Healthy Wisconsin Council Reinsurance Institute Presentation July 19, 2007 Jim Johnston, DOA Milda Aksamitauskas, DHFS

The Changing Wisconsin Health Care Market Office of Commissioner of Insurance; Department of Health and Family Services * Estimated figure for Self-Funded Population. As of 2004, the publicly insured now exceed the commercially insured.  32%  21%  37%  32%

Wisconsin’s Medicaid Program

Wisconsin’s Uninsured  Wisconsin has 5.3 million residents  276,000 were uninsured for the whole year (5%)  38,000 children were uninsured for the whole year (3%) and 110,000 children were uninsured for at least a portion of the year (9%)  Source: Wisconsin Health Insurance Coverage, 2005 (annual report)

Wisconsin’s Uninsured All uninsured children Uninsured adults up to 200% of FPL

January 2006 Governor Calls for Reform July 2006 Governor Issues Executive Order  Create Healthy Wisconsin Council  Reduce the number of uninsured  Reduce health care premiums  Improve the individual and small group market  Increase the number of businesses that offer comprehensive, affordable insurance

Council Membership  Anthem Blue Cross/Blue Shield  United HealthCare of Wisconsin  WPS Insurance  WEA Trust  Wis. Federation of Coops  Humana  2 State Senators  1 State Representative  Wis. Independent Businesses  Wis. AFL-CIO  2 Doctors  1 Hospital Administrator  5 Business Representatives

Healthy Wisconsin Council Agenda  Define target population  Mapping the structure of reinsurance  Funding options  Participation in the program

Options Considered  Primary insurance product for small group market with Reinsurance  Reinsurance product for small group market  Statewide catastrophic Reinsurance pool  Medicaid expansion for low-income, uninsured adults

Council’s Recommendations  Medicaid expansion to childless adults  Reinsurance Authority  Reinsurance Product  Subsidy (cigarette tax)

Council’s Recommendations – cont.

Lessons Learned Large subsidies needed to make a substantial impact on health insurance premiums

Lessons Learned cont.  Challenge between helping uninsured and businesses that already provide insurance  Actuarial analysis vital to finalizing recommendations  The Council failed to reach a unanimous consensus on all recommendations

Governor's Seven Point Strategy to Achieve Health Care Goals 1) Universal Access – BadgerCare Plus Expansion 2) Lower Premiums Tax Deduction 3) Decrease Smoking Increase Tobacco Tax 4) MA Provider Rate Increase 5) Reduce Health Care Costs –Establish Healthy Wisconsin Authority 6) Strengthen Co-op Care 7) Improve Quality and Reduce Medical Errors by promoting e-Health Initiatives

98% Access to Health Care

Future Directions  Governor’s budget request includes Healthy Wisconsin Authority  Senate budget plan retains Authority concept, but broadens mission to implementing a universal insurance plan  Assembly budget plan deletes Healthy Wisconsin and instead emphasizes personal responsibility and HSAs

Additional Information Healthy Wisconsin Council website: