Assembly Health Chair Sanfelippo says Maintaining Coverage is “Priority #1”

Borgerding: WI well positioned to shape “the path forward” and sustain coverage gains

January 13, 2017

Health Committee Chair Rep. Joe Sanfelippo said Assembly Republicans are committed to preserving the gains in coverage Wisconsin made when Gov. Scott Walker used a unique approach to expanding Medicaid by lowering eligibility levels to 100 percent of the federal poverty level (FPL) and utilizing the exchanges to provide subsidized coverage to those with income above the FPL. 

“We picked up nearly 200,000 people in coverage here; we don’t want to lose anything or give up any ground we have gained,” Sanfelippo said.

Sanfelippo told the group he believes allocating funds to the states for Medicaid through block grants, which are being discussed at the federal level, could be favorable for Wisconsin. 

“There are a lot of good ideas that states are trying around the country and right now, you have to apply for waivers and it is hit or miss and it is cumbersome,” Sanfelippo said. “If you switch to block grants…the strings and waivers are gone, and it gives us the ability to put programs in place and adjust them once they are in place so they do what we want them to do.” 

Sanfelippo emphasized the importance of state legislators working with the Wisconsin congressional delegation to ensure decisions made in Washington do not have an adverse impact “back home.” 

Joining Sanfelippo at a panel discussion on “Trumpcare: What’s in Store,” sponsored by Wisconsin Health News (WHN) January 10 were WHA President/CEO Eric Borgerding; Coreen Dicus-Johnson, president/CEO, Network Health; Donna Friedsam, health policy programs director, UW Population Health Institute; and, Mike Wallace, president/CEO Fort HealthCare. WHN Editor Tim Stumm moderated. 

Borgerding reiterated the important role that the Governor, who now leads the Republican Governors Association, and Speaker Paul Ryan could have in determining “what’s next.”

Borgerding said the achievements in coverage in Wisconsin have relied on the exchanges and the fact that those premiums are heavily subsidized. He said 67 percent of the coverage in the individual market comes through the exchange and well over half of those who get subsidies are under 200 percent FPL. 

“The exchange has been a key tool in achieving the reductions in uninsured in Wisconsin,” Borgerding said. “We have to communicate that back to DC. If something changes, such as subsidies being based on age instead of income as is being discussed, what happens to those in Wisconsin who get premium subsidies who are 100-200 percent of FPL?” 

Borgerding said state lawmakers have a critical role to play in shaping what is ahead. 

“Wisconsin could be a model and join some of the other states that have used federal funds to expand Medicaid and get funding for what we did in Wisconsin,” he said. “Wisconsin is very well positioned to influence the path forward.”

Structural issues embedded in the ACA have created financial stress for insurers and providers alike. Dicus-Johnson pointed out the problems with allowing young adults to stay on their parent’s insurance and the impact that has on rates when they do not sign up for coverage. 

“The individual mandate has not been effective. When you look at the penalty compared to cost associated with the plans, they say ‘I will just pay the penalty’,” according to Dicus-Johnson. “The issue is how do we have policies that require continuous care so they have access to affordable care? We tied an entitlement to a private market, and that just doesn’t work.” 

Wallace said one of the greatest weaknesses of the ACA is the cost. 

“We see what has happened with payers in the exchanges. We have more people covered but we are not covering the cost of caring for those people,” Wallace said. “We did a good thing, but it is not sustainable in its current form.”

Friedsam said the biggest success that came out of the ACA was it changed the national dialogue on insurance to a theme of how to make coverage affordable and accessible. 

“Prior to the ACA, there was understanding about the lack of insurance coverage, but it is not clear we had agreement on the need for reform,” she said. “People now have access to some form of affordable insurance. The failure was in the inability to explain the benefits of it and some design flaws…some people did not buy in; we didn’t have balanced risk pools.”

In a sea of uncertainty, Borgerding said the biggest question is not whether the current law sunsets or disappears, but what happens in between. That is the crucial question, he said. 

“Our position is they tend to recognize there needs to be a stable smooth transition and we think that is very positive. When you look at what is at stake in Wisconsin, we have about 250,000 covered by Obamacare. When you grasp those numbers, this is not something that can be unwound overnight,” according to Borgerding. 

Watch the full discussion. See press coverage.

This story originally appeared in the January 13, 2017 edition of WHA Newsletter