The Wisconsin Legislative Council has released an Information Memorandum describing relevant major provisions of the Patient Protection and Affordable Care Act (PPACA) and discussing the Supreme Court’s decision and its implications for Wisconsin.
Excerpted below is the Council’s discussion of implications for Wisconsin.
HEALTH INSURANCE EXCHANGE
As a result of the Court’s holding that the individual mandate is constitutional, most Americans will be required to have health insurance in place by January 1, 2014. Those without insurance from another source, such as through their employer or a public program, will be required to purchase insurance through a health insurance exchange or pay the shared responsibility payment.
The federal HHS has established a deadline of November 16, 2012, for states to submit their proposals to operate their own exchanges, so that HHS is able to meet the exchange certification deadline of January 1, 2013. Wisconsin has conducted preliminary exchange planning activities under both Governor Doyle and Governor Walker. However, these activities were halted in December 2011 pending the outcome of the U. S. Supreme Court case. Now that the case has been decided, the state will determine whether to implement its own health insurance exchange, alone or in a consortium with other states; allow the federal government to operate the exchange for Wisconsin; or enter into a hybrid arrangement with the federal government.
As a result of the Court’s holding on the Medicaid expansion, the new eligibility floor of 138% FPL created under the Medicaid expansion may be regarded as optional for the states. Prior to the next budget cycle, Wisconsin must decide whether to implement changes in its Medicaid program, which may allow it to qualify for new expansion funds.
Some questions that may impact Wisconsin’s options with respect to Medicaid expansion were not expressly addressed by the Supreme Court’s opinion, such as whether a partial expansion will be allowed, and what other Medicaid- or CHIP-related provisions, if any, may be regarded as optional for the state because they are included within the Medicaid expansion.
The Secretary of HHS is expected to provide guidance regarding HHS’s view of the scope of the Medicaid expansion. However, it will ultimately be up to each state to determine how to proceed.