WHO IS COVERED?

All residents and workers in Wisconsin are covered by Healthy Wisconsin, unless they receive health care through Medicare, Medicaid, BadgerCare, or a federal employee health insurance Plan.

Adults who move into Wisconsin but who are not employed must satisfy a twelve month residency requirement.  There is no residency requirement for pregnant women or children.

WHAT BENEFITS ARE PROVIDED?

Healthy Wisconsin benefits are based on the comprehensive State Employee Uniform Benefits Plan, to which has been added mental health parity and preventive dental care for children.  This benefits plan basically covers all medically necessary care plus prescription drugs, as well as preventive care, wellness programs, alcohol and chemical dependency programs, mental health parity, etc.

WHAT IS THE HEALTH CARE DELIVERY SYSTEM?  CAN I CHOOSE MY OWN DOCTOR?

There will be a state-wide fee-for-service plan that anyone can choose.  If there are no other options in a given area, there will be no additional charge for this plan.

“Health Care Networks” will submit per-person bids to the Healthy Wisconsin Board of Trustees. 

A “Health Care Network” is defined as “a provider-driven, coordinated group of health care providers comprised of primary care physicians, medical specialists, physician assistants, nurses, clinics, one or more hospitals, and other health care providers and facilities, including providers and facilities that specialize in mental health services and alcohol or other drug abuse treatment.”  (Examples would be Marshfield Clinic in the northern part of the state, Dean Care in Madison, Group Health in Eau Claire or Columbia-St. Mary’s in Milwaukee.)

On the basis of their bids, these Networks will be divided into categories:  those that are lower cost and higher quality and those that are higher cost and lower quality.  There is no additional cost if a person chooses the lower cost network option.  If they choose the higher cost network, they must pay, on a monthly basis, part or all of the difference in cost between the plans.

Both in the fee-for-service plan and the Network options, everyone must choose a primary care provider (physician, nurse practitioner, physician’s assistant, etc.) who is responsible for coordinating health care for you or your family.

HOW IS HEALTHY WISCONSIN FINANCED?

All employers must pay 9-12 % of wages of their employees (up to the limit of taxable Social Security wages, which is currently $102,000).  Employees must pay 2-4% of their Social Security wages.  An actuarial analysis estimates that the actual figure in 2007 would have been 10.5% for employers and 4% for employees (4% maximum of $102,000 per family).  For small firms of ten employees or less, the employer share will be phased in over three years. THESE PAYMENTS REPLACE THE PREMIUMS AND OTHER PAYMENTS FOR PRIVATE HEALTH INSURANCE NOW BEING PAID BY EMPLOYERS AND WISCONSIN RESIDENTS. 

The average family income in Wisconsin is about $42,000.  So for the average family, the cost would be $140 per month in payroll deductions.  On average, the employer would pay about $370 per month.

Unions may bargain, or employers may offer, to pay any part of the employee’s charges, as well as provide additional benefits (including vision, dental, etc.).

Self-employed persons and those with income but no wages pay 10% of income up to the Social Security wage limit. 

WHAT ARE THE DEDUCTIBLES AND CO-PAYS?

There is a yearly deductible of $300 per adult (none for children).

There is a $20 co-pay for office visits and hospital admission, except that there are no co-pays for preventive care, children, or for office visits for those participating in a chronic disease management program.  Prescription drug co-pays are $5 generic, $15 brand name, and $40 for non-formulary drugs.

Out-of-pocket expenses are capped at $2000 per adult or $3000 per family.

HOW IS HEALTHY WISCONSIN GOVERNED?

A Board of Trustees is nominated by the Governor and confirmed by the Senate.  Four members shall be selected from a list of names submitted by statewide labor coalitions (of which one must be a public employee); four members shall be selected from a list of names submitted by statewide business organizations (one of which must be a public employer); one member from a list submitted by statewide school teacher labor organizations; and two members who are farmers, selected from a list of names submitted by statewide farm organizations.

Governance of Healthy Wisconsin shall be vested in the Board of Trustees, which shall provide health care benefits within the parameters sketched above.  It is responsible for the financial health of the system, and may adjust the payroll deductions within the ranges noted above to assure that adequate revenues are available to finance the benefits specified.  Legislative approval is necessary for changes beyond these limits. 

There will also be an Advisory Committee to the Board, which shall be comprised of experts from all aspects of the health care community.

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Healthy Wisconsin Reduces Health Care Costs:  Right now we pay too much for too little health care. Wisconsin has among the highest health care costs in the country.  Billions are wasted in private bureaucracy and in insurance company and hospital administrative costs. Insurance companies profit by covering healthy people and avoiding covering the sick. This shifts costs onto everyone else when people who have been denied routine care must go to the emergency room, and can’t pay their bills.  By using the buying power of the people of Wisconsin to negotiate drug prices, streamlining administration, discouraging inappropriate emergency room visits, and encouraging healthy lifestyles and preventive care, Healthy Wisconsin will save an estimated $1.3 billion per year.

Healthy Wisconsin Avoids a $13.8 billion tax on doing nothing: Over the next 10 years, if Wisconsin does nothing to change the way we pay for it, it is estimated that health care costs will be $13.8 billion higher than they will be under Healthy Wisconsin.  That’s over $13.8 billion that can be pumped back into the economy of the state, rather than the coffers of large insurance companies.

Healthy Wisconsin Reduces the Cost of Government in Wisconsin: Wisconsin state and local governments are being hit hard by skyrocketing health care costs.  Under Healthy Wisconsin, it is estimated that state and local government will save $1.3 billion.

Healthy Wisconsin will Spur Job Creation: Right now Wisconsin’s high health care costs deter job creation.  When companies consider adding jobs in Wisconsin, they see the high cost of health insurance as a tax on every new job they create.  Healthy Wisconsin will give Wisconsin a competitive advantage by guaranteeing lower than average health insurance costs to every business in the state.

Read the actual text of the Healthy Wisconsin legislation (SB 562 )