A recent poll of 400 likely voters from across the state finds that 75 percent support a proposed hospital assessment if used to capture hundreds of millions in federal revenues, increase payments to hospitals to help care for the poor and uninsured and provide funding for health care programs (the text of the question appears below). In other words, by a margin of nearly four to one, Wisconsin voters support the hospital assessment similar to that recently proposed by Governor Doyle.

"Clearly, when people understand the benefits of the hospital assessment it makes sense," said Ken Buser, president and CEO of WFH-All Saints in Racine and chair of the WHA Board of Directors. "WHA agrees, and believes it is time to move beyond the notion that this is just another ‘tax’ and get this done in a bipartisan way."

Of those polled who said they usually vote Republican, more than half supported the assessment. Of those who said they vote equally for Republicans and Democrats, an overwhelming 87 percent said they support the assessment. Support was strong in all regions of the state, and only 19 percent of all respondents opposed the idea.

The Checkpoint Survey poll was conducted between February 26 and March 2, 2008 by Wood Communications of Madison and has a margin of error of +/- 5 percent. The results are available on WHA’s Web site at: www.wha.org.

The poll’s release comes on the heels of two major endorsements of the hospital assessment. The Wisconsin Manufacturers & Commerce (WMC) and the Metropolitan Milwaukee Association of Commerce (MMAC) both announced last week they will support the proposal as a way to capture more federal dollars for Wisconsin and begin alleviating the impact of Medicaid cost shifting.

Medicaid is the state/federal health care program for the poor and uninsured. Hospitals take care of all Medicaid patients who walk through their doors, yet they have not received an increase in what they are paid to treat these patients in over a decade. According to WHA, the state now pays hospitals about 48 cents for every dollar they spend treating Medicaid patients. As a result, over $600 million in unpaid costs (not charges) are annually shifted to everyone else. Under the proposal offered by Governor Doyle and backed by WHA, WMC and MMAC, a good portion of this "cost shift" could be addressed.

According to the non-partisan Legislative Fiscal Bureau, hospitals would be assessed a total of $416 million over two years. About $125 million from the assessment would be used to support the state’s Medicaid and BadgerCare programs, with the rest being used to capture hundreds of millions of federal dollars and boost Medicaid payments to hospitals. When combined, $708 million would flow back to hospitals via higher Medicaid payments—$292 million more than the assessment over two years. Senate Democrats have offered a similar proposal.

Like other groups, WHA had opposed the original version of the hospital assessment introduced in February 2007. But last fall, after negotiating key amendments that will ensure the funding goes for its intended purpose, WHA changed its position to support.

"We commend WMC and MMAC for taking a fresh look at the reworked proposal, understanding the actual benefits, and now backing it," said WHA President Steve Brenton. "Both groups represent major employers in Wisconsin and recognize that the time has come to finally do something about Medicaid cost-shifting."

WHA believes the new poll, coupled with the support of major business groups, shows that there is widespread support for the plan and that it can and should be approved by the Legislature.

"We hope this will take the debate in a new direction, and we want to reach out and work with legislative leaders on both sides of the aisle to try to address any concerns and make this a ‘win-win’ proposal," said Eric Borgerding, WHA’s executive vice president. "The hospital assessment can help us finally begin to reduce cost-shifting, make a considerable dent in one of the major cost drivers in health care, and result in a solution to our budget deficit without cutting Medicaid, BadgerCare or other safety net health care programs."

Poll Question

"Currently, Wisconsin hospitals are not receiving adequate payments from the state or federal government to offset the cost of caring for our poor and uninsured patients, and these costs are eventually shifted to all of us in the form of increased health care costs.

There is a proposal in the state Legislature to assess Wisconsin hospitals on their gross revenue. The federal government would match the funds received from this assessment and the state would gain an additional 410 million dollars in federal revenue. These funds would be used to increase payments to hospitals when they care for the poor and uninsured and help fund health care programs. Considering this information, how supportive of this legislative bill would you be?"

This week the Senate Finance Committee approved an amended version of the budget repair bill that included the hospital assessment put forward by Governor Doyle. The assessment is a key component of the plan put together by Senate Democrats to address a projected shortfall of $650 million in the state’s general fund by the end of the current biennium (June 30, 2009).

The assessment proposal, is nearly identical to the one offered by the Governor during last fall’s budget negotiations. Under the proposal approved by the Senate Finance Committee, hospitals would be assessed $416 million over the 2008-09 biennium. When combined with the federal matching revenue, the assessment would capture a total of $708 million paid to hospitals in the form of much needed increases in Medicaid payments — $292 million more than the assessment.

