2018 Elections: What’s at Stake for Wisconsin’s Health Care

Who gets elected this fall could impact the state’s health care environment – and your organization

September 18, 2018

“Health care dwarfs every other issue in this election. Voters care about access to health care for their families—and cost.” 

That was the message from WHA President/CEO Eric Borgerding at the Wisconsin Health News (WHN) panel discussion about what’s at stake for Wisconsin families and the health care industry in this fall’s elections.  

Borgerding was part of a WHN Newsmakers event that included Wisconsin Medical Society CEO Bud Chumbley, MD; Wisconsin Primary Health Care Association CEO Stephanie Harrison, LeadingAge Wisconsin CEO John Sauer, and Wisconsin Association of Health Plans CEO Nancy Wenzel.

Bottom line:  who gets elected this fall could further Wisconsin’s efforts to stabilize its health care market, and it’s important to maintain comprehensive coverage for Wisconsin’s low-income citizens to keep costs in check.

The panel tackled a number of issues including:

  • Efforts to repeal the Affordable Care Act (ACA) or strike it down as unconstitutional
  • Medicaid expansion
  • Requiring drug testing and/or co-pays for Medicaid participants
  • Block grants
  • Workforce needs

Repealing the Affordable Care Act. Tim Stumm, WHN editor, moderated the discussion and asked the panel for their thoughts on Congressional efforts to repeal the ACA, and the Trump administration’s support to do so.

In response to repealing the ACA, speakers noted that Wisconsin is a leader in health care innovation and has taken great strides to maintain comprehensive coverage for Wisconsin’s low-income citizens. Borgerding noted the coverage aspects of the ACA have been in place since 2014, and Wisconsin has seen a nearly 50 percent reduction in its uninsured rate. “Sustaining Wisconsin’s coverage gains needs to be priority number one going forward,” Borgerding said.

“It is not easy to repeal Obamacare as some of those that have been its staunchest opponents have learned, sometimes stingily. If Obamacare is going to be legislatively repealed, you’re going to have to have a Congress that looks different than what it looks like today,” said Borgerding. (See Borgerding’s previous column, Unwind Obamacare with Caution.)

Dr. Chumbley remarked that many may think repealing ACA would lower the cost of health care, but says that’s not true. Nancy Wenzel said there needs to be an alternative to comprehensive health care coverage in place because repealing could leave behind a more fragmented market, which was echoed by Stephanie Harrison who said the ambiguity of repealing the ACA would be difficult to manage. 

The panel was also asked about the lawsuits to strike down the ACA and what would happen in Wisconsin if the courts were to rule the ACA unlawful.

“The governor and Legislature have taken ‘a rational approach’ toward the Affordable Care Act,” Borgerding said. He cited bipartisan support for legislation preserving pre-existing condition coverage and a $200 million reinsurance program meant to stabilize the individual market. “I’m optimistic, I’m not going to say certain, that Wisconsin would step up to the plate and do something as quickly as it possibly can because we have a predisposition for already being willing to do that,” he said. 

Wenzel said Wisconsin has taken steps to stabilize the impact of the ACA and the exchange, and noted, “that’s a lot of important health care policy that…has been implemented and efforts to stabilize the impact of all of those elements are in place.  So, what we [would] have to do in Wisconsin is do what we always do—we find a way to get all the parties together, roll up our sleeves, and approach tough challenges in a bipartisan way.”

Expanding Medicaid.  The panel also pondered the idea of expanding Medicaid in Wisconsin. As reported by WHN, “…Borgerding predicted at a Wisconsin Health News event Tuesday that if Evers is elected governor, the Legislature will likely receive a budget bill that expands the program.”

Borgerding stressed that if the Legislature considers expanding Medicaid in the State’s next biennial budget, WHA will be adamant that the extra dollars are directed toward maintaining access and coverage of quality health care in Wisconsin. “They’re not to be used for whatever else, you can take your pick, is in the budget,” he said. “Those dollars are for health care, and voters agree.”

Sauer noted that Wisconsin has led the way in Medicaid innovation, and there isn’t any “fat to squeeze” from the program. He also remarked that Wisconsin is an older state and will see the number of people with dementia double in the next 20 years.

Medicaid Drug Testing or Co-Pay Requirements.  WHN asked the group for their thoughts about requiring a co-pay or some sort of premium in the Medicaid program, or drug testing requirements.

Borgerding said a co-pay would have a minimal impact because those enrolled in the Medicaid program are at 100% of the federal poverty level.  

“People will come to the emergency department and will get treated….it’s not a disincentive,” said Borgerding.  “These are individuals with a very low income.  I’m ok with people, health care consumers having some skin in the game—personal responsibility.  But health care providers shouldn’t be left to bear the brunt. I agree with the idea philosophically, but it shouldn’t be on the back of safety net hospitals.”

WHA has consistently advocated that co-pays should be payable to the State and that premiums for those in Medicaid be actually payable. (See WHA’s comment letter on WI’s 1115 Medicaid waiver.)  

Medicaid Block Grants. WHN followed with discussions about reinstituting block grants for the Medicaid program.  While block grants seem to be flexible, that flexibility has to be adequately resourced, Borgerding remarked.

“With flexibility must come resources. This is a position Governor Walker and other advocates for block grants have taken, and one that WHA strongly agrees with if we go the block grant route,” Borgerding responded. “WHA was heavily engaged in the repeal and replace debate, advocating for provisions in the Graham-Cassidy-Heller-Johnson bill that would have provided about $5 billion in additional Medicaid funding through 2026 along with block grants.” (See Borgerding’s previous column, The AHCA’s Painful Contradiction.)

If the Medicaid program were to reinstitute Medicaid block grants, Sauer said the federal government must also release Wisconsin from many of the cumbersome rules and regulations, or the State and providers will have no flexibility in administering the Medicaid program.

Workforce Needs. The last topic of the WHN event was the issue of health care workforce needs.

Borgerding said, “We asked our hospital and health system CEO members what are the issues that threaten your ability to provide high-quality care. The top issues, in this order, were workforce, insurance market stability and government reimbursement; workforce being at the top of the list. We’ve always approached this as yes, it’s trying to get more people into the workforce, more people into those pipelines, [a] ‘numbers game.’ But it’s also, in addition to that, trying to use public policy and the regulatory process to make sure that we are able to leverage the health care providers and practitioners and caregivers that we have right now in the system.”

In addition to taking the two-prong approach of getting more people into the pipeline and building upon public policy successes such as the Graduate Medical Education program, WHA will advocate in the upcoming biennial budget for regulatory reforms that induce expansion of telemedicine in Wisconsin.

WHA is putting together a robust agenda to change the regulatory environment and Medicaid reimbursement for telemedicine in Wisconsin. Borgerding noted the Medicaid program spends $75 million each year on transportation for patients, and appointments could instead be conducted using telemedicine technology, ultimately saving the State millions of dollars.

For more information and comments from the WHN 2018 election event:

This story originally appeared in the September 18, 2018 edition of WHA Newsletter