WHA continues to break new ground in lobbying. The 2003-04 session-ending report from the Wisconsin Ethics Board shows that WHA once again ranks in the top echelon of Wisconsin lobbying organizations. WHA has moved to fifth out of 707 registered lobbying organizations. Excluding single issue groups, WHA moves to number three, behind only lobbying giants WEAC and WMC.

Most noteworthy, however, is WHA’s ranking as the top lobbying group on the 2003-05 state budget. WHA staff logged 2,402 hours, almost 400 more than the second ranked organization – WEAC. According to the Ethics Board report, WHA spent 23 percent of its total time in 2003-04 lobbying on Medical Assistance.

"Some people take a dim view of ‘lobbying’," said WHA’s Eric Borgerding. "Well, I can tell you we will never apologize for aggressively representing our members in the State Capitol and with state agencies — it’s what we’re all about. We have a great team at WHA, and, most importantly, a membership that is committed to and supportive of our advocacy efforts."

According to the report, WHA also ranked high on other headline-grabbing issues, ranking third in lobbying on concealed carry legislation with 271 hours, seventh on the Taxpayers Bill of Rights (TABOR) with 271 hours, and eighth on the Job Creation Act with 168 hours.

The state’s Hospital Bioterrorism Program is funding, through WHA, a "Hospitals’ Guide for Mass Casualty Events," that will be released soon. The Guide will be distributed free of charge to all Wisconsin hospitals. The law firm of Michael Best and Friedrich, LLP is preparing the Guide and will provide education programs and training to Wisconsin hospitals on the legal issues surrounding disaster preparedness, response and remediation. Watch The Valued Voice for more information concerning the Guide’s release and the related education programs.

The survey that was just done by ACS and WHA that showed 77 percent of the people were in favor of it—and the fact that when people were asked if it made a difference that it was a tax increase and it didn’t matter, will make an impression on the legislature.

What I’ve tried to tell people who asked me about it is, it isn’t about the money. It is all about trying to prevent youngsters from starting and getting people who are now smoking to quit. There is a good statistic that shows that for every 10 percent increase in the price of a pack of cigarette, there is a 7 percent decrease in the number of kids who don’t start. That means we can prevent literally THOUSANDS of kids from ever smoking! And that is not just smoke and mirrors -- those states that have increased the tax have seen those kind of dramatic declines in smoking.

The question people ask is if we raise the tax, would people go to other states to buy cigarettes? The simple answer is no, people buy cigarettes by the pack, not the carton. When I talk to my constituents in the 42nd District, they tell me, "Raise the tax, Doc. It will serve as an incentive for me to stop smoking."

It really bothers me when I see kids smoking. If we can prevent this, we need to do it. We know how much it is costing us in health care costs every time someone smokes. That is what it is about—it is not about the money, it is not about the revenue, it is about STOPPING SMOKING. Period.

2. In a recent poll, 77 percent of the respondents favored a $1 hike in the cigarette tax. Did the support for the $1 increase surprise you?

No, the level of support for a $1 increase didn’t surprise me at all. I surveyed the 42nd District a year ago and had similar results.

The one thing that residents of this state can do to benefit themselves and others is to urge their legislator to vote for legislation that will raise the cigarette tax. All the way up to the Governor.

3. What liabilities do you see for legislators who DO back the $1 increase in the cigarette tax?

Absolutely none. One thing I can tell any legislator who wants to listen, if they talk to their constituents, they will find that it will cost them absolutely nothing if they support the tax. As a matter of fact, it might gain them votes in their district.

The only negative feedback I’ve received comes from organizations like Phillip Morris, the Tavern League and lobbyists who represent convenience stores. I will stand by my belief that it is not about the tax, not about the revenue, it is about health. That is why we need to raise the cigarette tax by $1.

Some of the legislators have been harsh, at the same time, others have been non-committal. I think when they see the results of the poll and talk to their constituents, they will support the $1 increase in the cigarette tax. My constituents are behind me. This is isn’t something I dreamed up. There are lots of statistics that show this is beneficial.

4. Why are you so passionate about this issue?

I have close family members who have suffered and died from smoking related illnesses. I still have family members who smoke, but my kids do not. I care about kids. I have 13 grandchildren. I want them and kids like them to live safe, healthy lives.