Aside from the higher payments resulting from the hospital assessment, the bill approved by the Senate Finance Committee also includes additional funding to boost Medicaid payments to many rural hospitals and IMDs, as proposed by Governor Doyle and strongly backed by WHA. The only change made to the assessment proposal by Senate Democrats was removal of the 2009 sunset. The sunset, which was proposed by Governor Doyle and supported by WHA, could be added back in to the bill at some later point in the process.

On a party-line 6-2 vote, Democrats on the committee approved the hospital assessment as part of their overall budget repair plan. The bill will go to the full Senate for a vote on Tuesday, March 25 and is expected to be approved.

As reported last week, Assembly Republicans adopted their own budget repair proposal that does not include a hospital assessment or any increases in payments to hospitals. The differing versions of the budget repair bill will move on to a conference committee where a compromise will have to be reached before a bill goes back to Governor Doyle to be signed into law. A similar process last year resulted in a several month delay in approval of the state budget.

WHA was pleased to work with the Doyle administration and Senate Democrats on important modifications to the assessment plan that addressed hospitals’ key concerns including: delivering the promised payment increases, clarifying the assessment amount, timing of the assessment and which hospitals would ultimately be affected. It was ultimately these improvements to the bill that led to WHA’s support.

"To the Hospital Association’s credit, we worked closely with them to get this to a point where they could support it, " Governor Doyle said in a press conference last week announcing his budget repair bill last week. "The only thing standing in the way of getting this done is some left over rhetoric from the last budget …. We can’t go back and fight (with the Legislature) over every budget battle we had last fall." (See the "President’s Column" in this issue of The Valued Voice).

Commenting on the Senate Finance Committee’s action this week, Committee Chair Mark Miller (D-Monona) said, "The Senate Democrats’ budget repair plan lowers health care costs for Wisconsin businesses and families by securing more than $400 million in federal aid for our hospitals. This will ensure the loss hospitals incur by serving Medicaid patients doesn’t get passed onto Wisconsin residents and business owners when they use hospital services. Our budget plan is fair and responsible."

The committee held a hearing on the budget repair bill in Milwaukee earlier in the week. Appearing on behalf of the Doyle Administration was Department of Administration Deputy Secretary Dan Schooff who included support for the hospital assessment in his comments to the committee. He said hospitals are not fully reimbursed to treat Medicaid patients and that much of the proposed hospital assessment would be used to increase those payments, easing the "hidden tax" caused by Medicaid payment shortfalls.

WHA, along with several member hospitals and hospital systems including Aurora Health Care, Children’s Hospital, Froedtert and Community Health, University of Wisconsin Hospitals and Clinics and Wheaton Franciscan Healthcare also testified in support of the assessment. Hospital testimony centered on the dismal Medicaid reimbursement rates that have gone unaddressed for over 13 years and the unfortunate cost-shift borne by the business community and commercial payers to cover Medicaid shortfalls. Committee member attention was also drawn to business support of the assessment that is clearly gaining momentum.

As previously reported, some of the state’s major business organizations including Wisconsin Manufacturers and Commerce, the Metropolitan Milwaukee Association of Commerce, and the Greater Milwaukee Committee have recently come out in support of the assessment as a way to capture more federal dollars for Wisconsin and begin alleviating the impact of Medicaid cost-shifting.

Also in their testimony, both WHA and member hospitals referred to results released this week from a recent WHA poll (see related story) conducted with 400 likely voters. The results showed that 74.5 percent of respondents (a margin of almost four to one) support a hospital assessment if used to capture hundreds of millions in federal revenues, increase payments to hospitals to help care for the poor and uninsured and provide funding for health care programs; only 19 percent opposed.

Committee member Senator Julie Lassa (D-Stevens Point) called the assessment a "No-brainer," after hearing testimony.

In the continuing fight to receive fair Medicaid reimbursement, the Wisconsin Hospital Association has joined with a coalition of health care providers, business groups and others on a grassroots advocacy site, www.stoptheshift.org. The Web site is designed to educate and motivate members of the public to demand increased Medicaid reimbursements for hospitals, including support for the hospital assessment now pending before the Legislature.

You can help Wisconsin hospitals receive long-overdue Medicaid increases through the following:

1. Log onto www.stoptheshift.org today!

2. Sign the online petition.

3. Email your legislators. www.wha.org/speakUp/emailLegislator.aspx

In a big victory for hospitals and the patients they serve, Governor Jim Doyle on March 17 signed Senate Bill 487, a WHA-backed bill that aims to improve the safety, quality and efficiency of Wisconsin hospitals by facilitating the development of interoperable electronic medical records systems. The bill begins to remove antiquated statutory barriers to communication that have impeded the implementation of such systems.

