The implementation of Obamacare running into problems
by James Wigderson
Special Guest Perspective for the MacIver Institute
The sky is falling in Barron County. Not enough members of the county board voted to spend state money to hire more social workers to spread the gospel of the Affordable Care Act, commonly referred to as Obamacare.
The vote, 15 in favor and 12 against, failed to achieve the necessary two-thirds needed to approve adding two more county workers to sign people up for the Affordable Care Act’s health care exchange. The votes of two-thirds of the county supervisors were needed for approval because the proposal would affect the current budget year.
According to WQOW-TV, the County Administrator Jeff French seemed surprised at the result. He told them, “I was surprised it was shot down. I did expect it to pass at two.”
Originally, the county was considering adding four positions to deal with the Affordable Care Act. As the Rice Lake Chronotype reported, last month the county board voted 17-11 to table that proposal. As the surrounding counties in a ten-county consortium began adding positions, the proposal was reduced to two positions and brought back before the board.
Barron County already has 13 economic support workers, each handling a workload of about 790 cases, according to WQOW. They report that there will be an additional 325 cases per worker due to the county board’s decision.
For those of you who are quick with the calculator, that’s 4,225 expected additional cases. That means the two additional positions were expected to handle over 2,100 cases each. The Rice Lake Chronotype editorial board reports “some 4,500 county residents” will need to be screened for eligibility. But the County Administrator said the two specialized, state-funded positions were needed because the county did not want to bother the current county workers with more than 1,000 cases.
County Administrator Jeff French also told WQOW, “20 percent of the county’s 45,000 residents,” could be eligible for the health care exchanges. That’s 9,000 people, according to my calculator.
As Chief Brody would probably say to French, “You’re gonna need a bigger boat.”
On the background paper provided to supervisors supporting the creation of the position, there are 94 case workers in the ten-county consortium handling 50,000 cases. That’s over 530 cases per worker, perhaps allowing some flexibility among the counties for the increased case load (estimated at an additional 12,000, or 128 additional cases per worker). That’s not including the positions added by the other counties in consortium for Obamacare implementation.
Supervisors gave a variety of reasons for opposing adding the two state-funded positions with most published accounts referring to the uncertainties of the coming Obamacare implementation, and they weren’t referring to French’s math.
Supervisor Terry Henck told Wisconsin Public Radio, “Right now I’m not comfortable creating a position that we’re not positive that we’re going to need. They’re not clear at the federal level or the state level that the exchanges are going to be even operating yet.”
Echoing fears at the state level about Obamacare funding, Supervisor Don Horstman said he was concerned that when state funding for the positions ended in 2015, the county would be stuck with needing to continue to fund the two positions. “I’ve seen it happen time and time again.”
The Chronotype reports Supervisor Bill Schradle as being concerned about taxpayers, as state money is money from the taxpayers, too. He’s right, of course.
According to the additional materials supplied to the county supervisors, the state has $54 million in the 2013-2015 budget to fund these county positions across the state. The ten-county consortium which includes Barron County will receive $4,030,830 for 20 total positions. That’s over $200,000 each over the biennium for salaries, benefits and training. However, the state money can also be used to train existing “income maintenance” personnel.
If the county can decide later that the postions are needed after all once they see the demand for the exchanges. Or the other counties in the consortium could use the money to add positions if needed. Or the state tax money could avoid being spent entirely.
While Supervisor Russell Rindsig is confident that the county could decide in two years whether to continue funding the positions depending on the continuance of state aid, the reality is that Obamacare is likely to be an ongoing burden even after the two-year budget cycle.
But by not taking the state money now, before the county is sure of the need for the positions, the county has the possibility of avoiding being stuck with unfunded positions later. If the county can avoid tying itself to a potential long-term liability in the Obamacare process, it’s an opportunity worth exploring. They may even save the state taxpayers some money, too.