are what are called the
six Marmot principles.
Michael Marmot is an
epidemiologist in the UK, and
he's studied and shown, like
many others, that there are
social determinants to health.
In other words, the lower a
person's social position,
whether it's the UK or the
United States, the worse that
person's health.
And the lower the median income
where somebody lives, the more
predictable of poor health.
It doesn't have to do with
insurance or medical care
access.
It has to do with social
determinants.
These six principles have been
shown to significantly improve
community health much more than
medical care.
So I would be very pleased to
further discuss my comments
during the question and answer.
Thank you.
[APPLAUSE]
>> One of the areas where there
is a great deal of confusion
and misinformation is in the
business area.
What do employers do?
If you're a small employer or a
large employer or what counts as
either/or?
And here to talk to us about one
of the groups of the businesses
is Lori Compass.
And Lori Compass is a small
business owner from
Fort Atkinson and the executive
director for the Wisconsin
Business Alliance.
She has been traveling the state
this fall talking with local
chamber of commerce members
about the Affordable Care Act.
And tonight she'll share with us
some of her experiences of
talking with small town
Wisconsin business owners.
Lori, welcome.
[APPLAUSE]
>> Our organization represents
business owners all over
Wisconsin, most of them small
business owners, and I've been
traveling around the state
talking with chambers of
commerce and particularly to
small business owners.
And the people that I'm talking
to are actually pretty
optimistic about this.
I guess you could say cautiously
optimistic about the Affordable
Care Act.
A lot of people who have small
business or who dream of
starting their small business
also have to keep a desk job so
that they can have insurance.
And so we are optimistic that
being able to get affordable
insurance through the individual
Marketplace or through the SHOP
Marketplace will free people
from having to spend eight hours
a day at a "real job" and allow
them to really put everything
into their small business, put
everything into their farm.
A lot of us know farm couples
where one of the spouses has to
work in town to keep their
insurance.
So we think it will lead to more
freedom for small business
owners, more security for
entrepreneurs.
It also helps us level the
playing field.
A lot of small business owners
know what it's like to hire and
employee, train them up, and
then lose them to a larger
employer that can offer
insurance.
So we're hoping that small
business will now be able to
offer the same kind of perks
that the larger employers do.
So it leads to more options
regarding health insurance for
employers.
And those options are, first of
all, small business owners don't
have to offer insurance at all.
And oftentimes when I go around
the state, people are really
surprised to hear this.
They have heard horror stories
of little mom and pop shops
having to close down because
they can't offer insurance to
their employees.
Well, the truth is they don't
have to offer insurance to their
employees.
If they have 50 or fewer
employees, they don't have to
offer insurance at all.
Those employees can go on the
individual Marketplace.
So that is my main point that I
hope you take away from this.
If you own a small business or
you have a friend who owns a
small business, if they employ
fewer than 50 full time
equivalent employees, they don't
have to offer insurance at all.
If they do currently offer
insurance, they can keep their
current insurance or they can
buy coverage in the new SHOP
Marketplace, which I'll talk
about more.
So that SHOP Marketplace, the
new Marketplace that's part of
healthcare.gov, is a new option
for small employers.
It is not a requirement.
So, what does that shop look
like?
SHOP stands for Small business
Health Options Program.
It's an online marketplace.
It offers standard coverage at
various levels, just like the
individual Marketplace,
platinum, gold, silver, and
bronze.
And, by the way, those metal
levels are not an indication of
the quality of care that people
will receive.
If you get a bronze plan that
doesn't mean you have to go to,
like, Joe's Hip Replacement and
Small Engine Repair.
You can go to a normal hospital
and everything.
Those metal levels are a
reflection of the plan's
actuarial value.
So a bronze plan, for example,
would have an actuarial value of
60%.
Whereas, a platinum level plan
would have an actuarial value of
90%.
It's much more generous, there's
much less out of pocket expense.
So this allows employers to
compare apples to apples when
they're looking at health
insurance plans for their
employees, and that's something
that has not been easy to do up
until now.
Who is eligible to participate
in SHOP?
It's open to employers with 50
or fewer FTEs, that's full time
equivalent employees, and it's
kind of complicated,
particularly here in Wisconsin
where we have a lot of seasonal
employees.
Farms might employ seasonal
workers.
A snow plow operating company
might employ seasonal workers.
So there's a form that I found
actually in Illinois that is the
best form that I found.
If anybody finds a better one,
let me know.
And I linked to it from our
website
WisconsinBusinessAlliance.com/
ACA
So you can go on there and it
allows you to calculate month by
month how many people you
employ, how many hours you pay
for, and then in the end you can
get you total so that you know
where you fall.
For the vast majority of
businesses in Wisconsin they
fall well below 50 full time
equivalent employees.
If you are self-employed with no
employees, you can get coverage
through the individual
healthcare insurance Marketplace
but not through SHOP.
Now, there are tax credits,
there are deductions, there are
all kinds of things associated
with this.
I'm not going to go into it now,
it's kind of a general audience,
but as Cori mentioned, we are
having more of these panels
tomorrow, and I'll be on a panel
that addresses some of this
stuff more in depth.
So if you're interested in that,
please check the details when
you go out.
If you have questions about the
SHOP Marketplace for businesses
with 50 or fewer employees, you
can call this number or you can
visit
healthcare.gov/smallbusiness.
And we have a lot of good
information on our website.
Again that's
WisconsinBusinessAlliance.com/
ACA.
So, thank you very much.
[APPLAUSE]
>> Thank you, Lori.
So the take away, small
businesses are not mandated to
have insurance, but there are
some new opportunities available
to small businesses through the
Affordable Care Act.
So if you do have a small
business, it might be good to
look into it.
But that's a little different
than large employers.
They are mandated to provide
insurance, and here to explain
exactly what that mandate is and
what the little tweaks have been
to it is someone who is working
in the field every single day in
her position, Kerry Arent.
Kerry is the senior vice
president human resources of
Appvion, which is formerly
Appleton Papers.
She has over 25 years of
experience implementing
healthcare cost management
strategies, ranging from
exclusive provider arrangements
in the 1980s through Appvion's
most recent efforts focused on
health improvement and the
implementation of an on-site
clinic in Appleton, Wisconsin.