"As part of my eHealth initiative, we are helping to modernize medical record keeping that makes it easier for doctors to get the information they need to help patients," Governor Doyle said at the signing held at UW Hospitals and Clinics. "Senate Bill 487 removes some cumbersome barriers to sharing relevant information. It’s a good, common sense bill that helps us be more effective in how we deal with medical information," the Governor added.

WHA worked with DHFS and workgroups of providers, IT experts, and patients over the last 18 months in the development of the bill. The proposals contained in the bill were recommended by the Governor’s eHealth Care Quality and Patient Safety Board in December 2007.

The bill eases restrictions on re-disclosure of health care records, reduces unnecessary documentation requirements, reduces barriers to sharing information with family members involved in the care of a patient, and permits a limited exchange of mental health information among providers for treatment purposes.

"Congratulations to the many individuals who helped support and provide input on the development of this new law," said Matthew Stanford, associate counsel, Wisconsin Hospital Association. "That work has yielded a good first step toward modernizing Wisconsin statutes governing health care records and helping hospitals further advance Wisconsin’s nationally-recognized high levels of quality and safe care."

The bipartisan bill was one of fewer than 110 bills in the 2007-2008 legislative session signed into law by Governor Doyle through March 17.

The bill is now officially 2007 Wisconsin Act 108. A copy of the act can be found at www.legis.state.wi.us/2007/data/acts/07Act108.pdf.

If you haven’t submitted data already, you still have time to participate in the WHA compensation surveys. Your participation in these surveys ensures you have up-to-date information that can be used to benchmark your salary information against other Wisconsin hospital and health system executives, and only those who participate will have access to the survey results.

WHA’s annual Executive Compensation Survey collects salary data on over 25 positions, and the Physician Compensation Survey (new for 2008) collects salary data on over 70 positions. The survey deadline is March 28, 2008.

Three premier Wisconsin business organizations have endorsed the hospital assessment as a vehicle to attract hundreds of millions of federal dollars that will reduce a major driver of rising health insurance premiums—cost shifting caused by inadequate Medicaid payments.

The three organizations: The Greater Milwaukee Committee (GMC); the Metropolitan Milwaukee Association of Commerce (MMAC); and the Wisconsin Manufacturers and Commerce (WMC), have concluded that assessing hospitals to generate state funds that will be matched with federal Medicaid dollars is a supportable public policy option that can begin reducing a "hidden tax" that has grown by hundreds of millions of dollars over the past few years.

Support from business organizations that consistently reject higher taxes to fund state government programs should be a "wake up call" for those who continue to call the hospital assessment a "sick tax." If this truly was the case, these historically anti-tax organizations would not be calling for enactment of the assessment. Instead, their support acknowledges that the assessment is not a tax in the traditional sense.

This week WHA released results of a poll showing 75 percent of likely Wisconsin voters support the hospital assessment when they understand the benefits it can bring (see related story). While some may dismiss the support of WHA, WMC, MMAC, GMC and several other organizations as simply coming from "interest groups," an accurate and fairly worded statewide poll that shows a greater than 3-to-1 margin of support among VOTERS is impossible to ignore.

The fact is that the Medicaid initiative actually nets almost $300 million in higher payments that can be used to reduce cost shifting. Those are federal dollars that have been left on the table far too long. That’s the tradeoff that led these business associations, WHA and a large majority of Wisconsin voters to support the assessment. That reality is being lost in the arguments offered up by legislative opponents.

The dwindling opposition to the assessment provides strong evidence that the issue has evolved to the point that it can become part of the solution to health insurance affordability. Even the opponents of the hospital assessment have long acknowledged the reality of the "hidden tax" and its corrosive affect on health insurance premiums. But the fact is, today’s "hidden tax" is the result of years of bipartisan inaction. The time for a solution is now, in the pending budget repair bill. The hospital assessment is that solution and it can be achieved in a bipartisan fashion.

Another biennium of inaction assures one thing—health care costs will continue to increase due to Medicaid cost shifting.

Steve Brenton
President

This week Reps. John Dingell (D-MI), chair of the House Committee on Energy & Commerce, and Tim Murphy (R-PA), also a member of the Committee, introduced legislation, HR 5613, entitled, Protecting the Medicaid Safety Net Act of 2008. The bill extends until March 31, 2009, moratoria on several Medicaid regulations put forth by the Centers for Medicare & Medicaid Services (CMS).

HR 5613 extends a current moratorium on three Medicaid provisions (due to expire on May 25) to additional CMS Medicaid proposals. Together the legislation places moratoria on provisions impacting certified public expenditures, intergovernmental transfers, graduate medical education, coverage of hospital outpatient services, state provider tax laws, coverage of rehab services for people with disabilities, outreach and enrollment in schools and specialized medical transportation to school for children covered by Medicaid, and case management services that allow people with disabilities to remain in the community.