5. How to fund the Medicaid program is a dilemma in Wisconsin. Health care providers are already paid far less than what it costs them to treat patients who depend on Medicaid. Some states are cutting eligibility and reducing covered services. What steps do you think Wisconsin could take to ensure the long-term viability of the Medicaid program?

I think as a legislator I have to do everything I can with my vote to make sure we take care of the less fortunate among us. Even if we take funds away from other things that are near and dear to our hearts, people who are dependent on society for their medical needs need us and we can’t abandon them.

We definitely need to take a long hard look at the Medicaid program. There is no easy answer to fixing the problems we have. It is my hope that Representative Gielow’s Medicaid Reform Committee will help us find some of the answers. The $1 increase in the cigarette tax is definitely part of the solution.

Advances in medicine have cured many of the acute diseases, and as such, we are becoming a society that suffers from chronic illnesses. Smoking contributes and exacerbates chronic illness. If we cut down on smoking, we reduce the number of chronic illnesses that we are now treating.

This week the Senate Committee on Health, Children, Families, Aging and Long Term Care held an informational hearing on the topic of hospital construction and its impact on health care costs. Committee chairperson Sen. Carol Roessler (R-Oshkosh) called for the hearing.

Roessler asked participants to address a list of ten questions focused largely around degrees of re-regulating hospital construction and competition. The questions that drew the most attention from those testifying revolved around limiting hospital construction and expansion. Key questions included:

• What are your thoughts regarding the creation of local boards that would approve or deny new hospital construction/expansion project proposals based on need and willingness to collaborate with existing resources in an area?
  
• If local boards were created to review new hospital construction/expansion project proposals, what are your thoughts regarding the inclusion of some kind of trigger that would prompt a state review of a proposal?
  
• What are your thoughts regarding a moratorium of at least two years on the construction of new inpatient hospitals?

Weighing in against re-regulation was Paul Westrick, vice president of Columbia St. Mary’s in Milwaukee. Westrick drew on his experience as a staff member to Wisconsin’s former Certificate of Need (CON) program in answering Senator Roessler’s questions.

"The Certificate of Need and Rate Setting programs were spectacular failures," Westrick said. "Studies conducted at the program termination showed that the costs far exceeded the savings."

"The problem then, and even more so now, is that the power to control capital expenditure decisions and total health care spending should reside with major purchasers," Westrick continued. "We must use the basic economic principles of rewarding high quality, lower cost providers and penalizing those who are not. We oppose the concept of a moratorium. Moratoria are the ultimate blunt instrument form of regulation and will do virtually nothing to address the root causes of health care cost escalation."

John Gillespie, manager of public relations for Fox Valley-based health system ThedaCare, testified strongly in favor of a moratorium on new hospitals. Gillespie dismissed many of the reasons and benefits often sighted for new hospital construction, including aging population, competition, and construction jobs.

"Like the Great and All Powerful Oz, they will tell you to pay no attention to that man behind the curtain – to ignore what is plain for you to see," Gillespie said.

Gillespie focused largely on a proposal to place a 24-month moratorium on new, non-replacement hospital construction. In support of the proposal, Gillespie stated that there is "demonstrated overcapacity" in Wisconsin, which serves only to drive up costs. Gillespie also noted that Minnesota has had an inpatient bed moratorium for 20 years, and suggested that health care costs there are 20 percent lower than in Wisconsin as a result.

Testifying for WHA, Eric Borgerding focused on the direction and implication of the questions. He cautioned lawmakers about going too far, noting that even in the manner the questions were framed, the notion of a 24-month moratorium seemed just the beginning of a slide to state regulation.

"Our members hold different opinions on the issue of reintroducing hospital regulation, especially if that question is limited to the notion of a ‘temporary moratorium’ on new hospital construction," Borgerding said in his testimony. "However, I am quite certain an overwhelming majority of Wisconsin hospitals will oppose full blown regulation of health care, as is clearly suggested by the ten questions."

Others who testified jumped on the opportunity of the hearing to call for even more drastic government regulation. Dan Schmidt, president of the Fond du Lac Area Businesses on Health, called on lawmakers to place a "moratorium on rate increases beyond the rate of inflation."

