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Wednesday, Dec. 8, 2010

Health Care Law Implementation Moving Ahead in Wisconsin

Walker and Van Hollen vow to sue, but insurance exchanges are being studied and debated

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Although Gov.-elect Scott Walker has promised to block federal health reform from being implemented in Wisconsin, he seems to be giving his blessing to it at the same time.

As he promised during his campaign, Walker will allow Attorney General J.B. Van Hollen to sue to prevent portions of the federal health care bill from being implemented in the state. Walker and Van Hollen both oppose the requirement that individuals purchase “minimum essential coverage” for themselves and their dependents.

But that isn't stopping the federal and state governments from moving ahead with reform.

Some portions of the federal bill have already gone into effect. Small businesses that provide insurance for their employees are eligible for a tax credit this year; seniors are eligible for $250 to help fill the Medicare Part D donut hole; young adults can be covered by a parent's policy; insurers cannot refuse to cover children with pre-existing conditions; insurers are barred from rescinding coverage from someone who becomes sick; and lifetime and annual limits are eliminated.

And despite Walker’s very public opposition to the “minimum essential coverage” requirement, it doesn’t mean that he wants to completely block the bill’s implementation in the state.

In fact, Walker seems to support the requirement that states must set up health insurance exchanges in which individuals and small businesses may purchase coverage. In these exchanges, consumers could use federal subsidies to purchase private insurance policies that are approved and regulated by the state or another entity. If a state doesn’t implement an exchange, the federal government will do so and the state could lose hundreds of millions of federal dollars.

Just last week Walker wrote to President Barack Obama saying he’s already got ideas about how Wisconsin’s exchange should operate.

“It is my hope that your administration will allow Wisconsin to take a free-market, consumer-driven system approach under the health care exchange provisions of the federal act,” Walker wrote to the president.

Walker’s transition office didn’t respond to the Shepherd’srequest to clarify the governor-elect’s position on health care reform.

Neither has his transition team given direction to a special committee set up by the state’s Legislative Council to study how to implement health care reform in the state and then forward its recommendations to the state Legislature.

Committee members include Democratic and Republican lawmakers plus a broad spectrum of experts on health care, representing the interests of consumers, health care providers, insurers and workers. Members include Robert Phillips, medical director, government relations at the Marshfield Clinic; William Petasnick, president and CEO of Froedtert Memorial Lutheran Hospital; Wendy Arnone of UnitedHealthcare of Wisconsin; Tim Bartholow, senior vice president at the Wisconsin Medical Society; Robert Kraig, executive director of Citizen Action of Wisconsin; Candice Owley, head of the Wisconsin Federation of Nurses and Health Professionals; David Newby of the state AFL-CIO; David Riemer, director of Community Advocates Public Policy Institute; Robert Palmer, CEO of Dean Health Plan; and Joe Leean, a former Republican lawmaker who implemented BadgerCare when he served as secretary of Health and Family Services under Gov. Tommy Thompson.

Sen. Darling Repeats Health Care Myth

The committee, chaired by state Sen. Jon Erpenbach (D-Middleton) and state Rep. Jon Richards (D-Milwaukee), met twice before the Nov. 2 gubernatorial election. The committee even brought in experts from Utah, which has its own version of a health insurance exchange.

But the committee’s work almost ground to a halt during its Nov. 9 meeting, when two Republican members—state Sen. Alberta Darling of River Hills and state Rep. Pat Strachota of West Bend—wondered why they were even convening at all.

Strachota said that since the committee had been set up while Democrats controlled both houses of the state Legislature, it would not be effective now that Republicans were in charge.

“Would we be the group that the new Legislature would choose?” Strachota asked the top-flight experts and her fellow lawmakers.

Darling said that the country had spoken on Nov. 2 and that she didn’t think the committee should proceed until after the new governor and Republican-led Legislature took over in January.

“We do not want to launch a government-run system,” Darling said.

Darling seemed to come around after Froedtert’s Petasnick suggested that the exchange should be built around plural markets, meaning that multiple private insurers could participate in it. He also suggested that the exchange should be governed by a third-party entity that’s isolated from politics.

“At least we’re not talking about government-run health care,” Darling said.

(Darling did not respond to the Shepherd’s request to comment for this article.)

Proceeding With Reform

Committee co-chair Richards told the Shepherd that it’s “nonsense” to believe that Walker’s election meant the end of the committee. He said Van Hollen’s potential lawsuit—which he called “frivolous” and “politically driven”—had no impact on the committee’s study of how the federal law could be implemented in Wisconsin. He also said that he hoped that Walker’s health care team would discuss their views with the committee.

“To address the crisis that we have with the cost of health care, it’s going to require everybody at the table,” Richards said. “That’s what we have with this committee. The questions should be answered publicly and accountably and it needs to be done now. I will fight any attempt to move this discussion to a backroom or to put it off for another year or another decade.”

He said that while Walker’s team hadn’t contacted him yet, he felt that the committee could come up with recommendations that would meet Republicans’ approval.

“I think there’s broad consensus within this committee that we want to have a pluralistic health care system,” Richards said. “We want to give people choices. That means that we have a strong private sector insurance market still in the mix providing health insurance for Wisconsinites.”

Kraig, of Citizen Action, said that Walker’s openness to a free-market-friendly health insurance exchange is in line with other Republican plans, including the exchange in U.S. Rep. Paul Ryan’s very conservative “Roadmap for America’s Future.”

Kraig said about 80% of Ryan’s proposed exchange is in sync with the committee’s discussions thus far.

“The question is whether you can negotiate on the other 20%,” Kraig said.

He said Wisconsin would miss a huge opportunity—and up to $900 million in federal subsidies to reduce health care costs—if it fails to implement an exchange.

“If we don’t do it, we would have double-digit rate increases and health care would be unaffordable in this state,” Kraig said. “So we have a huge incentive to do this. We need the provider community and advocates and other leaders to come together in a public and transparent process.”

The committee’s next meeting will be held on Monday, Dec. 13, in Madison.

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