Kerry Arent received a
bachelor's degree in business
administration human resources
from the University of Wisconsin
Oshkosh and holds a senior
professional human resources
certification.
She also serves on the board of
directors for Harbor House
Domestic Abuse Programs and the
Fox Valley Family Practice
Residency Incorporated
corporate board.
Welcome, Kerry, and please join
me in welcoming Kerry.
[APPLAUSE]
>> I think as a large employer,
one of the challenges we have
is that we typically offer
a benefit plan, one or two,
maybe three, depending on the
employer, that our employees can
choose from, but what we're
really doing is shopping and
buying that plan, designing that
plan, and in what we believe to
be the best interest of our
employees.
And so the challenge we have
with the Affordable Care Act,
like many of you looking at it
from an individual perspective,
is trying to figure out what it
all means.
And it's a little
nerve-wracking, actually, to be
here as an expert on a panel
when we're still trying to
figure it out as we go along
too, just like everybody else
is.
So I'll just give you a little
bit of information that I have
on it tonight, and then we'll
add some more as we go along the
way.
We do have compliance
challenges.
Some of the people have spoke to
those things already.
The law is very complex.
We all heard about the thousands
of pages that were out there.
So we do rely on a lot of
consultants and brokers to help
interpret that for us.
And I am starting to notice some
consistency in interpretation,
but there's still some things
out there that we're figuring
out too because just like the
exchanges didn't open until
October 1, well that's when some
of the consultants were seeing
some of the numbers for the
first time too.
And the challenge as an employer
is that most folks will run a
January 1 plan.
Well, that means we're doing our
planning in August/September so
that we can be rolling our
communications out to our
employees in October and they
can be making those selections
in November.
Well, it's hard to decide what
to offer if the information
isn't available.
So we've had that in a lot of
ways as this has been unfolding.
One of the big questions that I
think came up in the very
beginning is, what would large
employers do?
Are they going to play or are
they going to pay?
And what that basically means is
are we going to offer coverages
that meet the minimum
requirements of the law so that
our employees can continue to
stay on the group plan with us,
or would we take the easy way
out and just give everybody some
money so that they could go in
the individual Marketplace, buy
on their own, and then we would
need to pay a fine of $2,000 per
employee if we decided to go
that way.
And there was a lot of
speculation that people would
just take that route because it
would be a lot simpler.
And sometimes I think maybe it
would be simpler, but I don't
think we can answer that
question yet because we don't
know what it is that we would be
sending out employees out to do
and how much would it really
cost them.
And, consequently, there's a lot
of uncertainty there, and at the
end of the day we're competing
for talent against other
employers and if we don't offer
a benefit package that's
competitive, we're going to have
difficulty retaining the
employees that we have or
recruiting new ones to come and
work for us.
And so some of the recent
statistics that I've seen,
they're saying that for 2014
it's less than 2% of large
employers that are opting to pay
and send folks into the
individual Marketplace.
I think as the market settles
down and as we get some rhythm
to how all this works and we can
see what the real costs are, I
think 2014 is a bit of a shot in
the dark when the pricing was
being set plans.
I think we may see some changes
in how that all unfolds, but
right now it's a little bit
early to tell because we're
going into, obviously,
uncharted waters there.
One of the things that also is a
concern is how do you compare
these plans, and what is the
value that employees are getting
if they go and buy as an
individual in the Marketplace?
When we think about value, there
are a variety of different
things that you want to keep in
mind.
The first thing that everybody
talks about is the benefit plan
design.
What's the deductible?
What's the coinsurance?
What's the out of pocket
maximum?
And that is where you'd want to
start as you look at plans and
you compare them.
But there's a number of other
things that aren't getting a lot
of attention that I would
encourage you to also try to dig
into.
The first is who are the
providers that are part of that
in-network group.
One of the gentlemen early on
had asked a question about what
kind of flexibility will I have
if I want to travel?
Well, what I'm hearing is that
some of the plans that are out
there in the individual
Marketplace have very what I'll
call narrow networks.
And you have to be careful of
the name of the company because
you may have a carrier, and I
won't name names, but you might
have a carrier that you
recognize the name, maybe you've
even been in their insurance
plan in the past, and you're
accustomed to having access to
four different healthcare
systems.
And when we talk about the
systems, those are ThedaCare,
Affinity, Aurora, those are some
of the common names here in
northeast Wisconsin.
But what you might find is that
their new plan in the individual
Marketplace only has one of
those groups in their plan.
And you need to dig in in order
to find if that's the truth or
not.
But if you find that it's only
that network, if you're using
doctors in that network today
and you don't ever leave the
area so you always get into
those doctors, then it's
probably not a problem.
But if you want to go to
Florida, you're not going to
find a ThedaCare provider or an
Aurora provider there, so that
could be a challenge then.
Then you want to look and see if
there's out-of-network benefits
and in-network benefits or only
in-network benefits.
So, very subtle but a very big
thing when it comes to the value
that that plan will bring you.
Same thing is true with
prescription drug formularies.
I'm hearing, and again I haven't
had access to be able to see
what's really out there, but I'm
hearing that some of these
benefit plans have much narrower
networks in terms of what's
covered in the prescription drug
realm.
Which drugs, by name, are on the
formularies.
So something else to be aware
of.
I always tell people to, when
you look at a plan, start by
first looking at deductibles,
coinsurance, then jump and look
at what's excluded from the plan
because that's always an
important thing that sometimes
people lose sight of.
We are seeing that the cost of
the plans vary by age, the
market locale, meaning are you
in Appleton, Madison, Milwaukee,
all of those are different from
a pricing standpoint, and then
one of the big things as an
employer when we think about how
this individual Marketplace
might work, if I give someone
cash and tell them to go out and
buy coverage, that income is
going to be taxable to them.
If I give them $8,000, it's
taxable income before they go
buy their health insurance.
Where, when they're getting it
through their employer, it's a
pretax benefit, and you don't
have that tax ramification.
So a lot of complexities in
there.
One other thing just to touch on
is that we do have about
two-thirds of our employees that
are covered by a union, the
United Steelworkers.
One of the challenges that we
see as we look ahead to 2015 is
that there are mandates in the
law that require certain benefit
plan designs that are different
than what we've negotiated with
the union.
And so if our contract doesn't
expire before this goes into
effect, we're going to have to
figure out what to do with that.
