MADISON – Although more than 90 percent of Wisconsin residents have some form of private or public health insurance, that is little consolation to the estimated 500,000 who find themselves without coverage.
Lily Hoyer-Winifield of Madison and her husband, Todd Cambio, were in that category. Having left his job to start his own business, Cambio no longer had insurance, nor did Hoyer-Winifield, who was self-employed and working nights at a local restaurant. And with a baby on the way, their health care needs were about to multiply.
Then, a self-employed friend told Hoyer-Winifield and Cambio about BadgerCare, the state of Wisconsin’s program to provide affordable health insurance to working families. It was a huge relief to know they had finally found some measure of protection from the staggering cost of medical care.
“The most important thing for me is that my family is covered and we have choices when it comes to care,” Hoyer-Winifield says. “It allows our son to have regular checkups and vaccinations. In the case that my husband or I need to seek medical attention, it has been extremely useful.”
Whenever a family like Hoyer-Winifield and Cambio’s joins BadgerCare, it’s another victory for University of Wisconsin-Madison Professor Roberta Riportella and the Covering Kids and Families (CKF) coalition. Riportella is director of CKF, a coalition of more than 65 organizations dedicated to making sure those who qualify for BadgerCare (and now its successor, BadgerCare Plus) know about it and enroll in it.
“We’re trying to connect people with insurance for which they’re eligible. That’s our mission,” says Riportella, incoming chair of the UW-Madison Department of Consumer Science and health policy specialist with UW-Extension. “We have been a force for education. What we do is present information.”
BadgerCare was created to provide free or low-cost health insurance to working families earning up to 185 percent of the federal poverty level. BadgerCare Plus was launched earlier this year to cover all children, regardless of family income, and expand eligibility for parents and pregnant women.
“CKF has helped spread the word about the program, which has been very successful in getting more people enrolled,” says Jeff Burkhart, an outreach coordinator in the Wisconsin Department of Health and Family Services (DHFS). “In the first three months, we’ve seen an increase of more than 75,000 people, most of them children. CKF has been a primary partner in connecting to communities around the state and sharing information about how to sign up for BadgerCare Plus.”
Riportella’s academic interest in barriers to health care access stems partly from her impressions of nursing homes as a young woman growing up in New York. With the goal of becoming a social worker, she worked with the elderly and would visit nursing homes to sing and play guitar and piano. But she became alarmed at the sight of patients receiving substandard care. “It was horrendous that in those days, people were abandoned to institutions that were not set up to adequately care for them,” she says.
And she was motivated to do something about it when she arrived at UW-Madison as a graduate student in the late 1970s.
“I came to graduate school in sociology to prove that it was wrong to make a profit off of people’s ills and misfortunes,” Riportella recalls. But her thinking evolved into a broader view. “In grad school I started to see things in a larger context. It became more than saying there were good guys and bad guys.”
While finishing her Ph.D. in sociology at UW-Madison, Riportella began her career in health policy research at the State University of New York-Stony Brook and then became a research associate and research assistant professor at the University of North Carolina at Chapel Hill. She returned to UW-Madison in 1991 as an associate scientist in the Department of Preventive Medicine. In 1993 she accepted her current integrated faculty position in the School of Human Ecology and the Family Living Program of UW-Extension. This latter appointment includes her duties as a health policy specialist.
The opportunity to create Covering Kids and Families came in the early 2000s when the Robert Wood Johnson Foundation (RWJ) was looking to expand its support of the statewide coalitions it began funding in 1999 to help each state implement their version of the federal/state partnerships known as the State Children’s Health Insurance Program (SCHIP). In Wisconsin, that program was BadgerCare. Riportella says it was Extension’s reputation for objectivity rather than advocacy that fit the foundation’s evolving criteria, and the Covering Kids and Families coalition was born in 2003.
“RWJ staff wanted to try a different kind of lead agency, one that didn’t have its own agenda regarding enrollment in SCHIP,” Riportella says. “Others looked to me with my affiliation with UW-Extension as meeting those new requirements well. My being a professor at UW-Madison sweetened the pot.”
She adds: “UW-Extension has a reputation as an unbiased source of information, and UW-Madison provides the infrastructure to support the development of interventions that we can now evaluate. So CKF staff, under my direction, have added a different type of value to this evolving Covering Kids and Families initiative. People trust that we are using data appropriately to make informed decisions. And this, coupled with a highly active statewide coalition membership, has made CKF highly successful in its mission.”
“Roberta takes academic concepts and applies them to very practical situations,” says DHFS’s Burkhart. “[She] strives to build connections among likely partners on and off campus. She works to develop common-sense approaches to helping people access the health insurance they need.”
Covering Kids and Families’ current emphasis is on a new initiative called Connecting Health Insurance with Lunch Data (CHILD). It began by matching BadgerCare eligibility with enrollment in schools’ free and reduced-price meals for low-income children. The eligibility criteria for these programs were similar, so enrollment in one could easily have translated into enrollment in the other. This was not always the case, however.
“One of the things we discovered was information is not enough to get people enrolled,” Riportella says. CHILD is designed to overcome some of the administrative barriers that can make it difficult for people to sign up and to encourage schools to take a more active role in assuring that children show up healthy and ready to learn.
And, because BadgerCare Plus is a family program, when one school child is enrolled, it can open a door for other family members as well.
“Your eligible population is a moving target – babies being born, people moving in and out of state … Some of the hardest families to reach are those who need it most. If you’re worrying about how to pay the rent, make the food stretch, it’s hard to think about insurance,” Riportella says.
Riportella credits state government with having the political will in a time of budget deficits to stay true to the BadgerCare program. “Wisconsin is fairly savvy in understanding that uninsured people cost the state money. It makes sense to have people insured from a business perspective. Our state is more progressive, more intelligent in how we see this.
“The reality is lots of legislators are swayed by anecdotes. Stories matter most if they represent a large number of people.” But stories aren’t enough, Riportella believes. “It’s understanding that data matters.”
Editor’s note: This story is part of a biweekly series focusing on The Wisconsin Idea in action. For more, visit http://www.wisconsinidea.wisc.edu/.
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