Borgerding also focused on the impact government health care programs have on the health care market. "While we will spend time and energy focusing on this limited aspect of health care costs, other more pressing issues go unaddressed," Borgerding stated. "The fact that almost a billion and a half dollars worth of government health care costs are shifted to Wisconsin employers and employees every year is not on this hearing agenda. The distortion such massive cost shifting inflicts on our health care marketplace cannot be ignored." Borgerding suggested the scheduling of a hearing to address that topic.

Other hospital systems testifying at the hearing included ProHealth Care (supported a 24-month moratorium), Aurora Health Care and Children’s Hospital and Health System (both opposed a moratorium).

WHA President Steve Brenton summed up the situation.

"Ultimately, WHA, and most people to some degree, believes a properly functioning marketplace is the solution," said Brenton. "The differences lie in how best to make the marketplace work. Do we simply put a lid on the supply side, or do we take the bull by the horns, make the difficult changes in how we purchase and consume health care, and make the marketplace work?"

Brenton noted that WHA, along with the Wisconsin Manufacturers & Commerce (WMC) and the Wisconsin Association of Health Plans, supports a comprehensive, market-oriented reform agenda (Healthier Choices) that includes: reducing the health care "hidden tax" from government program underpayment; embracing private sector-led transparency initiatives (CheckPoint, PricePoint and the Wisconsin Collaborative for Healthcare Quality) that measure, report and improve performance; and allowing small and medium-size employers to purchase health insurance that is free from government imposed benefit mandates.

Over the past year, hundreds of non-profit, community hospitals have been accused of price discrimination against the uninsured. Lawsuits have been filed in dozens of jurisdictions claiming that non-profit hospitals "gouge" the poor. The spotlight clearly is on billing and collection practices of non-profit hospitals nationwide. And at least one major congressional committee…the House Ways and Means Committee…is expected to hold public hearings on the topic this year.

But the billing and collection issue is hardly a stand-alone challenge. Local officials across the nation, and in Wisconsin, are questioning just why "profitable" hospitals aren’t making payments to financially strapped local units of government for services they use, either directly or standby, that are currently funded with residential and commercial property tax dollars. And make no mistake about it; there is no more important issue for the electorate than the rising property tax burden.

However, it’s not just billing and collection practices and property tax-exempt status that is focusing a potentially harsh spotlight on non-profit hospitals. Some policymakers complain that hospitals, at least some hospitals and health systems, increasingly are behaving more like entrepreneurial businesses than community-based, charitable organizations. They ask the question…Is the historic tax-exempt status still deserved? Is it still earned?

These are legitimate questions. And it’s time that the hospital field appropriately responds or face a deteriorating public environment that may have troubling consequences.

In late February, the WHA Board approved a recommendation to create a new Task Force on Community Benefit. The Task Force will discuss the current state and national environment, review ongoing national and state efforts to address public policy concerns surrounding the community benefit issue, and determine if a WHA-led Wisconsin initiative is appropriate.

We are interested in your thoughts. We are aware that the American Hospital Association, the Catholic Health Association and other organizations have already suggested specific programming to address this challenge. And, we suspect that many of our members are engaged in measuring and reporting their community and public benefit messages. This is a great opportunity to share your thoughts, ideas and concerns with WHA as we envision this new task force to be at the focal point of what will be a major 2005 theme.

Six Wisconsin hospitals were among those named to the Solucient "Top 100" hospitals list. The hospitals on the list are selected using nine clinical, financial and operating-efficiency measures, such as mortality and infection rates, average length of stay, operating profit margins and expenses per discharge.

The Wisconsin hospitals included in the "Top 100" are:

Hospital Name                                                      Category

University of Wisconsin Hospital and Clinics            Major Teaching Hospitals
St. Elizabeth Hospital, Appleton                             Medium Community Hospital
Mercy Medical Center, Oshkosh                             Medium Community Hospital
Bay Area Medical Center, Marinette                        Small Community Hospital
Sauk Prairie Memorial Hospital & Clinics                 Small Community Hospital
Riverside Medical Center, Waupaca                        Small Community Hospital

"As a group, Wisconsin hospitals already rank among the best in the nation when it comes to financial performance and quality measures. To have six Wisconsin hospitals listed in Solucient’s "Top 100" is quite an achievement," noted WHA President Steve Brenton.

