The Wisconsin Joint Finance Committee is scheduled Tuesday to work and vote on a budget for the Department of Health Services.
And according to a new report by the Institute for Reforming Government (IRG), Wisconsin’s state-based health care reforms offer a model other states can follow, save taxpayers money, and represent zero coverage gaps.
For the majority of the population not on Medicaid, the Wisconsin Institute for Law and Liberty (WILL) has proposed seven reform measures, which have received bipartisan support, to lower costs and increase access to care.
“While liberals and conservatives might not always agree on the means, we are often concerned about the same ends – lowering costs and increasing access to care,” Will Flanders, WILL’s director of research and co-author of the report, said. “This new report tries to provide ideas with unique appeal that could move the ball towards addressing those concerns.”
After former Gov. Scott Walker and the Legislature reformed the state’s Medicaid program, BadgerCare, in 2014, “everyone living in poverty in Wisconsin has access to health care services providing full benefits for the first time in history,” the state’s Department of Health reported.
“With an innovative approach to Medicaid reform to address the specific needs of Wisconsin, residents at all income levels have access to health care coverage either through employer-sponsored or private insurance, a public assistance program, or the health insurance marketplace,” Michael Heifetz, the state agency’s Medicaid director, said.
As a result, IRG argues, “Wisconsin’s reforms stand as a clear example of state-based reform providing better solutions than the federal government ever could. Rather than take federal money that leaves the state of Wisconsin – and its taxpayers – on the hook for future obligations as federal support could decrease.”
According to the National Conference of State Legislators (NCSL), 26 states have expanded Medicaid through the Affordable Care Act.
Of the rest, 14 chose to not expand; voters in Idaho, Nebraska, and Utah chose to expand via a ballot initiative, but their states have not yet implemented an expansion; and eight states are “currently implementing expansion” through a CMS waiver.
“As other states continue to debate Washington’s costly Medicaid expansion, Wisconsin offers a beacon of hope in the form of bold state-based reform,” Rob McDonald, IRG’s chairman of the board, said.
The Centers for Medicare and Medicaid Services (CMS) approved the BadgerCare Reform Demonstration Project in late 2013. Effective on Jan. 1, 2014, it allowed the state to offer the Medicaid standard benefit plan to adults without dependent children who have household incomes of up to 100 percent of the federal poverty level. BadgerCare also provides health coverage to more than 178,000 childless adults with incomes below the poverty level.
In 2017, Wisconsin applied for an exemption waiver from Medicaid expansion, which CMS approved in late 2018. It includes the state implementing a new Health Risk Assessment (HRA) program “to help the state better identify and support high risk beneficiaries.”
Wisconsin is now among 17 states authorized to use Medicaid toward financing complete continuum of care for individuals combating substance use disorders, including full coverage of residential treatments, CMS notes.
Wisconsin is also now only the fourth state operating a community engagement program that helps incentivize working-age adult beneficiaries to participate in activities like job training and employment, CMS notes.
“Wisconsin’s uninsured rate is one of the lowest in the country – 5.8 percent without expanding Medicaid – and the state is one of just a handful with no coverage gap,” the WILL report states. “Yet, Wisconsin voters in 2018 ranked healthcare as their top issue.”
The WILL report recommends that the state allow for direct primary care to reduce costs and increase access to healthcare. Direct primary care cuts out the insurance middlemen and allows patients and doctors to decide on care through transparent, up-front prices, the report argues.
Other suggestions include creating a dental therapy license, reforming retroactive eligibility for Medicaid, and allowing Wisconsinites to purchase insurance plans offered in U.S. territories, and take full advantage of short-term limited duration plans.
WILL also recommends that legislators support “free speech in medicine,” which allows for access to information about off-label uses of prescription drugs. The FDA currently prevents drug manufacturers from doing so. WILL also urges the legislature to repeal the minimum markup on prescription drugs, which prevents retailers from selling prescription drugs below cost.
Despite the success of the state program, Gov. Tony Evers and Democrats in the legislature wants to expand Medicaid in Wisconsin under the Affordable Care Act. Lawmakers will debate that at Tuesday's hearing.