Bills would impede Gov.-elect Tony Evers’ changes to health care

December 5, 2018 GMT

Gov.-elect Tony Evers would be hamstrung to make some big health care changes under wide-ranging bills to be taken up Tuesday by the state Legislature.

Two dozen health care organizations — including UW Health, the Wisconsin Hospital Association and the Wisconsin Medical Society — said they have “significant concerns” about the legislation’s “numerous changes to an already complex $9 billion Medicaid program.”

The bills would require Evers and fellow Democrat Josh Kaul, elected last month as attorney general, to get approval from the Republican-controlled Legislature to withdraw Wisconsin from a federal lawsuit seeking to overturn the Affordable Care Act, also known as Obamacare. Evers and Kaul have said they plan to drop the state from the suit when they take office on Jan. 7.


Republicans said they’ll approve other protections for people with pre-existing conditions. But health care advocates said such protections fall short by letting insurers avoid key benefits and set annual or lifetime caps.

“This is no substitute for the consumer protection language in the ACA,” Bobby Peterson, executive director of ABC for Health, a nonprofit public interest law firm in Madison, said in a statement.

Under the bills, the state Department of Health Services would have to require some childless adults on Medicaid to pay premiums and co-pays, take health risk assessments and work or lose coverage after four years. Those are chief components of Gov. Scott Walker’s Medicaid waiver approved in October by the Trump administration.

Evers has said he might not implement the work requirement, by revising the waiver with the federal government. Work requirements have been approved in four other states, including Arkansas, where the measure has led some 12,000 people to be removed from the rolls.

A letter Monday from 24 health care groups, including many of the state’s largest health care systems and insurers, said they haven’t been included in the process. The bills could have unintended consequences, they said.

“Rather than simply codifying (Walker’s Medicaid waiver), the legislation appears to be more restrictive than the waiver itself, which could create unforeseen implementation challenges that negatively impact the Medicaid program and its members,” the letter said.


The health department would also have to get legislative approval to make significant changes to Medicaid, including reimbursement rates and payments to providers.

The bills “would make it more difficult and time consuming to make technical changes (and) adjust programs to make them more responsive to state needs,” Beth Swedeen, executive director for the Wisconsin Board for People with Developmental Disabilities, said in a statement.

Evers’ administration couldn’t change Walker’s reinsurance plan, which aims to keep premiums down on the private health insurance marketplace by covering large claims.

The Legislation would add four members, appointed by the Legislature, to the 11-member Group Insurance Board, which oversees benefits for state workers. The Senate would confirm the governor’s six appointees.

Walker has vetoed such changes to the insurance board — including last year, when his bid to self-insure state workers was rejected by the Joint Finance Committee.

“I do not believe that they should micromanage plan design, contract negotiations and the financial and programmatic management of the program,” Walker said at the time.