And that's different than what
we've had in the past because
typically in the past when there
have been legal mandates,
there's usually an exception in
there for collectively bargained
plans, and they're allowed to
stick with what was bargained
until the end of the that
collective bargaining cycle.
And then the new plan that would
be negotiated would need to
reflect the new mandates within
the law.
But this one's different.
And so that will be another
challenge.
And then we still offer coverage
to some of our pre-Medicare
retirees.
And so we were hoping the
individual Marketplace would
give us some options on that.
And we did take a pass for 2014
because we couldn't figure out
what it was going to be yet, and
so we'll revisit it again come
2015 to see if it may be
advantageous for them to go that
route instead.
And I think I've covered along
the way why we chose to play for
2014, and we'll revisit that
again in 2015.
[APPLAUSE]
>> Thank you very much, Kerry.
And now we're going to turn to
the state of Wisconsin
specifically, and how the
Affordable Care Act is working
here.
As you probably know, Wisconsin
is part of a federally
facilitated exchange and we
chose not to have the Medicaid
expansion.
And here to talk to us about
Wisconsin's philosophy on how we
are implementing the Affordable
Care Act here and the BadgerCare
change that will occur
January 1st is Bill Hanna.
Bill is the director of Area
Administration at the Wisconsin
Department of Health Services.
Area Administration is a part of
the Office of the Secretary and
is the primary link for DHS with
local county human services
agencies.
In recent months, Area
Administration staff, located in
five regional offices around the
state, led the department's
effort to facilitate the
creation of 12 regional
enrollment networks across the
state to help with setting up
the operation of the Affordable
Care Act and changes to
BadgerCare Plus that were
included in the state's biannual
budget.
Bill has a master's in public
administration from the
University of Georgia.
Welcome, Bill.
Please join me
in welcoming Bill.
[APPLAUSE]
>> Thank you.
Yes I went to graduate school
in Georgia, but I'm actually
from Appleton.
I was born and raised in
Appleton, went to Appleton West,
and actually went to Lawrence
University for my undergrad.
So I'm happy to be back here
in the Fox Valley.
So the video talked about, I
think, part of the changes that
are happening in BadgerCare
Plus, but there's some other
parts, I think, that were maybe
glossed over.
So, in the most recent budget,
the entitlement reforms were,
we had three goals.
One was to ensure that every
resident has access to health
insurance, either through the
BadgerCare Plus expansion for
childless adults or through the
Marketplace.
The goal is also to reduce the
number of non-elderly uninsured
in Wisconsin, and I think we
heard the number, about 500,000
in Wisconsin.
The goal is to decrease that in
half in the next two years.
And the third goal is to
simplify the Medicaid program by
moving to one set of benefits
for those that are enrolled in
the BadgerCare Plus program.
So this is what BadgerCare Plus
looks like today.
Children and pregnant woman are
eligible for BadgerCare Plus up
to 300% of the federal poverty.
But you see from the 200% to
300%, that green section, those
children and pregnant women are
eligible for the benchmark plan.
That's a limited set of
benefits.
It doesn't include dental.
It doesn't include behavioral
health services.
So they have a limited set of
benefits.
In the childless adult section
in red, that's even fewer
benefits than the benchmark
plan.
And currently that plan is
capped.
There's a wait list.
There has been a wait list
almost since its inception.
And you can see from the numbers
down below, we have about 16,500
people in the childless adult
population, and 769,000 people
enrolled in BadgerCare Plus.
This is what the world of
BadgerCare Plus will look like
after January 1st.
You see that children and
pregnant woman are still
eligible up to the 300% of
federal poverty, but what was
that green section, that
benchmark plan, is now yellow.
So those individuals that are in
the 200% to 300%, those children
and pregnant women, are going to
have an enhanced set of benefits
starting January 1st.
What you did hear in the video
are those members that will be
transitioning from BadgerCare
Plus to the Marketplace.
You see in the parent and
caretaker column, the
eligibility level changes from
200% to 100%.
Originally, we estimated that
was about 92,000 people when we
did the budget that would be
transitioning.
We've since run the numbers and
sent out letters to individuals.
It's 77,000 individuals will be
transitioning from BadgerCare
Plus to the Marketplace.
The last column, childless
adults, you see went from red to
yellow.
So, again, enhanced benefits,
part of the standard plan, and
the income went from 200%
to 100%, but there is no
more wait list.
There is no more cap.
Anybody under 100% of the
federal poverty level will be
eligible for BadgerCare Plus
benefits.
So what was that 16,500 people
that are currently enrolled,
childless adults that are
enrolled in Wisconsin now goes
to 98,641 individuals in the
childless adult section.
So we're actually adding 82,000
individuals into the BadgerCare
Plus population, and you see the
estimated total number to
802,000 individuals enrolled in
BadgerCare Plus.
All right, I think this
gentleman here brought up that's
a lot of people that are moving
either onto BadgerCare Plus or
transitioning to the
Marketplace.
So, how are we doing that?
In the introduction they talked
about regional enrollment
networks.
DHS has partnered with the
Wisconsin Primary Healthcare
Association, Covering Kids &
Families, the Milwaukee
Healthcare Partnership, to
design, develop, implement,
manage, continue to grow
regional enrollment networks
around the state.
We have 12 networks.
These are public/private
partnerships of individuals,
organizations.
They include county health
departments, county human
service departments, hospitals,
insurance brokers, nonprofit
organizations, volunteers all
with the same mission of helping
people enroll into the
Marketplace to help get the word
out and help them be able to
complete applications either on
healthcare.gov or on paper
applications.
DHS, specifically, we are
targeting those 77,000
individuals that we know will be
transitioning from BadgerCare
Plus to the Marketplace.
We have already sent, and as you
saw in the video, the initial
letter notifying people that
they likely will not be eligible
for BadgerCare Plus starting on
January 1st.
Recently, and you may have heard
about it, but starting next week
we are sending additional
letters to those same people,
and this time we are including
with that letter a copy of the
family application and
instructions.
So if everything works smoothly
and the website was operating
like we planned that it would,
we wouldn't need to do this.
But we're rolling with it like
everybody else.
So this is our strategy to make
sure that people do have access,
that they are applying, and they
will get coverage in the
Marketplace.
The actual notifications, the
final and last notification will
be sent to individuals in
November.
