At the invitation of the Assembly Committee on Federalism and Interstate Relations, WHA President/CEO Eric Borgerding testified at an April 5 hearing in Madison on the impact health reform could have on the state’s Medicaid program. He said the Medicaid debate must occur in both Madison and Washington and he told Committee members the Medicaid issue will land "squarely in your laps."
WHA has been heavily engaged in the health reform debate at both the state and federal level. Borgerding said the outcome of any reform will have significant implications for hospitals and patients in Wisconsin and for state public policy, including the current state budget.
Borgerding explained the "hybrid" approach Wisconsin took to expanding coverage, often referred to as the "Wisconsin Model." It relies on two key programs to substantially expand coverage—Medicaid and subsidized premiums on the Obamacare exchange. In all, the Wisconsin Medicaid program added 130,000 people under 100 percent FPL, all "in poverty," which he said in and of itself is a "significant Medicaid reform." However, because Wisconsin did not expand per the Obamacare definition, the state did not receive the enhanced federal funding. It is, according to Borgerding, a classic example of Washington’s "our way or the highway" mentality that created a patchwork of haves and have nots that is proving to be one of the biggest snags in the effort to repeal the ACA.
"Our rough estimate puts the added cost to Wisconsin for not ‘expanding’ Medicaid the Washington way...at about $280 million per year," according to Borgerding. "In other words, 31 states receive nearly 100 percent federal funding for the exact population that Wisconsin now spends hundreds of millions to cover."
Those dollars, he said, could be used to expand the health care workforce, train more doctors and nurses and improve access in underserved rural and urban areas, as well as reduce the Medicaid cost shift to employers and their families. And, he said, Wisconsin could have created a low-income insurance pool if Congress eliminates the income-based premium subsidies that were so important to the Wisconsin Model of coverage expansion.
Medicaid Director Michael Heifetz also testified at the hearing. He said the state plans to release a draft of a plan soon that would allow the state to cap eligibility, charge premiums and drug test childless adults in BadgerCare, according to Heifetz.
Borgerding said he was concerned about how co-pays and premiums would be collected.
"I’ve said for years that if co-pays are a great idea in Medicaid, then maybe we should have them made payable to the state, not collected and payable to providers," he told lawmakers. "Because the truth is most of those simply won’t be paid. It’s hard to collect those. And we certainly won’t be denying care based upon those."
To watch the entire hearing go to WisEye. WHA is a key sponsor of Wisconsin Eye’s JFC and state budget coverage.