Frederica Freyberg:

The future of the Affordable Care Act in Wisconsin is once again uncertain, and residents are caught in a health care tug-of-war. At issue, in some states including Wisconsin, the governor opted not to set up a state-run exchange. Wisconsin instead opted to join the federal exchange, but the ACA specifically states subsidies are only for those enrolled in a state exchange. On Tuesday, two federal appeals courts issued conflicting rulings, with one agreeing that the subsidies were illegal for health care participants in states like Wisconsin. This week, the Walker administration issued this response, saying, The two conflicting rulings only further highlight the irresponsibility of passing a law before knowing what is in it. This illustrates the ongoing issues states face due to the federal government’s inept implementation of their own flawed law. What does all this mean for Wisconsin residents who joined the Affordable Care Act federal exchange? This week I talked with Bobby Peterson, executive director of ABC for Health, a Wisconsin based non-profit law firm specializing in health care, to get some answers on the conflicting court rulings.

Bobby Peterson:

Well, it will probably be reviewed by the US Supreme Court. And it’s likely that that could happen, since the Virginia 4th Circuit upheld the subsidies and say they were okay. So it’s one of those issues that it looks like it could be headed to the Supreme Court.

Frederica Freyberg:

And so what does that mean for people who are currently getting those subsidies as part of their plans?

Bobby Peterson:

Right, I would encourage people not to worry about it right now. It's not something to be totally unconcerned about looking forward. It could happen, the likelihood is somewhat slim. But most people are going to keep their subsidies for the near future.

Frederica Freyberg:

Have you gotten any calls from people?

Bobby Peterson:

Yes, we have, yeah. And we’ve tried to just reassure people that the subsidies aren't going to be taken away immediately. This has to work its way through the courts, it’s a slow process. But it’s something to keep an eye on.

Frederica Freyberg:

Governor Walker’s office calls this DC ruling as an example of how irresponsible it was to pass a law without knowing what was in it. On the other hand, as you know, Wisconsin counted on ACA plans and these subsidies for people newly ineligible for BadgerCare.

Bobby Peterson:

Yeah, I think it's– You know, there’s a lot of blame to go around here. Governor Walker executed a plan that was poorly thought out in my mind. He could have accepted the Medicaid expansion funds that would have been 100% federally funded. He relied on what he's calling a law that they didn’t know what’s in it to subsidize all the parents that were terminated from BadgerCare and moving to the marketplace. So I’m not sure I agree with that statement. A lot of blame to go around. But the end of it is that Wisconsin could be in a better position than they are right now. But Governor Walker bears significant responsibility for that.

Frederica Freyberg:

What about the idea of at this point Wisconsin setting up its own exchange? Very likely at all?

Bobby Peterson:

Not likely, because I think, you know, Governor Walker is going to be stubborn on that issue. He doesn’t want to support the ACA. You see from his public comments, he’s already criticizing congress for passing a law that they didn’t know what was in it. But it would be a solution. If Wisconsin set up its own exchange, which many people advocated for, including the business community, policy analysts, a lot of folks said Wisconsin should do their own. That would be a step in the right direction because then Wisconsin folks would be eligible for those subsidies.

Frederica Freyberg:

How far behind, though, would we be in setting up our own exchange?

Bobby Peterson:

Well, you know, I think we’ve got a lot of talented, creative people in this state. We were really way ahead of the curve. Back in 2010 we had a model set up. We’ve learned a lot from what has happened in other states. The technology platforms are out there. I think we could do it.

Frederica Freyberg:

Speaking of those who were moved off BadgerCare because of income ineligibility, recent analysis from the state showed that fewer than a third of them signed on for health care through the exchange. Has your office learned anything about how many of those people are actually uninsured?

Bobby Peterson:

Well, we know that many of them are uninsured because it’s just– The eligibility process is like a corn maze. I mean, it’s very challenging and difficult. So we’re not surprised at all that a lot of folks did fall off the program. They’re looking, they’re trying to identify coverage, but sometimes the immediate concerns are food, housing, you know. The kids are covered under BadgerCare so the parents might go without for a while. One of the other critical elements that could rectify this situation would have been Governor Walker's acceptance of the Medicaid expansion funds, because a lot of those folks between 100% and 130% of the federal poverty limit, lower-income folks, would qualify for BadgerCare. It would take the pressure off a lot of those lower-income folks losing their subsidies under the marketplace.

Frederica Freyberg:

But we’ve talked about this and talked about this, and again that’s not a likely scenario because of Governor Walker’s displeasure with the idea of taking federal funds which he worries might dry up.

Bobby Peterson:

But he’s taking federal funds for the expansion that he had for people below 100% of the federal poverty limit. Those are federal funds, he took them. It’s part of his plan. Wisconsin takes $12.5 billion, the legislative audit bureau report from the last biennium. We take a lot of federal funds. For Governor Walker to cherry pick certain federal funds, it exposes the political nature of the decision, and it’s not really good public policy.