Evers Enacts State Budget with 78 Line-Item Vetoes

July 09, 2019

Governor Tony Evers signed his first biennial budget into law on July 3, using his partial veto authority to change or delete 78 different items with varying impact on process and policy. State agencies will now begin implementing the state budget, which will be law through June 30, 2021.

“The enacted state budget includes a number of WHAadvocated priorities that will help improve access to health care across Wisconsin,” said Eric Borgerding, WHA President. “The final product reflects the overall priority that Democrats and Republicans place on health care, and WHA recognizes and appreciates both the Legislature and the Governor for their work.”

Below are areas addressed in the final enacted budget that impact WHA’s legislative agenda:

  • Overall Medicaid Funding: The Governor funded the $886 million Medicaid cost-to-continue, making a small adjustment to reflect updated Medicaid spending projections in his veto message. This marks the fourth straight budget in which the cost of continuing the Medicaid program has been fully funded, with no cuts to base funding. This is not the situation in many other states and should never be taken for granted. More so, overall the enacted budget boosts Medicaid spending by $510 million in state dollars (GPR) and about $1.4 billion in all funds (i.e. state dollars and matching federal dollars) in the coming biennium.
  • Disproportionate Share Hospital Program (DSH): The Governor approved the WHA-backed funding increase for DSH in the Legislature’s budget but vetoed the Legislature’s earmark of $60 million GPR ($147.8 million all funds) over the biennium. Instead, the Governor’s veto will “allow the Department of Health Services the flexibility to determine the amount of additional funding under the Disproportionate Share Hospital supplemental payments to hospitals.” The Governor retained the increased DSH cap that was included in his original budget, ensuring that currently capped hospitals can participate in the coming, but yet-to-be-determined, DSH increase. WHA will work with the Wisconsin Department of Health Services (DHS) and policymakers as work moves forward to implement this provision.
  • Rural Critical Care Program (RCC): The Governor approved the WHA-backed RCC, including the Legislature’s full increase for the program, which provides a significant reimbursement boost to rural hospitals that do not meet certain qualifying criteria for DSH. Under the signed budget, funding for the RCC increases from $1.2 million to $10 million all funds over the biennium, an increase of more than 800%, while expanding the number of hospitals that will qualify.
  • Telehealth: The Governor approved WHA-proposed telehealth reforms, including adding provider-to-provider consultations and remote patient monitoring as covered services in Medicaid.
  • Broadband Expansion: The Governor approved the Legislature’s $44 million in funding for broadband expansion in rural Wisconsin, an important ingredient in expanding access to care through telemedicine.
  • Graduate Medical Education: The Governor approved, without veto, WHA-proposed changes to the Graduate Medical Education grant program that will result in training more primary care physicians, psychiatrists and other in-demand specialty physicians who will practice in Wisconsin.
  • Health Insurance/Coverage Navigators: The Governor approved the full $1.1 million for health insurance outreach and education, which originated in his budget proposal and made its way through the legislative process. WHA was a strong proponent of these additional resources that help expand coverage and connect the nearly 50,000 people currently eligible for Medicaid and the estimated 240,000 people currently eligible for subsidized insurance on the Affordable Care Act (ACA) marketplace who have not enrolled in either program.
  • Health Insurance Premium Stabilization: The Governor approved full funding for Wisconsin’s share of the Healthcare Stability plan, which helps stabilize and actually reduce premiums for those who purchase coverage on the ACA marketplace and helps maintain Wisconsin’s low uninsured rate. In part because of this program, premiums on the marketplace in Wisconsin actually declined by 4.2% in 2019.
  • Special Needs Dental Services: The Governor approved the Legislature’s $2.5 million all funds in Medicaid reimbursement increases for dental services for those with disabilities. While not specified in the budget bill, the Governor’s previous budget documents state the increases are for patients needing treatment in higher cost settings, including hospital operating rooms.

State budget advocacy begins well before the Governor gives his budget address in February. During the last 12 months, WHA councils, task forces and work groups were not only involved in developing policy recommendations, but their work—along with WHA’s lobbying and advocacy efforts—led to key WHA-crafted policies becoming incorporated into Wisconsin’s two-year state budget.

“I can’t say enough about the advocacy effort mounted by WHA and our members over the past several months,” Borgerding said. “That hard work helped deliver a budget bill that will improve access for vulnerable populations in every corner of Wisconsin.”

WHA’s advocacy arm supported direct lobbying in the state capitol through a variety of means including 2,500 HEAT member emails into the capitol, more than 500 Advocacy Day attendees meeting with 130 state elected officials, 10 HEAT Roundtables in state legislator’s districts, in-person testimony from hospital leaders at all four Joint Finance Committee public hearings, over 100 hospital leaders signing onto written budget committee testimony, and more than two dozen personalized letters sent to the Governor from hospital leaders over the past week as he considered final action on the budget.

For more questions about the budget, contact Kyle O’Brien at 608-274-1820.

This story originally appeared in the July 09, 2019 edition of WHA Newsletter