1 Amp Up the Public Voice: The Importance and Limitations of Public Health Insurance in Wisconsin University of Wisconsin-Madison School of Medicine and Public Health May 11, 2012 Katy Lois Brynne McBride Ana Martinez-Donate Lori DiPrete Brown Barb Duerst
2 Overview I. Introduction and Background II. Methods III. Findings IV. Discussion V. Conclusion
3 I. Introduction and Background: The Need for Health Coverage National estimate (conservative, 2009) for cost of inadequate coverage: $138 BILLION every year!
4 I. Introduction and Background: Public Programs Do Not Match Need Of those who manage to enroll, approximately 24-40% will lose their coverage after one year
5 I. Introduction and Background: Insufficient Public Input Encourages Public Program Mismatch Despite strong evidence of structural barriers inhibiting needed coverage Only 7 Medicaid-related public hearings were held in 2011 in Wisconsin Only 2 of those 7 were conducted outside of business hours, neither were held in a rural area, yet nearly 2/3 of all program enrollees work How can these PUBLIC programs match the PUBLIC need without a sufficient PUBLIC voice?
6 We Have a Public Health Problem on our Hands
7 II. Project Methods: Public Voice Amp Up Step 1: Conduct review of public health coverage programs available to Wisconsin residents Step 2: Expand testimony collection 7 Wisconsin sites, from March to September 2011, Option to submit in written and video format, in English and in Spanish Step 3: Categorize general demographic of individuals providing testimony Step 4: Analyze testimony for re-occurring and interconnected themes considering 6 broad coding domains
8 III. Principal Findings: Overarching Themes Emerging from Testimony Policy-related or bureaucratic limitations The current centralized Food Share & Badger Care Core, Badger Care Basic for consumers without dependents has been frustrating for people. Having to apply either a) on the website - having difficulties if something is incorrectly put in - being unable to go back & fix it. b) over the phone where I've heard people are on hold for 45 minutes or longer. When Badger Care Core was started there was such a demand they couldn't keep up & I believe some county employees were contracted to help with the processing. You don't know who your worker is. You have to send verification to them by mail or fax. Let alone the bulk of mail to a centralized place & lost or misplaced mail, and it not being processed timely - affecting benefits. The centralized location now can't keep up and process timely - going beyond the timeframe required by the county. -Public Voice #82
9 III. Principal Findings: Overarching Themes Emerging from Testimony Culturallinguistic limitations We don t know much about BadgerCare. I hear the words but nobody really seems to know much. People know the name but nobody I know truly has it because it is very complicated and nobody is sure if they can get it and how to use it. -Public Voice #108
10 III. Principal Findings: Overarching Themes Emerging from Testimony Financial limitations
11 III. Principal Findings: Overarching Themes Emerging from Testimony Disease- or conditionspecific limitations
12 III. Principal Findings: Overarching Themes Emerging from Testimony Perceived importance or benefits of program People forget that BadgerCare, among other things, is a lifeline for family farmers, and I grew up on a dairy farm, and farming is a dangerous occupation, and all the money in the world doesn't buy a farmer health insurance because the private health insurers look at your occupation and they say, You're too high of a risk. BadgerCare is a lifeline for those family farmers. -Public Voice #29
13 IV: Discussion: Four Recommendations Based on Findings Recommendation One Recommendation Two Recommendation Three Recommendation Four Methods of applying for programs must align with the population in need of such programs Outreach surrounding public health insurance programs must increase Rules and procedures for program participation must be streamlined and clarified for enrollees of public coverage programs Legislative oversight must be incorporated back into the regulation of public health insurance programs
14 V: Conclusion: 4 Things to Remember Today Health Coverage = Needed Public health coverage programs are imperfectly aligned with the in-need population The public voice surrounding public health coverage is currently muted Amping up this voice will increase the likelihood that coverage programs align with the public need Amping up the public voice surrounding health coverage is conducive to increasing well-being in Wisconsin
15 Thank you for your time and attention. Any Questions? Acknowledgments: Most notably, thank you to the individuals providing testimony and contributing to the public voice. Their expertise was crucial to the realization of this project. Special thanks to the members of my capstone committee, Brynne McBride, Ana Martinez-Donate, Lori DiPrete Brown, and Barb Duerst, for their ongoing guidance with this project. Also, thanks to ABC for Health, Inc. and the University of Wisconsin-School of Medicine and Public Health for their project support. Background references and project details available upon request