State Budget, Price Transparency Covered at WHA’s Public Policy Council Meeting

Future of Governor’s Proposed Budget a Focus of State Advocacy Discussion

March 12, 2019

During the March 7 meeting of the WHA Public Policy Council, WHA President and CEO Eric Borgerding and Senior Vice President of Government Relations Kyle O’Brien led a state-level advocacy discussion centered around the recently proposed Governor’s budget, which includes an expansion of Medicaid to all individuals living up to 133% of the federal poverty level and reimbursement increases for hospitals and health care providers. According to the Evers Administration, the Governor’s proposed budget uses an estimated $320 million in state savings to invest in health care.

Borgerding discussed the political dynamics at play between Evers and the Republican-led Legislature and its impact on the future of Medicaid initiatives proposed as part of Governor Evers’ budget.

“Whether they are using the argument to support or oppose Medicaid expansion, lawmakers of both parties are agreeing that Wisconsin’s Medicaid reimbursement rates for hospitals negatively impact access for patients and drive up the cost of health care for our state’s employers,” said Borgerding. “As WHA has done every legislative session, we will continue to pursue an agenda with the Governor and the Legislature that finds bipartisan solutions to improve reimbursement, reduce cost-shifting, expand access and stabilize insurance markets in Wisconsin.”

So far in 2019, O’Brien reported that 10 WHA-initiated hospital roundtable meetings have taken place in state lawmakers’ districts to show how reimbursement is impacting the ability to expand access and reduce costs for patients. 
According to O’Brien, WHA will continue this broad “bottom-up” approach to advocacy, engaging Democrats and Republicans in the Legislature to support the Association’s budget agenda.

WHA to Restart Transparency Task Force; Price Transparency, Surprise Billing Remain Federal Policy Issues
WHA Vice President of Public Policy Lisa Ellinger and Director of Federal and State Relations Jon Hoelter presented on WHA’s internal work on price transparency and recent federal focus on “surprise billing.”

Ellinger provided background on WHA’s Transparency Task Force (TTF), which was created in 2015 to prepare WHA members for impending Affordable Care Act transparency requirements. The first objective of the TTF was creating tools and education on these new federal requirements, and the second was to analyze ways providers and payers could work together to improve the process for patients to understand their out-of-pocket costs for health care services. A subcommittee of the TTF, which included insurer representatives, developed a pilot project to identify challenges with creating price estimates, identify successful models, and share best practices. The TTF will again reconvene in 2019 to review the results of this pilot and prepare final recommendations.

Hoelter then provided an overview of how the concept of transparency in health care is translating to public policy debates in Congress, including last year’s focus on prescription drug pricing transparency. While prescription drug pricing is expected to continue to be a hot topic in this new session, federal lawmakers are also starting to focus on surprise billing and hospital price transparency. Additionally, last year’s inpatient rule requiring hospitals to post machine-readable chargemaster data online may be only the first step in a larger transparency initiative from CMS that could carry forward this year. 

The Council also discussed how Wisconsin continues to lead the way in price and quality transparency, being the first state in the country to develop an online hospital price transparency tool that is now leased out to 10 states. Wisconsin’s PricePoint website, operated by the Wisconsin Hospital Association Information Center, also provides patients with how-to videos and professional/ancillary fee cost estimates in addition to hospital prices.

Finally, Hoelter walked through the American Hospital Association’s guiding principles on surprise billing, which were presented to a bipartisan group of Senators who had asked for feedback on how Congress might help reduce the occurrence of patients receiving “surprise bills.” Hoelter and Ellinger invited the Council to pass along any ideas their hospitals and health systems may have as the Task Force reconvenes, and this topic progresses at the federal level.

If you have any questions, contact Ellinger or Hoelter.

Wisconsin Health News’ Tim Stumm Joins Public Policy Council as Guest Speaker
Tim Stumm, founding editor of Wisconsin Health News (WHN), joined the Council as a guest speaker to provide background on WHN and offer his observations on how Governor Evers and the Republican-led Legislature may find common ground on health care issues this legislative session. 

Stumm launched the nonpartisan, online news service eight years ago to delve deeper into important health care issues impacting Wisconsin. In addition to its daily electronic publication, WHN hosts regular events with health care professionals and policymakers about issues that matter to Wisconsin’s health care leaders—and WHA is a proud sponsor of key panel discussions, such as the annual CEO roundtable.

Stumm expects some issues in Wisconsin’s upcoming budget session will have bipartisan support, such as dental therapy, increasing Medicaid reimbursement rates, and opioid proposals. Stumm also noted the significant differences that exist between legislative leaders and Governor Evers on Medicaid expansion, which remains one of the most hotly debated items included in Governor Evers’ budget proposal.  

Since 2018, Stumm has also covered Illinois health care issues through a similar news service to WHN called Health News Illinois. Stumm said an important difference between the two states is that health care leaders in Wisconsin are willing to work together, which is not always the case in Illinois. The Council also discussed the differences in health care policy issues that face hospital leaders and lawmakers in Illinois versus those in Wisconsin, including the state’s liability environment for physicians.

“That trait of unity and support is evident among our members and the composition of our Board; we have small and large, rural and urban hospital leaders working together to address critical health care issues facing our state,” said Eric Borgerding, WHA President and CEO.  “Another big difference is Wisconsin’s balanced medical liability system that allows us to attract physicians to our state, while also providing assurance to injured patients.”

This story originally appeared in the March 12, 2019 edition of WHA Newsletter