THE VALUED VOICE

A bipartisan panel of the state Legislature’s budget-writing Joint Finance Committee participated in a legislative panel for WHA’s virtual Advocacy Day event. The panelists’ discussion included several issues impacting the state budget as well as a lengthy dialogue on the impacts of Medicaid expansion in Wisconsin and what we have learned from a policy perspective as our state responded to the COVID-19 pandemic.
 
“Wisconsin tends to be an asterisk in all the white papers on Medicaid expansion,” said WHA President and CEO Eric Borgerding. “Medicaid expansion has known and unknown impacts on access, provider reimbursement and state revenues,” he noted. Borgerding asked panelists their position on the governor’s proposal to expand Medicaid coverage to people living between 100% and 133% of the federal poverty line.
 
“We’ve already made clear that we are not looking to expand our welfare system here in Wisconsin,” said Assembly Co-Chair Mark Born (R-Beaver Dam). “I think we showed last budget that we can make even larger investments in health care without having to expand the welfare program.”
 
“We have a low number of uninsured individuals in Wisconsin compared to other states,” continued Born. “If we do expansion, we take a good number of people on private insurance now and put them onto the welfare program. We think that is a mistake. We think it has negative effects on their access to health care and it has negative effects on how hospitals and doctors are reimbursed.”
 
Sen. Jon Erpenbach (D-West Point) disagreed with the description of Medicaid expansion as welfare expansion. “It’s not welfare, it’s health care,” said Erpenbach. “If you take a look at the amount of money the state has turned down by not expanding Medicaid, it is staggering. In this budget, if we expand Medicaid and provide coverage for individuals making $8 per hour, we will save $620 million in general purpose revenue.”
 
Sen. Dale Kooyenga (R-Brookfield) discussed a hybrid approach to Medicaid expansion. “Let’s get people out of the range of poverty or lower-middle class, so they don’t need Medicaid,” said Kooyenga. He outlined three conditions that could lead to a potential compromise on Medicaid expansion that would: 1) use Medicaid expansion funding to cut taxes for individuals and encourage people to move into the middle class; 2) create a solvency fund for Wisconsin’s Medicaid program in case the federal government cuts Medicaid; and 3) implement additional free market reforms related to overall cost that have been pursued in other states.
 
“Just having coverage doesn’t mean you have access,” said Rep. Evan Goyke (D-Milwaukee). “A number of people making $13,000 to $15,000 per year may have a workplace insurance program, but it doesn’t mean it is good insurance or provides quality access.”
 
Borgerding then asked the panel about the future of a state budget if it doesn’t include Medicaid expansion and the revenues associated with expanding Medicaid.
 
“I think the governor has built his budget around Medicaid expansion, and I’m not going to give up on that item,” said Goyke. “We need to have solvent and functional hospitals and providers around the state, so we need to make sure you are made whole by meeting the need for reimbursement rates.”
 
“Our focus will be on making investments,” said Born, disagreeing with Erpenbach’s previous assessment that Medicaid expansion is about health care. “It’s an insurance program; it’s not health care. Health care is what your hospitals provide. Health care is what doctors provide. Our focus is on access to health insurance to help people get access to the quality health care we have in Wisconsin and making investments in that health care—not seeing how we can grow the welfare system.”
 
“The money is there right now,” said Kooyenga to do many of these health care priorities.
 
In referring to WHA-led telehealth reform legislation signed into law as 2019 Wisconsin Act 56, Kooyenga highlighted his work as lead author of this legislation that provides additional coverage for services through telehealth. “I swear we did not have a crystal ball. That was obviously a godsend as we dealt with COVID, and we must do more of this. While you can’t replicate presence, you can provide more access based on using more telehealth type services,” Kooyenga observed.
 
Borgerding acknowledged the support by everyone on the legislative panel of recently enacted legislation in response to the COVID-19 pandemic, enacting various “lessons learned” including critical provider licensure reforms for providers licensed in other states to practice in Wisconsin.
 
Asked about additional lessons learned from COVID-19, Erpenbach reflected, “There were procedures that were put off, elective surgeries that were put off. A lot of things stopped, but what did not stop is the quality of care and the dedication of the heroes of health care. It didn’t stop with nurses; it didn’t stop with doctors; it didn’t stop with administrators—everyone was pulling together in a hospital to get us through this pandemic and reassure us.”
 
“A lot of sectors stopped,” Erpenbach continued. “A lot of our lives were put on hold. But not hospitals. Not doctors. Not nurses. Because they couldn’t.”
 
“WHA led with the data dashboard to give people a better understanding of COVID,” said Born. “The thing that struck me the most after talking to you, Eric, and the hospital leaders in my area, is people’s fear of going to the hospital and getting normal treatment and what that has done to put us behind on the care that people need. I’m not sure we know what the answer to that is if we find ourselves in a similar situation in the future, but it is certainly something that we need to work on. But I know our hospitals did everything they could with marketing campaigns to make sure people knew they could still get their care.”