September / October 2011
What Does Health Reform Mean for Wisconsin? Depends Who You Ask
It’s hard to tell what we learned more from – a report by Gorman Actuarial on the Impact of the Affordable Care Act (ACA) on Wisconsin’s Health Insurance Market, or the spin around the release of the report. Last year, the Wisconsin Department of Health Services (DHS) contracted with Gorman Actuarial and Dr. Jonathan Gruber, a renowned health care economist at MIT, to assess the impact of the Act on Wisconsin insurance markets. Three reports on the existing individual, small, and large group markets in Wisconsin were released earlier in the year. However, only recently, at the end of August, did the Office of Free Market Health Care release the second piece of the contract work, an analysis and report on rating, premium, and economic impacts of the ACA in Wisconsin.
The report contains insights and analysis that will help Wisconsin to better implement the ACA. However, the invitation-only press briefing and press release from the Office of Free Market Health Care focused only on pieces of the analysis and findings, barely mentioning certain statistics related to the number of people in Wisconsin expected to gain insurance coverage because of the ACA. Word of this emphasis and spin was made known by Robert Kraig, executive director of Citizen Action of Wisconsin. As an astute organizer and activist, Kraig attended the DHS press briefing, only to be asked to leave. Citizen Action’s press release on the report sheds light on the extent to which the Administration slanted the findings.
The presentation given by DHS to the press, and later released publicly, focused on disruptions to the Wisconsin markets and new mandates in the ACA. The release highlighted premium increases in the individual and small group market prior to the application of tax credits, without mentioning incoming federal subsidies totaling $729 million, or that 41% of Wisconsinites in the individual market will receive large premium reductions averaging 56%. It also frames the fact that 40% of Wisconsinites will have richer benefit packages as an unwelcome regulation, whereas a recent Commonwealth Fund analysis showed that nationally the number of underinsured adults rose 80% between 2003 and 2010, and that the ACA could reduce the number of underinsured Americans by 70%. Underinsured Wisconsinites with inadequate coverage are exposed to unaffordable medical costs. Arguably, the most important finding of the report--that 340,000 uninsured Wisconsinites will gain coverage because of the ACA--was not mentioned at all in the DHS press release, and it was not mentioned until the last page of the presentation given at the closed media briefing.
Citizen Action’s countering of the DHS spin led many to look further into this report. Shawn Doherty of the Capital Times wrote an in-depth article on the spin, contacting the author himself, Dr. Gruber, for his thoughts on the report and the way in which it was presented by DHS. Gruber disputed the conclusion DHS shared in their release regarding “major concerns that are demonstrated by the results of this study.” Gruber actually came to a general conclusion that “overall I think health care reform is a great thing for Wisconsin.” “Here’s my counterspin,” Gruber was quoted as saying. “It’s not that people have to pay more. It’s that people have artificially been paying too little.” To end these “discriminatory practices where young and healthy people get a good deal and old and sick people get a bad deal…what that means in the state of Wisconsin, which has a wild west market, is that young, healthy guys are going to get a hit.”
DHS Secretary Dennis Smith responded in an op-ed that appeared in the Wausau Daily Herald. He continued to focus on the premium increases and disruptions to those with coverage, closing his piece with, “the implementation of PPACA will bring both opportunities and threats. If you work for a large company that provides health insurance coverage, the impact of PPACA should be modest. But it will be a wild ride for everyone else.”
Clearly the release of a report by an MIT economist on the impact of the ACA in Wisconsin demonstrated much more than the content of the report itself. The widely disparate views on the ACA held by DHS, advocates, and outside experts were on display, as they will continue to be during implementation of the Act. The federal government gives states a lot of discretion regarding implementation of the ACA, recognizing that different states have different insurance markets, regulations, and climates in which to adapt the law. However, it is important that health care consumers—and not just insurance companies—have a real voice in the dialogue.