WHA’s 2018 Advocacy Day March 21, disagreeing on the approach states should take to provide Medicaid coverage for low-income Wisconsin residents but agreeing that the state’s worker’s compensation program is working well, showing opposition to a proposal currently languishing in the state Legislature to implement a medical fee schedule.
The panel, moderated by WHA’s President/CEO Eric Borgerding, included a bipartisan group of lawmakers: Sen. Jon Erpenbach (D-Middleton), Rep. Debra Kolste (D-Janesville), Rep. Joe Sanfelippo (R-New Berlin), and Sen. Pat Testin (R-Stevens Point).
Borgerding tied the panel's conversation around the top three issues facing hospital leaders in Wisconsin, including workforce, insurance stability and reimbursement from government payers.
Reinsurance program receives bipartisan support from panel; Medicaid expansion still heavily debated
While the first question from Borgerding was referring to the Governor’s recent reinsurance proposal signed into law to stabilize the individual health insurance market, the panel quickly began to debate Wisconsin’s decision to expand Medicaid coverage only for people living below the poverty line and not to those living between 100 percent and 133 percent of the federal poverty line (FPL).
Sen. Jon Erpenbach, a member of the state’s powerful budget-writing Joint Finance Committee and ranking Democrat on the Senate Health and Human Services Committee, reacted first to the question. “Yes, it’s a good step the Governor took, but it’s essentially the Governor—quoting a colleague of mine – putting out a fire that he started. Nothing will create instability more than the leaders of our state saying ‘Obamacare is going to go—it’s gone—it’s going to go.”
“Certain politicians in Wisconsin have yet to embrace that Obamacare is the law of the land,” said Erpenbach. “Medicaid expansion is still available, despite what the Governor has said and others have said that it is not or won’t be available.”
“The instability that we have seen here in Wisconsin is not unique to Wisconsin, so I don’t think it is fair to blame it on the direction that we took. To say that we didn’t do Medicaid expansion in Wisconsin is not correct; we did do a Medicaid expansion, we just chose to fund it differently,” said Assembly Health Committee Chairman, Rep. Joe Sanfelippo. “As a result, the Kaiser Family Foundation reported that Wisconsin is the only state in the country that does not have a gap in coverage even compared to states that did take the federal expansion.”
Sanfelippo continued by comparing Wisconsin’s experience with experiences of Medicaid programs in other states. “Taking the federal expansion is not the golden parachute that some say that it is, because the states that did take it are having as much—or greater—problems in their market than what we are seeing in Wisconsin.”
“Whether you agree with the Affordable Care Act or not, we can all agree on two things. One, the ACA has created a market and insurance rates that are unaffordable and unsustainable for a lot of our families here, and the other thing is that the ACA has provided coverage for a lot of people who did not have it before, so the last thing we want to do is to see that we roll that back,” said Sanfelippo.
Medicaid reimbursement concerns causing lawmakers to “think outside the box”
Wisconsin’s Medicaid reimbursement rates are the second worst in the country, only covering 65 percent of cost, said Borgerding. “Quite honestly, I think that number would be worse, except for the fact that hospitals in Wisconsin are doing a very good job controlling their costs.” Borgerding asked panelists what more can be done to address Medicaid reimbursement for Wisconsin’s hospitals and health care providers.
“This is obviously an issue that we hear quite a bit about—Medicaid reimbursement. We should look at how to increase payment as much as we possibly can within the confines of what we are able to do. A lot of it boils down to needing to think outside the box, do more on the preventive side, because an ounce of prevention is worth a pound of cure,” said Sen. Pat Testin.
Borgerding recognized Sanfelippo’s leadership on looking at new ways to deliver better care for patients in the Medicaid program, including a WHA-supported piece of legislation that Sanfelippo authored to create a care coordination pilot program for Medicaid enrollees, which received strong bipartisan support in the Legislature. Assembly Bill 871 was approved by the Senate March 20 and will now head to the Governor’s desk for his signature.
Borgerding also asked the panel their thoughts on a waiver from the Walker administration that would require Medicaid enrollees to take on additional cost-sharing requirements, including co-pays and premiums.
“You are not alone with your concerns regarding Medicaid reimbursement,” said Democratic Health Committee Ranking Member, Rep. Debra Kolste, “Regarding the waiver, I’m concerned that if we move forward with this even more people will be taken off the Medicaid rolls. When you take people off of Medicaid rolls without changing some of the other dynamics, there are just going to be increases in costs for uncompensated care.”
Lawmakers believe additional federal support for Medicaid should be used to fund health care
Borgerding asked those that supported Medicaid expansion to 133 percent FPL, rather than the Medicaid expansion Wisconsin did to 100 percent FPL, what EXACTLY they would do with any additional funding from the federal government resulting from changing Medicaid eligibility.
Erpenbach said he would “plug some holes” where the Legislature has taken money from to put into Medicaid, but “at the same time, I would plow most of that back into reimbursement.”
“Reimbursement rates are important and I would spend a significant amount on reimbursement rates,” said Kolste. “But we can also use this for training to get more people to come back into the health care workforce. I think it is important to use this to increase reimbursement rates.”
But Sanfelippo cautioned attendees on this question, “We are talking about this as if in states that have taken Medicaid expansion it is chocolate and roses and it’s not. They’re having the same problems. In fact, they are having them to a greater extent than what we are having here in Wisconsin.”
“Well maybe Wisconsin should show every other state how it should work and how it can work,” responded Erpenbach to Sanfelippo’s comments. “We should at least try, and the fact that we have not at least tried goes against everything Wisconsin stands for.”
“I think we are. Wisconsin is the only state in the country without a coverage gap—the only state—even when comparing those that took the expansion,” said Sanfelippo. “You can’t say we aren’t leading the way—we are.”
In asking the question, Borgerding noted that many legislators who have supported full expansion in the past have been more interested in using the federal dollars for other state spending, not for Medicaid.
Panel: Worker’s comp program working well right now; panelists express opposition to fee schedule
Borgerding then asked the panel about a proposed medical fee schedule in Wisconsin’s worker’s compensation program, a proposal that has been before the Legislature now two times—never getting enough support to even move out of a Senate or Assembly Committee. The legislation would have government set reimbursement rates rather than having those reimbursement rates negotiated between a health care provider’s and worker’s compensation insurance carrier.
“I haven’t seen anything that leads me to believe that we need a fee schedule,” said Sanfelippo, garnering applause from the Advocacy Day audience.
“I don’t support it,” responded Testin.
“I’m a scientist, I’m driven by data and results. There is nothing currently that says we should change the system; it’s been working. If you change the levers in a system something will go out of whack,” said Kolste.
“We have a national model here in Wisconsin, and there’s absolutely no reason in the world to change it at all – right now or into the foreseeable future,” said Erpenbach. “This is one of those change for the sake of change things that is just way off target.”
Erpenbach continued, recognizing that this year’s fee schedule proposal failed to even have one single legislator put their name as an author or sponsor of the legislation. “There is a reason why legislators are not putting their names on this, and there is a reason why legislators will continue to not put their names on this; we don’t need to make a change at all.”