In addition, we have 168,000
people that were on the wait
list for childless adults
that were on the wait list.
So we have also sent letters to
those individuals saying that
if you're under 100% of the
federal poverty, apply for
BadgerCare Plus starting
November 18th, and there are
no more wait lists, so you
would eligible for BadgerCare
Plus starting January 1st.
And if you're over 100% of the
federal poverty level and you
were on the wait list, you now
can go to the Marketplace and
apply for insurance via the
Marketplace.
So that's our outreach strategy.
We have a lot of people that are
moving one way or the other, but
we have a lot of great partners,
really a grassroots effort to
help people transition
successfully, and to have all
Wisconsinites covered by
insurance.
[APPLAUSE]
>> Thank you, Bill.
And as we talk about the
Marketplace or the exchanges,
those are interchangeable, they
are both the same thing.
Some people use Marketplace,
some exchanges.
I know that we've all been using
both tonight, and I want to make
sure that you understand that.
Last but not least, certainly,
is Jose Araujo, and Jose has
over six years managing several
state and federal grants.
Currently, Jose is the program
director of the Navigator and
Partners Cares 4 Kids Program,
Volunteer Center of Sheboygan
County, Hispanic American
Information Center, and
AmeriCorps program.
Jose holds a bachelor's degree
in international business and a
master's in business
administration from Lakeland
College.
He currently serves as the
president of the board of
directors of Mental Health
America of Sheboygan County,
commissioner of the City of
Sheboygan Planning Commission,
vice president of the
Professional Hispanic Network of
Sheboygan County, chair of the
nonprofit division of The United
Way of Sheboygan County campaign
committee, and that's just part
of what he is doing.
Jose was recently named, not
unsurprisingly, the Top Young
Professional of the Year Award
by Coastal Connections.
Jose moved to Sheboygan County
from his homeland in Peru in
2003.
And Jose is a navigator.
He is the one person that has
been professionally and
federally trained to help all of
us better understand and access
the Marketplace and the
Affordable Care Act.
So we're all going to have our
ears perked to hear what you
have to say, Jose.
Welcome.
[APPLAUSE]
>> Thank you very much.
Is this one okay?
Yes.
Okay.
I like moving when I talk.
So, first disclaimer, as she
mentioned, I'm from Peru so when
I speak in front of crowds, I
tend to get a little nervous and
my accent gets a little worse.
I apologize in advance.
So, I represent the navigator
crowd.
As Bill was saying, as part of
this Affordable Care Act, the
law created new positions,
per se, new roles in how are we
going to hit the road and make
this accessible to the people
that are going to be taking
advantage of the Affordable Care
Act.
So the Affordable Care Act
created, basically, four new
positions, per se: the
mobilizers, the navigators, the
certified application
counselors, and there was a role
that we already had that is
still in there which is our
friends are insurance brokers or
insurance agents.
So the mobilizers are people,
like you and I, that have
certain kind of information
about insurance and about the
Affordable Care Act and are able
to relay that information to
others and help others find
help.
The certified application
counselors and the navigators,
they're basically the same
thing.
The difference in the title is
where is their funding coming
from.
Navigators, the funding is
coming from the CMS which is the
Center for Medicaid and Medicare
Services.
CAC, certified application
counselors, comes from an arm of
CMS which is HRSA.
But they're about the same.
Our goal is to bring information
out to the general public, help
you navigate, the term is to
navigate the website or navigate
the entire system, and make sure
that you're able to enroll.
We are not able to give you,
inform, or help you choose a
plan.
That's why we have our agents.
That's why we have our brokers.
We need to remain as unbiased as
possible.
When you, as a client, come up
with questions on which plan
should I choose, is plan A
better than plan B, we cannot
give you that answer.
We are not certified agents.
That's when we need to refer you
to our friends, the brokers, and
we are becoming very acquainted
with them in and working closer
together in our communities.
The nonprofit organization that
I work for, Partners for
Community Development, is based
out of Sheboygan County.
We've been servicing our state
since 1975.
We have plenty of experience
managing state and federal
funding and programs.
But this program is new to us.
So we are going to be serving
and are serving already the
counties of Ozaukee, Sheboygan,
Manitowoc, Kewaunee, and Door.
To be specific, that's where our
grant was written for.
But the requirements from the
grant and the requirements from
the Affordable Care Act require
us to serve anyone, regardless
of where they are located in the
state of Wisconsin.
Our grant, in specific, is also
to target the Hispanic and Hmong
communities and make the
information that you're
receiving available to them in
either Spanish or Hmong.
Make sure that that information
is relayed to them in a way that
they can understand it and is
culturally acceptable to them.
So I think I'm going to try to
keep it as short as I can.
I'm going to stop because I know
there's a lot of questions out
there.
But that's what navigators are
there to do.
So if you ever approach a
navigator or a certified
application counselor, they are
here to help you navigate the
process, but please keep in
mind, we cannot give you advice
on what type of program or what
type of plan you should choose.
We can give you all the
information you need for you to
make that educated decision, but
we cannot give you advice on
which plan you should choose.
Thank you.
[APPLAUSE]
>> Thank you, Jose.
And one comment, something that
we haven't addressed tonight but
I thought I would just mention
it because I think there are a
couple of us here who might be
on Medicare, and people are a
little confused about Medicare
and some think that they have to
go to healthcare.gov to reapply
for their Medicare or make
another choice, and that is not
the case.
That Marketplace is not for
those of us on Medicare.
And Medicare benefits have
actually been expanded some.
They are now including, with
this new focus on prevention,
prevention benefits at no cost,
no co-pay.
So it's first dollar coverage
for certain prevention benefits.
You also get an annual wellness
exam.
And when you make your
appointment with your physician,
with your medical provider, make
sure that you're saying that the
appointment is for you annual
wellness exam.
Again, that is no cost,
no deductible, no co-pay.
It is free.
And then, thirdly, the doughnut
hole is closing, and that's
going to continue to close over
the next years.
By 2020, it will be all closed.
So there are some new benefits
that are really focused on
wellness and health and the
common sense things that are
costing seniors more money than
sometimes is affordable.
And, secondly, the
healthcare.gov, there's a phone
number to call also that you can
connect with them.
And that's 1-800-318-2596.
