In 2018, even with increased access to health insurance in the United States, there remains critical gaps leaving

millions of Americans and hundreds of thousands of Wisconsin residents underinsured, uninsured or lacking

dental, vision, and behavioral health services.

Certainly the Affordable Care Act (ACA/ “Obamacare”) made health insurance more affordable to many;

however it is not (and was never intended to be) universal health coverage. The current percentage of uninsured

in Wisconsin is 5.3% or about 300,000 uninsured Wisconsin residents (U.S. Census Bureau, August 2017).

Clearly, Wisconsin’s free and charitable clinics are still needed.

The Wisconsin Safety Net is comprised of Free and Charitable Clinics (FCCs), Federally Qualified Health

Centers (FQHCs), and Rural Health Centers. The 100+ Wisconsin free and charitable clinics continue to be

critical safety net providers, in response to the remaining gaps in health care.

The non-profit Wisconsin Association of Free and Charitable Clinics (WAFCC) formed in 2014, joining together

many of the state’s FCCs in response to the continuing gaps in the changing healthcare landscape. The WAFCC

has found that many Wisconsin residents remain uninsured for various reasons.

WHO ARE THE REMAINING UNINSURED IN WISCONSIN? THOSE WHO: 1. Find employer, individual, or family coverage “unaffordable”; usually not eligible for

subsidies because of how “affordability” is defined.

2. Cannot enroll in BadgerCare (Medicaid).

3. Are exempt from Insurance Mandate & confusion around the “Shared

Responsibility Payment.”

4. File taxes separately from their spouse, rendering them ineligible for subsidies in the Market-

place.

5. Are 65 or older and find Medicare Part B and Advantage premiums “unaffordable.”

6. Are waiting for their insurance to kick-in (many employers have a 90-day wait for new hires).

7. Have had a change in situation such as divorce, left school, death of spouse or parent, or change

in employment status (lost or changed jobs).

8. Are caught in the difference of income determination between the Marketplace (annual income

$12,140 single, $25,100 family of four) and BadgerCare (monthly income $1,011.67 single,

$2091.67 family of four).

9. Are undocumented residents and cannot purchase insurance in the United States (e.g. no Social

Security number or legal document number).

10. Are unable to quit, or choose to smoke, and are penalized up to 50% higher

premiums, thus making insurance “unaffordable.”

11. Missed Open Enrollment (no waiver for this).

12. Do not have dental or vision insurance.

HOW DOES NOT HAVING INSURANCE EFFECT OUR

COMMUNITIES’ HEALTH?

1 in 5

People without insurance said that they decline care because of

costs. Compared to those with insurance, the uninsured are more likely to describe issues

getting care. 4

Annual Salary (250% FPL Single) $30,350

Less Expenses

Income Tax 21% (Federal & State) $6,373.50

401K /Savings Account (3%) $910.50

Rent Insurance Premiums $129.96

Life Insurance Premium $330.00

Transportation (Based on AAA estimates annual costs of auto ownership, maintenance, fuel, insurance, and transit use.)

$11,096.90

Food (Based on USDA’s national “low-cost” food plan.) $2,984.35

Other Necessities (Apparel, personal care, house-hold supplies which includes items ranging from furnishings to cleaning supplies to phone services, reading materials, school supplies.)

$3,710.00

Housing (Based on Department of Housing and Ur-ban Development’s rental costs (shelter rent plus utili-ties) at the 40th percentile.)

$6,211.13

Yearly Entertainment/Netflix/Hulu $191.76

Funds Available for Health Care -$1,561.10

Less Health Care Expenses

SILVER Marketplace Plan Premium (8.15% of Income; the premium tax credit “subsidy” re-duces the premium by 32% or $1,142 )

$2,474.00

Deductible* (no Cost Sharing Reductions) $2,500.00

Medications (2 per month at $30 each) $720.00

Dental Insurance Premium $360.00

Vision Visit & Glasses or Contacts $360.00

Annual Debt with Health Insurance -$7,975.10

2018 Federal Poverty Levels (FPL)

100% FPL Single

100% FPL Family of 4

250% FPL* Single

250% FPL* Family of 4

$12,140 $25,100 $30,350 $62,750

Despite Wisconsin’s best efforts to give residents access to

affordable health insurance– the subsidies offered by the ACA are

not enough or the rules prevent those who need subsidies most

from being able to receive them; leaving many working residents in

need of affordable health coverage. The below single person does

not qualify for Marketplace Cost Sharing, the FoodShare program,

and many other government income-based programs. This working

resident has a negative cash flow available for health care!

For More Information

WISCONSIN ASSOCIATION OF FREE

& CHARITABLE CLINICS, INC .

Website: www.wafcclincs.org

Email: wafccdirector@gmail.com

Tel: 262-308-6839 (9AM-9PM CST)

Facebook: www.facebook.com/WAFCC

*Cost Sharing Reductions (CSR) stop at 250% of the FPL. CSRs lower the amount

folks have to pay for deductibles, copayments, and coinsurance.

Budget Sources: Economic Policy Institute Calculator and Kaiser Family Foundation

Subsidy Calculator

49%

1 year

Of the uninsured do not have a regular medical facility when they

need care. For the uninsured, preventative services or regular

outpatient care is likely to be skipped. As a result, they are more likely to have negative

health outcomes. 3

Of going without insurance produces poorer access for adults than having insurance for part of the year. Being uninsured for even short amounts of time decreases access to health care and increases adverse health effects. 5

WHAT IS STOPPING PEOPLE FROM OBTAINING HEALTH

INSURANCE?

Lack of information on insurance and Marketplace (healthcare.gov)

Concerns about immigration status

Perceptions of insurance affordability

Income (45% of uninsured adults said that high costs prevented them from purchasing insurance) 1

Age

Access to a health insurance navigator or access to an agent that is contracted with all plans in the Marketplace & is familiar with the process (Patient navigator programs can increase successful enroll-ment) 2

Language barriers

Literacy (According to the National Adult Literacy Survey, 39% of Wisconsin adults are Below Basic and Basic Literacy)

1, 3-5 Foutz, Julia, Anthony Damico, Ellen Squires and Rachel Garfield, “The Uninsured: A Primer - Key Facts About Health Insurance and the Uninsured Under the Affordable Care Act.” Kaiser Family Foundation. 2 Sessions, Kristen, Amal Hassan, Thomas G. McLeod, and Mark L. Wieland, “Health Insurance Status and Eligibility Among Patients who Seek Healthcare at a Free Clinic in the Affordable Care Act Era.” Journal of Community Health 43 (April 2018): 263-267.