The Wisconsin Department of Health and Family Services’ Hospital Bioterrorism Preparedness Program is providing funding to the Wisconsin Hospital Association to contract with the law firm of Reinhart Boerner Van Deuren, SC to provide information to Wisconsin hospitals concerning disaster- related legal issues. This service will be provided from April 1, 2005 until the funding is exhausted. Any Wisconsin hospital may submit a question to the "hotline," through WHA, using the following procedure only:

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In a ruling from the U.S. District Court for the Eastern District of Wisconsin, a lawsuit challenging the validity of the Milwaukee County ordinance referred to as the labor peace ordinance was dismissed. The lawsuit asserted that the ordinance, § 31.02, is preempted by the National Labor Relations Act, violates the First Amendment, and violates the Due Process clause of the Fourteenth Amendment.

The ordinance applies to contractors from whom the county purchases human services for the elderly or disabled when such purchases total more than $250,000. It requires such contractors to, among other things, provide a labor union a list of names, addresses and phone numbers of the contractor’s employees, and to afford a union reasonable "access to the workplace for the purpose of providing employees with information about the [union.]"

Any appeal of the decision would next go to the 7th Circuit Court of Appeals.

WHA welcomed Jenny Boese to the government affairs department this week as vice president, external relations and member advocacy. Boese comes to WHA most immediately from Washington, D.C. where she spent a year working for a U.S. State Department task force on human rights. Prior to that, she served over six years as the chief lobbyist and grassroots coordinator for the Wisconsin State Bar Association.

"Jenny brings immediate expertise in grassroots and experience in political advocacy to the WHA Government Relations team," said WHA’s Eric Borgerding. "Her primary focus will be turbo-charging our grassroots advocacy program, and she has already hit the ground sprinting."

Boese is a 1993 graduate of Indiana University-Bloomington with a BA in Political Science and minors in French and History. She has also pursued coursework at Fuller Seminary (Pasadena, CA) and has been on the leadership team of her church’s long-term commitment to a community in the Dominican Republic. She has traveled to the Dominican Republic numerous times to provide that community with development assistance.

The University of Wisconsin and the Wisconsin Technical College System (WTCS) have been working on making it easier for students to move into the University System with their technical college courses and credits. In Wisconsin, graduates of technical college programs are often encouraged by their employers to move on to Baccalaureate degrees. Too often, these students have found that their technical college courses do not transfer or translate into credits at University of Wisconsin campuses. At the urging of Speaker Gard’s Task Force on the Wisconsin Technical College System, chaired by Representative Sue Jeskewitz, the two systems have been working to improve the ease with which credits can be transferred from one system to the other.

At an informational hearing held by the Senate Higher Education and Tourism Committee and the Assembly Committee on Colleges and Universities on March 2, Daniel Clancy, president of the WTCS and Kevin Reilly, president of the University of Wisconsin System, reported on progress made to date by the two systems to improve the ability to transfer credits. As part of their report, they demonstrated a new credit transfer tool accessible at www.uwsa.edu/tis/.

The site’s Credit Transfer Wizard contains information on the UW four-year campuses, the UW colleges and the WTCS. Students may enter courses and the ‘transferring from’ and ‘transferring to’ program and the site will provide a report on transfer as well as a commitment that the information provided by the Web site will be valid for them. Visitors are encouraged to print the commitment and keep a copy to present (if necessary) to the ‘transferring to’ organization. The site also offers the name of persons to be contacted with questions.

"Having transfer information, a commitment and a name to contact are all giant steps forward for students who are trying to transfer credits into the UW system from the technical college," according to Judy Warmuth, WHA’s vice president for workforce development. "For many health care professionals who want to further their education, this will be a valuable resource."

Warmuth said the Credit Transfer Web site will be helpful for students who:

• Dropped out of a program and now want to resume their education at another institution.
• Have a diploma or degree from a WCTS institution and want to pursue a bachelor’s degree.
• Obtained a degree in one field and want to consider another degree.

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