So make sure you write that down
if you are going to be calling
or contacting the Marketplace
that that is one of your
options.
There are several options on how
to get into the Marketplace now.
With that, I want to thank all
of our panelists for the
wonderful information.
I'm sure you heads are spinning,
and you have questions in your
minds from different directions
of what was said.
And the microphones are
available, and we have a little
bit of time so we will take your
questions.
Yes, sir.
>> Yes.
Question for Mr. Hanna.
Hi.
Are you related to Tim?
[LAUGHTER]
Okay.
Welcome home.
Wisconsin turned down the
Medicare expansion, and we wound
up, in this budget, paying some
money to the healthcare
community.
It's my understanding that
that's to make up for the harm,
the financial harm that turning
down the expansion was all
about.
Can you, first of all, explain
that, clarify my possible
misunderstanding of the purpose
of this Wisconsin payment, and
then please tell the numbers,
the amount of money that we gave
up and what we're paying.
And finally, part three of this
question, it's my understanding
that if healthcare providers
take patients under Medicare,
there are some financial
restrictions on what they can
charge or how they're
reimbursed.
Do those same restrictions
on reimbursements apply
to what we're, from our
Wisconsin tax dollars,
paying to these physicians?
Start wherever you want.
>> Yeah, okay, let's see if I
can remember all of them.
The first one, I believe, was
about the DISH payment, which is
disproportionate shared hospital
payment.
That is to cover uncompensated
care, but that was a one time
payment in this biannual budget
versus an ongoing amount that
the state would pay to hospitals
to cover uncompensated.
[INAUDIBLE]
I don't have budget numbers.
>> It was $73.5 million to the
hospitals for emergency coverage
of care.
Was there some process in place
by the state of Wisconsin
to determine these people who
are going to go off BadgerCare
that had typically been on
BadgerCare before and getting
into the Marketplace that this
would be something new and
different for them, they were
going to have to be accountable
for monthly insurance premiums,
co-pays, some of them don't
have checking accounts, that
kind of thing, and there was
going to be a period of
transition that might be more
complicated.
And was there some thought to
how some of the difficulties
might be handled smoothly in
Wisconsin?
>> So, unfortunately, I started
in June of this year, which
meant I missed most of the
budget discussion and the
background behind that.
And that was the intention,
that there is going to be some
turnover.
This transition isn't going to
be 100% successful.
It's not going to be perfect,
and there will be some churning
that happens which is why it was
a one time initiative in this
budget for this transition
period.
>> I just bring that up because
I've done a few of these panels
across the state,
and this comes up.
What about these people that
aren't used to this, and this
is kind of a big learning curve.
Does that help address your
question, sir?
Pardon?
>> You have a list on you.
>> If anybody would like to
write down a question and pass
it in, I'd be happy to read it
from here rather than go to the
microphone.
We want to make sure that people
have the questions, too.
You were standing there already,
so I'll take your question
first, and then we'll address
the question that was just
handed to me.
>> Thank you, everyone.
I work for a small nonprofit in
northeast Wisconsin.
We have less than 50 full time
employees.
We're exploring bringing on
interns, and I think if I
understand correctly because we
have less than 50 full time
employees, we would not be
required to offer health
insurance benefits to our
interns as well.
Is that a correct assumption?
>> Right.
You're not obligated to offer
insurance.
You can offer insurance, and as
a nonprofit you would be
eligible for a tax credit.
So you might want to explore the
option.
>> Okay.
Thank you.
>> The question is, how will
healthcare reform treat the
businessman who has zero
modified adjusted income?
And does he qualify for
BadgerCare?
Can anybody?
Bill.
>> If your monthly income is
below 100% of the federal
poverty level, you would be
eligible for BadgerCare Plus.
>> And can you explain that
modified adjusted income
because that's...
Anyone on the panel,
please jump in.
[LAUGHTER]
>> There are...
>> Not the whole text.
>> There are trainings that are
over three hours on the changes
that are happening with how we
calculate eligibility, and I
know there are people in the
room that are far more
knowledgeable on how that works.
But it's really a way of looking
at how we determine what is a
household.
And that is going to be
dependent on tax filing, how you
file you taxes.
And then there are some
exceptions if you don't file
taxes which get even more
complicated.
And then it also changes what
counts as income.
I think in the video example,
one of the big changes is
currently child support counts
as income when determining
eligibility, starting January
1st child support no longer
counts as income.
So there's a laundry list of
things that are changing, and I
can't go over all of them from
the top of my head.
The benefit is that the way the
Marketplace determines
eligibility is the same way that
BadgerCare Plus determines
eligibility.
In fact, the same way all
Medicaid programs in any state,
the eligibility, the process is
the same.
>> Jose, do you have anything to
add to that because I'm certain,
is that what you go over with
people to figure out what their
incomes are and what their
choices might be?
Even though you can't help them
make the choice.
>> Right.
And to add a little bit to what
Bill was saying, I think this is
an important step in the right
direction because having the
same eligibility requirements,
speaking of income, in the
Marketplace and BadgerCare
program is going to make that
transition from one system to
the other.
And, eventually, when this
Marketplace website works
properly, we're going to be able
to enroll everyone through one
website that's going to make the
choice for us on whether I'm
going to have to get insurance
through the Marketplace or go
into the BadgerCare program.
So it's just simplifying things
in the big scheme of things.
>> Does anyone else have
anything to add to any of the
configurations on how to not
make it feel so overwhelming
with the Affordable Care Act?
Are there any other questions?
Yes, sir.
>> A question for Lori.
A nonprofit, small business,
less than 50, would it seem to
be more advantageous to
discontinue offering insurance
because as a nonprofit the only
tax credit we could get would be
off of FICA?
Does it seem advantageous to
both the employee and the
employer to discontinue offering
healthcare, let the employees
pick it up on the Marketplace,
and then pay them whatever a
fair amount would be in order to
at least duplicate their
previous coverage, if not
improve it?
Realizing, of course, there are
also some tax implications on
that extra stipend.
>> Well, first of all,
is this working?
I can't ever tell if it's
working.
So you operate a nonprofit
organization?
>> Yes.
>> You actually would be
eligible for a tax credit if you
buy your health insurance
through SHOP.
You could be eligible for a tax
credit up for 35%.
