A divide between the insured and the poor may be opening up in the cost of services for domestic abuse victims.
As the Affordable Care Act goes fully into effect next year, one area that will see changes is in health screenings and counseling for domestic abuse victims.
Under the provisions of the Act, costs for those services will be completely covered for people with private medical insurance.
But a disparity is also opening up for people on BadgerCare – Wisconsin's subsidized healthcare system for the poor. They would likely see increases in out-of-pocket costs for those same services.
Reporter Brendan O'Brien says currently under BadgerCare, people pay minimal or no copays for screenings by doctors and emergency rooms, as well as for counseling.
But recent changes to BadgerCare could mean that many poor patients won't be covered the same way in the future - and that could mean higher costs.
"Most people don't have to make a huge decision between $10 or $20," he says. "When you're really poor, it could mean either buying dinner or going to a counseling session five miles away on a bus on a cold winter day. The decisions that the poor make are that much more magnified, and they are in some cases, in this case, they could be life or death."
O'Brien has looked at the impact of these changes in BadgerCare as part of a special report on the policy implications of the Affordable Care Act for the online Milwaukee Neighborhood News Service.
He says those probable increases stem from Governor Scott Walker refusing to take federal Medicaid dollars to expand BadgerCare in the state. Those who will stay on BadgerCare may see an increase in copays.
Moreover, without the expansion, fewer poor people will be covered by BadgerCare. O'Brien says it is currently unclear if those who no longer qualify will pay more for domestic violence screening and counseling under the Affordable Care Act's coverage.
"We have a situation potentially where those that are on BadgerCare or those who were on BadgerCare and they were kicked off, are going to have less availability or more cost in front of them when it comes to domestic screenings and counseling than those that are on private insurance," he says.
Counseling for victims of domestic violence usually plays out over a long period of time, which means out-of-pocket expenses can add up. But O'Brien says it's a necessary service for victims.
"It is a re-jiggering of your whole being, of who you are, what you believe in, your self-worth, your self respect," he says, "and so all of this has to be reconfigured and that's why counseling is such an important critical component to healing from domestic violence."
O'Brien says the potential increases in costs for poor victims of domestic violence depend on whether the federal government approves the waiver application Wisconsin will submit, asking to opt out from the expansion of Medicaid.