Healthy Wisconsin

Healthy Wisconsin

Your Choice. Your Plan.

How does the plan help Wisconsin businesses and families?

• Cost stability and predictability helps businesses with financial planning – no more double-digit premium increases.
• No hassling with insurance companies.
• Less employee turnover.
• Healthier employees are more productive and have fewer sick days.
• Levels the playing field among businesses in Wisconsin.
• Money businesses save on health care can be used to increase salaries and create more jobs.
• The benefits are the same benefits that legislators have, with added mental health parity and preventive dental for children.
• Lowers state and local property taxes by $1 billion and provides for property tax relief for homeowners and businesses.

Plan Overview

• Reins in costs through streamlined administration and delivering the right kind of care at the right time in the right setting.
• Focuses on preventive care and chronic disease care.
• Requires everyone to pay their fair share.
• Levels the playing field among competing businesses.
• Restores the doctor-patient relationship.

How It Works

All Wisconsin residents and employees under age 65 are covered.

Participants choose their own doctor, and their own network.

Employees pay 4 percent of Social Security wages through a payroll deduction. An employee earning the average Wisconsin salary will pay $140 monthly.

Businesses will pay approximately 10.5 percent of Social Security wages per employee, or $370 monthly for the average salary.

There is a $300 per person deductible and a $600 family deductible.

Co-pays
$20 co-pay per non-preventive doctor’s visit.
$20 co-pay per emergency room visit.
$60 co-pay if the emergency room visit is deemed inappropriate.

Unions can bargain or employers can pay for benefits not covered by the plan, including dental, vision, or long-term care, as well as any employee charges, including the 4% employee share.

Prescription Drugs
Pharmacy Benefits Manager will be used.
Co-pays: $5 generic drugs, $15 brand name formulary drugs, $40 brand name non-formulary drugs.

There is no cost sharing for preventive care (e.g, annual physicals).

There is no cost sharing for chronic disease management, as long as you are following a plan designed by you and your physician.

There is no cost sharing for children under the age of 18.

A fee-for-service option is available statewide.

This is a public-private partnership.

Skyrocketing Costs

Health care costs in Wisconsin are rising at an unsustainable rate making the need for comprehensive reform urgent. Rising costs are seriously threatening the ability of our businesses to globally compete, farms to thrive, government to provide needed services, schools to educate and local citizens to form new and successful business ventures.

• Total health care spending in Wisconsin this year is projected to be $42.3 billion and in the next decade with rise to $76.9 billion – a jump of 82 percent.
• The cost of employer-provided health care in Wisconsin soared by 9.3 percent in 2006, averaging $9,516 per employee and 26 percent higher than the national average.
• Employee premium contributions and out-of-pocket costs are rising faster than wages.
• Rising costs have led to a decline in employer provided health benefits. In 1979, 73 percent of private-sector Wisconsin workers had employer-based health insurance coverage. This number dwindled to 57 percent receiving health benefits in 2004.
• At least half of all personal bankruptcies in the United States are the result of medical expenses. Over 75.7 percent of this group had insurance at the onset of illness. In 2004, there were 13,454 medical bankruptcies in Wisconsin affecting 37,360 people.
• The costs of health services provided to individuals who are unable to pay are shifted to others. Of the $22 billion charged by hospitals in 2005, $736 million was not collected. Those who bear the burden of this cost shift have an increasing difficult time paying their own health care costs.

Limited Access

There are a large and increasing number of people who have no health insurance or who are underinsured. For this growing population, health care is unaffordable and most often not received in the most timely and effective manner.

• Over one half million Wisconsin residents were uninsured at any given point during 2007.

HEALTHY WISCONSIN: Your Choice, Your Plan