So, for-profit businesses are
eligible for a tax credit or
could be eligible for a tax
credit up to 50%.
Nonprofits are eligible up to
35%.
So you might want to look at
that.
It's only for plans offered
through SHOP.
As to your individual
circumstances, I really can't
advise you.
>> Sure.
>> It's just one of those
things, you would need to go
online, look at the different
plans, think about your
employees' individual
circumstances, and you just have
to make the decision yourself.
>> If you don't have a tax
liability or very minimal tax
liability, is there any other
opportunity to receive the tax
credit?
It comes off of the tax that you
would pay as a result of your
position, correct?
>> Correct.
But you don't, I'm sorry,
can you, what exactly are you
asking?
>> Is this a deduction off of
the tax that you would pay, or
is this actually a credit which
could actually be a positive
amount beyond what you would
pay?
>> No.
I don't think so, but there
might be someone, I see Mary
Ellen Schill in the back.
Mary Ellen, you could probably
answer that.
>> For a nonprofit, you don't
actually pay federal taxes, so
it's actually a credit that you
get, a rebate so to speak.
>> Okay, did everybody hear
that?
If it's a nonprofit,
it's a credit.
It is not a tax deduction.
And then there are other
benefits by going through the
Marketplace on what's taxable
income or what isn't.
Lori, could you explain the
difference because 2014 is the
first year of SHOP, and it's a
little more limited this year
than what it's going to be in
2015 and on.
Can you explain?
>> As far as the number of
employees?
>> No, the options.
There's not as many companies
that are being offered out there
for small employers.
There's only one insurer,
I think.
>> It depends on where you are.
Various areas of the state have
more options in SHOP.
>> And then the employees can
only pick from that, the
employer picks the one company
for 2014, but beginning in 2015
I think it works like any other
state employees or whatever.
They have several options of
companies to pick from.
>> It might expand.
Yeah.
>> Yeah.
>> Also, the number of employees
you have will go up.
The number of employees that you
can have to be eligible for SHOP
will go up to 100 in 2016,
I believe.
So right now it's 50 or fewer,
but in a couple years it will go
up to 100 or fewer.
>> Kerry, regarding the
employers, does somebody have a
mic for her?
You are not required to pay a
penalty in 2014.
>> That's correct.
>> And how is that working with
large employers?
Are some just not looking at the
Affordable Care Act and taking
any kind of coverage or using
what they had?
Do they still have to provide
the essential benefits in some
of the coverage?
>> There are minimum benefits
that are required by law that
actually have been phasing in
over the last few years, and so
they need to continue to make
sure that their plan is in
compliance by meeting those
requirements.
So, for example, many plans used
to have annual limits on what
the maximum benefit would be
that the plan would pay out.
Those types of benefits have
been falling by the wayside over
the last couple of years.
Plans are required to cover
dependent children up to age 26,
where many used to end
at age 23.
So those are the kind of changes
that large employers have been
making.
And most are continuing, I
think, to offer the same types
of plans that they have in the
past.
We're not seeing many large
employers, in fact, I'm not
aware of any in the area that
have dropped their plans and
gone sort of the cash route
I'll call it.
>> And there's no penalty even
if it isn't?
>> That's correct.
And if somebody did decide to do
that, there isn't a penalty in
2014.
>> Beginning 2015.
>> It was initially, and then it
was delayed one year.
>> One of the other tweaks that
I don't know if it got mentioned
tonight or not, but in the
Marketplace it's open enrollment
until March 31.
But you needed to have,
originally you needed to have
your insurance in place by March
31st, which meant that you
needed to be enrolled by
February 15th because you needed
it by March because April 1st
would have been too late.
Well, now they've changed that,
and you can enroll as late as
March 31st and there is no
individual mandate penalty.
So they have extended the
enrollment.
So that's an important point
too.
That was just changed.
Any other?
Let's see.
Oh, there you are.
Yes.
Please.
>> Carol, you mentioned that
some of these forums that you've
done, the issue of the state
taking the $73 million from the
federal government for aid to
emergency rooms has come up
several times.
>> It wasn't from the federal
government; it was from the
state.
>> Pardon?
>> It's from the state.
The state gave the hospitals
$73.5 million.
>> All right then.
Please educate me.
I'm under the impression,
though, that there was a federal
amount of money that the state
of Wisconsin took, federal funds
not state funds, that are to be
used to supplement the income
that will be lost by an influx
of people coming to the
emergency rooms in the coming
year, particularly those people
who were removed from
BadgerCare.
Am I mistaken?
>> I don't know about the
federal dollars.
I do know that the state
legislature gave to the
hospitals for emergency room
$73.5 million.
>> Yeah, okay.
Do you know where that money
came from?
>> I can offer some comments.
The state of Wisconsin had got
$38 million to set up a state
exchange, a state marketplace,
under Governor Doyle, and
Governor Walker chose to give
that $38 million back because we
didn't set up a state exchange.
We're, instead, using the
federal facilitated Marketplace.
One of the economic impacts of
rejecting the federal funds to
fully expand Medicaid, because
we're partially expanding.
We're expanding for under 100%
of federal poverty for many
people who need health coverage,
but we're asking folks who are
above 100%, some of whom are on
BadgerCare, to move to the
federal exchange.
We're not doing a full Medicaid
expansion.
So some of the economic
consequences of making those
choices is that we miss out on
$940 million in federal funds
for Wisconsin healthcare in 2016
and $4.4 billion in federal
funds over the next decade.
It adds $50 million to Wisconsin
taxpayers in the current
biennium, 2013-2015, and large
employers may end up paying
$20 million to $30 million in
federal tax penalties for about
12,000 uninsured employees
in 2015.
We also won't be creating new
jobs because new federal money
brings in resources for economic
development, not only hospital
systems but the supply chain.
So, one of the reasons this
happened is that under the
Affordable Care Act the federal
funds that would come in to
cover Medicaid beneficiaries
would be at 100%.
The state wouldn't have to pay
any of that for a few years.
>> Right.
>> Whereas, the current
arrangement is a federal/state
match.
About 60% federal money,
40% state.
So by not accepting 100% federal
money to fully expand Medicaid,
we continue that 60/40
arrangement, and that costs the
state a bit more.
Well, quite a bit more.
$50 million more.
>> I just conclude by asking, as
I said, I could stand corrected,
but I feel certain that I read
there was a match for this
$73 million.