WHA supports HR 5613 as a backstop against continued erosion of Medicaid payments.

Urge Wisconsin House of Representatives members to cosponsor HR 5613. They are: Reps. Baldwin (a member of House Energy & Commerce Committee), Kagen, Kind, Moore, Obey, Petri, Ryan and Sensenbrenner. Email legislators at www.wha.org/speakUp/congressional.aspx. As always, let HEAT know you’ve taken action by emailing Jenny Boese at jboese@wha.org.

Congress Initially Rejects Bush Medicare Cuts

In setting the framework for the federal budget, both the House and Senate individually rejected the President’s initial proposal to cut Medicare funding by $135 billion dollars over five years. Wisconsin’s portion of the cuts would have been $1.4 billion. The House resolution was approved by a vote of 212-207 with the Senate approving its version 51-46. Wisconsin’s Congressional delegation voted along party lines:

Yeas                 Nays

Baldwin             Petri
Kagen               Ryan
Kind                 Sensenbrenner
Moore
Obey
Feingold
Kohl

Additionally, both resolutions include reserve funds to increase payments for physicians as well as a $50 billion reserve fund to reauthorize the State Children’s Health Insurance Program. The House budget plan also includes reconciliation instructions directing the House Ways & Means Committee, which has jurisdiction over Medicare, to develop legislation that decreases spending or increases revenues by $750 million over five years. WHA will continue to advocate against funding cuts throughout the budget process.

Congressman Dave Obey (D-Wausau) got a tour of Osceola Medical Center’s new facility March 17 by Jeff Meyer, Osceola Medical Center CEO. Obey was instrumental in securing $142,000 in appropriations funding for three negative pressure rooms in the new facility. Negative pressure rooms prevent airborne particles generated in the room from escaping into the corridor and the rest of the building. These rooms help limit exposure of communicable illness to other patients and are just one example of why hospitals must continue to update and modernize current day facilities.

"Whether they are dealing with bird flu or the common cold, our medical centers should have the facilities they need to keep patients, staff and visitors safe," Obey said.

Laura and Gloria have been friends and neighbors for many years. One of the activities they enjoy together is the Diabetes Support Group at Spooner Health System. The friends have been attending the Diabetes Support Group for over two years.

The Diabetes Support Group meets once a month and is free to the community. Claudia Hagen, Spooner Health System Education Coordinator, presents information and organizes speakers for the group. Gloria credits the Diabetes Support Group with helping her to manage her diabetes through diet. She feels that without the group she would have become insulin dependent sooner.

The friends recall when Claudia Hagen arranged for a presentation on diabetic comfort shoes. After the presentation, attendees could order specially fitted shoes. Laura and Gloria also take advantage of the Free Foot Care Clinic offered by Spooner Health System’s Home Health Department. The clinic is offered every week by appointment.

From nutrition information to foot care, Spooner Health System provides services that are important to diabetics. The friends say that "even with the price of gas, we make it a priority to attend the Diabetes Support Group and the Foot Care Clinic."

Calumet Medical Center has been a proud sponsor and coordinator of a Progressive Agriculture Safety Day™ for six years. 73 volunteers from all over the community and Calumet Medical Center staff spend the day educating and guiding 150 children ages 8 to 12 through various learning stations in an effort to prevent injury. This year Calumet Medical Center’s Progressive Agriculture Safety Day™ took place at the Calumet County Fairgrounds. The learning stations included tractor safety, hidden hazards, drug awareness, household electrical safety, hazardous materials, seatbelt safety, severe weather awareness, disability awareness, water rescue, and firearms safety. Learning methods included presentations, activities, demonstrations, and games.

Calumet County is one of the 362 locations in the United States and Canada where children are provided the opportunity to participate in this type of interactive, hands-on learning experience, emphasizing home, farm, and outdoor safety. The goal of the Safety Day is to provide children with knowledge and skills that will allow them to make better decisions regarding their own safety.

"The Progressive Agriculture Safety Day is a great opportunity for children of all backgrounds," says Karin Wille, education and community service coordinator of Calumet Medical Center. "It’s not only educational, but the children also have a lot of fun."

Each child is presented with a take-home bag and a t-shirt to remember the day, along with the knowledge they have gained. Materials related to all of the learning stations are included in the take-home bag giving the parents and children an opportunity to review the information together at home after the Safety Day.

The major funding for the event this year was provided by grants from St. Elizabeth Hospital Community Foundation, University of Wisconsin Extension Center for Agricultural Safety & Health, Calumet County Youth Safety Organization, three local large animal veterinary clinics, and 51 local sponsors and donors.