While there are significant differences in how the Affordable Care Act (ACA; also known as "Obamacare") is playing out in Minnesota and Wisconsin, on both sides of the river kinks are still being worked out in the electronic and face-to-face networks intended to connect people and new insurance exchanges.
Minnesota is one of the 16 states in the Union operating a state-run health insurance exchange: MNsure. Wisconsin turned down federal Medicaid/BadgerCare funding tied to the ACA and declined to set up a state-run exchange. Consequently, the federal government is running a new health insurance exchange for Wisconsinites and residents of 34 other states: HealthCare.gov.
MNsure.com, HealthCare.gov, and their respective hotlines were overwhelmed by an initial rush of visitors and callers when they opened on October 1. Wait times have since improved, but would-be shoppers may still find it hard to find impartial, face-to-face assistance.
On both sides of the Mississippi, public and private sector professionals are serving as the ACA's boots on the ground by providing face-to-face help. There are three kinds of "assisters:"
- Certified application counselors are employees of medical institutions, non-profits, and other groups who help people fill out their applications.
- Certified navigators teach people about the exchanges and are paid per enrollment with federal funds.
- Certified agents/brokers, unlike other assisters, are allowed to advise buyers on selecting plans and receive compensation from insurance companies.
Assisters who are not being paid by insurance companies are scarce in Winona, Buffalo, and Trempealeau counties. There are no navigators and no application counselors based in Winona County or any of the surrounding counties, including Olmsted, according to MNsure listings as of last Friday. There are no application counselors in either Buffalo or Trempealeau counties, and one navigator serving Buffalo County, according to county staff and local listings. There are nine certified agents/brokers in Winona County and 22 in Trempealeau and Buffalo counties, according to listings.
"We're really interested in getting a certified application counselor in Buffalo County to help our residents," said County Health Officer Jennifer Rombalski. "But we are not sure exactly when that will occur." Until then, Buffalo County is directing questions to HealthCare.gov and its hotline, and the Western Region for Economic Assistance, a consortium of local counties that have combined their welfare programs. Western Region for Economic Assistance, based in La Crosse, is the local agency primarily responsible for shepherding Wisconsinites through the health insurance exchange while counties are taking limited responsibility, county officials said. Trempealeau County's role, Health Department Director Sherry Rhoda explained, is to direct people to the federal website or Western Region for Economic Assistance. There just are not enough county staff members for them to serve as application counselors, she added.
Exchange organizers have cautioned the public to check official listings of certified assisters to avoid fraud. Navigators, counselors, and agents must all be authorized by the state or federal government. Applicants should be careful not to seek help from impostors and should be careful not to share sensitive information with assisters not authorized to handle it. Official assister listings for Buffalo and Trempealeau counties can be found by visiting www.lacrossecounty.org/humanservices/aca/#assistance. Official assister listing for Minnesota can be found at www.mnsure.com.
Organizers encourage those without computers to access exchange websites at local libraries. For Winona County residents, computer kiosks are available at the Winona County Office Building, 202 West Third Street, Winona.
Minnesota small businesses using MNsure can provide coverage to Wisconsinite workers, but employees should make sure that hospitals near their home are included in network coverage, MNsure officials advised. Wisconsin officials could not be reached to confirm how out-of-state employee coverage works through HealthCare.gov before the Winona Post went to press.
In both Minnesota and Wisconsin, government-run health insurance exchanges give individuals, families, and small businesses the option to shop for, compare, and purchase private health insurance plans with standardized levels of coverage. The exchanges will also automatically check eligibility for and apply for Medicaid, insurance subsidies, and other government aids. Anyone can still purchase health insurance from the exchanges, directly from companies, through brokers, or through employers. Starting March 31, 2014, anyone without health insurance will face fines.
The ACA in Wisconsin
- Federally-run www.healthcare.gov (1-800-318-2596)
- Western Region for Economic Assistance organizing local assistance (1-888-627-0430)
- Counties do not provide computer access or paper applications
The ACA in Minnesota
- State-run www.mnsure.com (1-855-366-7873)
- State organizes local assistance
- MNsure computer kiosks; paper applications at Winona County Office Building
BadgerCare cuts, expansions
Wisconsin Medicaid coverage, or BadgerCare, is undergoing a significant change. After Governor Scott Walker turned down federal funding for Medicaid expansions tied to the ACA — part of the expansion's cost would have been transferred to the state over time — BadgerCare is being cut in some areas and expanded in others. Parents and childless adults between 100 and 200 percent of the Federal Poverty Level ($11,500 - $22,980 per year for one; $23,550 - $47,100 per year for a family of four) will lose BadgerCare coverage and will be required to purchase health insurance on their own. Pregnant women and children between 200 and 300 percent of the poverty line, who had been receiving partial benefits, will now receive full benefits.
The waiting list for adults who do qualify for the new BadgerCare rules will be eliminated, according to state officials. State budgets project that the waiting list elimination will actually increase the number of total BadgerCare recipients, despite the cuts.
BadgerCare recipients subject to the changes should expect to receive letters from the state announcing the change by the end of next month. Buffalo and Trempealeau county residents with questions should contact the Western Region for Economic Assistance at 1-888-627-0430.