I think half of it was federal
money and half of it may have
been state money.
And I'm just saying to a
layperson, it seems like a mixed
message related to anticipating
more people flooding emergency
rooms when really and truly they
were anticipated to have used
the Marketplace.
>> Right.
It's the opposite of what we
were trying to accomplish is
having less people use the
emergency room for healthcare.
It is not the most cost
effective, and it's only
treating the moment.
But I will certainly will double
check all of that, and if you
give me your name and address
and if anybody else wants to
take, Bill, if you want to take
some responsibility to get back
to the gentleman.
[LAUGHTER]
To understand because we need
to have the accurate
information.
That is the most important
thing.
It's not to really promote one
thing versus another, but it's
to have accurate information so
we all know how to move forward.
>> Could I ask a quick question,
Carol?
Can a panelist ask a question?
>> Oh, yes.
>> Just wondering, is there a
deadline?
Is it possible to change our
minds?
Could Wisconsin decide to accept
that money?
>> Yes.
Yes.
>> At some time?
>> Yes.
>> What's the cut-off?
>> We have three years that we
could get 100% of the Medicaid
expansion money beginning
January 1st.
If we change our minds January
1, 2015, we have two years.
>> Okay.
>> If we change our mind in
2016, we have one year.
And then it goes down to 95% and
then, I believe, to 90% and then
it holds.
Am I correct, John?
>> Right.
>> Please correct me if I'm
saying anything incorrect.
But that's my understanding.
Yes.
>> Good evening.
My question is for Mr. Hanna.
I am part of this volunteer
group that is trying to reach
these thousands of people who
have received these
disconcerting letters saying
you're not longer going to be
eligible for BadgerCare.
And I know you talked about the
grassroots effort and what the
state's trying to do, but, quite
honestly, there are going to be
thousands of people who have no
clue what to do.
I am happy to hear that they'll
be getting a copy of the paper
application, but I'm working
with groups here locally in the
Fox Cities to try to see how are
we going to reach people.
Maybe we can have volunteers,
and that seems kind of crazy to
me that the most needy in our
population who probably don't
have a computer at home who look
at this 11-page application
and say, oh, my,
what am I going to do?
There is not enough state effort
being put towards assisting or
making a real concerted effort
to get to these people.
I'm trying in my city of
Kaukauna to do something in our
library, but it shouldn't, quite
honestly, be a grassroots
effort.
It should be a real standardized
effort.
We're working with a local
partnership, but it's going to
be a real hit or miss and there
are going to be, I think,
hundreds and hundreds of people
who don't enroll either because
they have no clue where to go.
Are you going to publicize to
these recipients, other than
healthcare.gov, where locally or
in the state they can go for
help?
Because, to me, this is a
crucial part of this being a
success.
>> So, a couple things.
The reason we went with this
strategy is from passed
experience with Medicare Part D,
spent lots of money but very few
people signed up at the
beginning.
And, in fact, most people found
out about signing up for Part D
not through some big public
service announcement but from
talking to people locally.
Talking to a friend or a
colleague that got it, talking
to their pharmacist that got it.
In addition, there's been some
national research done by Enroll
America that shows that the
effective messaging comes when
somebody receives a message from
somebody they trust.
That could be a doctor, that
could be a colleague, it could
be their income maintenance
agency.
So really, the research shows
that the grassroots effort is
the best way to get the message
out.
>> I don't disagree with that,
but what are we doing to have
people in each larger population
center who have been trained?
Other than being a CAC or
navigator.
I understand that.
But do you understand what I'm
saying?
I agree the trust has to be
there, but how do we ensure that
we're going to reach the
majority of people?
>> So then, again, it's part of
those regional enrollment
networks.
We have a staff person from Area
Administration, one of my staff
person, that's representing the
department in each region.
We have an AmeriCorps member
that's sponsored by the
Wisconsin Primary Healthcare
Association and DHS that's
coordinating the effort in each
region.
We also have a lead agency
that's agreed to kind of
spearhead the effort.
If you're not plugged in to a
regional enrollment network, I
encourage you to get plugged in.
You can find that information on
our website.
>> Right, and I am
to one that we have here.
>> So that is the method we use
to get the information out, and
if regional enrollment networks
need resources, need
information, that's what the
department is here to do, is to
provide them the training, the
resources, the information they
need to help deliver that
message from a trusted source
locally.
>> Okay, thank you.
>> Just to add to that,
certified application counselors
and navigators, part of our job
is to make sure that information
is as available as possible to
all the clients that are going
to be transferring from
BadgerCare into the Marketplace
or people that, for some reason
or another, are losing their
insurance coverage and need to
go into the Marketplace to find
insurance.
We are trying to, and we are
establishing connections in
relationships with the local
libraries, for example.
One of the programs that we are
utilizing extensively is the
libraries tend to have
volunteers that help people, for
example, create email accounts
in order to sign up for health
insurance through the
Marketplace.
That's one of the requirements
in order to be able to go
through the process.
So we are utilizing those
volunteers to help people create
those email accounts.
And, to add to that, we're
helping them to send them our
way, refer them to our CACs and
navigators in order for us to be
able to complete the process.
We're partnering with aging and
disability resource centers,
we are partnering with other
organizations,
nonprofit organizations,
churches that are servicing
and are providing already
services to the population
we're targeting.
So we're just not sitting in our
offices just waiting for
somebody to knock on the door
and ask for help.
We're trying to go out there as
much as possible.
Our organization is specific,
for example, and I know that
many others are doing the same.
We have four full time
navigators that are going to be
traveling around the five county
areas that we are covering.
So they're just not staying in
one location and that's where
everybody has to go.
They are going to be moving
around as the need arises.
>> You have your work cut out
for you, Jose.
>> Yeah.
>> There aren't enough of you.
But it's wonderful that we have
you.
Are there anymore questions?
Yes, we have one here.
>> Mine is kind of an example
here.
So you're in the Marketplace and
you're paying your premium and
there's an unfortunate thing
that happens to your family and
you can't pay that premium that
month.
Is there a penalty?
Is there a place, I see a lot of
nonprofit agencies here, is
there a place you can go to get
help to pay for that premium for
the month?
A grant a nonprofit can write
for anything?
>> Any of the panelists?
I do know that you can apply for
hardship.
And so you won't be penalized
for not paying your premiums,
but I don't know that your
insurance would continue.
And it depends on the local
nonprofits if somebody is
stepping up.
I know The United Way of Dane
County has started a program to
fill in the gap between those
people who are now transitioning
into the Marketplace and are
really not financially able to
do that or don't have the
wherewithal, all of the tools in
place to do that.
And so they are assisting.
So you might begin with
The United Way because they work
with so many agencies.
I would suggest that.
>> I am interning there.
[LAUGHTER]
I am an intern at United Way.
>> Well, okay.
So they get a good plug.
>> I have something to add
to that.
>> Yes.
>> I'm the regional enrollment
network coordinator for
east-central, and I am stationed
with Partnership Community
Health Center.
This is something that our
steering committee
is working on.
We're trying to develop or we
find, throughout the community,
resources for people if they're
unable to pay their monthly
premium.
We're looking at educational
programs to be able to help
people understand who've never
had to budget for something like
this.
Educate them as to how to do
that.
And as well as after purchasing
this new item, how to use it and
to utilize it.
So there are things happening.
Not everybody sees them, but
there are things going on behind
the curtain, I guess, where
we're trying to figure things
out like that.
>> There's a continuing need for
lots of communication and
getting the word out.
Anything else?
>> Just one more quick thing to
add to that.
>> Yes.
Any of the panelists, any final
comment you have.
>> Just in regards to this
topic, it's very important that
when people are shopping for an
insurance policy, they look at
their agreement on what's the
period that one has if they're
delayed on payment.
There's a grace period.
Now, there may be the case that
the insurance plan that you
choose may not pay for services
received while there wasn't a
payment on that insurance plan
for that specific month.
But the insurance will give you
a grace period, and it will vary
depending on the insurance plan
you choose.
A grace period of how many days
you can be late on your payment
a month.
>> Any final comment, brief from
any of the panelists?
Kerry.
>> I would just add that I've
watched people go through the
open enrollment process in our
business, and I don't think
they're unusual from sort of the
general population.
A lot of people have a tendency
to procrastinate on making these
kinds of decisions because
they're hard, and I would
encourage you not to
procrastinate and to get that
word out to people too because
there's two things that are
going to happen.
One, the agents that are out
there that are there to answer
your questions only have so many
hours in a day, and I was
talking to someone earlier
tonight who said I get 20
messages and I can't get through
answering those calls to
everybody and I go home at night
and when I come in in the
morning I've got 25 more
voicemails waiting for me to
answer.
And by the time he gets into the
list a little way, there's
another 20 messages waiting for
him to answer.
So, as we get closer to December
15th, that's not going to get
any better; it's only going to
get worse.
So don't procrastinate.
And I'm not sure what's going to
happen when all those paper
enrollment forms start flooding
in because I don't know what
sort of infrastructure has been
built behind the scenes, but
expect a long lag time, I would
think, on hearing back in terms
of whether that has been
processed.
It's just the reality of getting
slammed, really, is what's
happening in a very short period
of time.
>> Excuse me, Carol.
>> Yes.
>> I also want to mention that
one of the things that we're a
little concerned about as well
is come January 1st, when you
have consumers going in to pick
up their prescriptions and
finding out they are not insured
because they did not move
forward with this process to
become insured.
So there's this big issue with
what's going to happen and how
are they going to pay for their
meds.
>> Well, we need a lot of help
from everybody.
From all of us through word of
mouth, with the nonprofit and
business organizations, and from
our state government.
We need a lot of help in
communicating the word and
helping people move through the
process.
You need to be enrolled by
December 15th in order for the
insurance to be in place by
January 1st.
And one final thought as we're
talking insurance and the cost
and everybody is worried about
cost.
There are big changes that are
going to be happening.
One of them you may notice as
you go to your health providers
now and into the future, they're
going to be talking a lot about
prevention.
They're going to be looking at
those issues that are going on
in your daily life that are
hampering your wellness and your
health.
And we are going to be as much
or a bigger part of the solution
than we ever had been before.
The only way healthcare costs
can really go down is if all of
us get a little healthier.
Now, the system is looking at
that and they're going from a
system of pay for procedure to
pay for value or outcome.
And hospitals and medical
providers are going to get
rewarded if you stay well and
you don't reenter the hospital
and you don't need to have a
whole lot of unnecessary tests.
They're actually, this is being
designed so they will be paid
more.
So it behooves all of us to
follow the rules.
Listen to our doctor and eat
that apple a day.
I thank you so much for coming.
You've been a most attentive
audience.
It's a lot to take in, and
please, if you have anymore
questions, come forward, and
anybody who would like a real
clear answer on anything that
was said that they question,
we'll get the accurate answer
for you.
And I also have cards, and I'll
run them out to the lobby as
you're leaving,
that have healthcare.gov
and the phone number on it.
1-800-318-2596.
Maybe still working a little
sluggishly, but it is beginning
to work.
So you might have some success.
If you're going on BadgerCare,
I think that you might go
through healthcare.gov.
If you apply for BadgerCare and
you're not eligible, it will not
send you to the Marketplace, but
the Marketplace will send you to
BadgerCare.
So that's another important
point.
>> Can I just add one thing to
that?
>> Yes.
>> Because everybody knows some
of the issues with
healthcare.gov, starting
November 18th if somebody
believes they would be eligible
for BadgerCare Plus, we
encourage them to apply directly
to the state.
>> Excellent.
>> The state website via Access
so that we know we'll get it,
and we will process it once
somebody submits an application.
So rather than go through the
Marketplace and wait for the
delay, starting November 18th
childless adults that would be
eligible can apply via Access
directly to the state.
>> Excellent.
And then if they aren't
eligible, will you send them
to the Marketplace?
>> Eventually.
>> Eventually.
>> Again, it's part of the
system.
>> Change is, when you think of
anything in your life that's
new, this first year is going to
be a real learning year and the
building of experience.
So have patience and tune in
and go to healthcare.gov
and spread the word.
And if you've got young sons,
daughters, grandchildren, young
professionals, encourage them
because we need those young
invincibles to get on board for
the benefit of all of us.
Thank you so much.
And thank you to the Wisconsin
Institute of Public Policy and
Service for presenting this
forum this evening.