Here & Now

Healthcare Expert Breaks Down Walker's New Plan For Wis.

Frederica Freyberg:

Now back to Governor Walker’s State of the State address and his proposals to tweak health care coverage in Wisconsin.

Scott Walker:

The biggest concern I hear about as I travel the state is from those who are worried about pre-existing conditions. With this in mind, I propose that we enact a law in Wisconsin that will guarantee coverage of pre-existing conditions.

[applause]

Frederica Freyberg:

Guaranteeing coverage of pre-existing conditions is one prong of what Governor Walker calls the Health Care Stability Plan. Under the plan, he would also seek a waiver to make the prescription drug assistance program, SeniorCare, permanent. And he calls for giving $200 million in state and federal money to insurance companies to hold down premiums. Bobby Peterson is the executive director at ABC for Health, a public interest law firm that helps people connect with health care coverage. Thanks for being here.

Bobby Peterson:

Glad to be here.

Frederica Freyberg:

I want to take these prongs of his plan one by one and see what they do and don’t do. On guaranteeing pre-existing coverage, doesn’t the ACA, which is still in effect, do that right now?

Bobby Peterson:

Yes, it does. So it’s a bit of window dressing what the governor has proposed, but also in case the ACA would ever get repealed, it would help partially Wisconsin folks that may have pre-existing conditions avoid certain limitations to access in coverage.

Frederica Freyberg:

So how would it compare what’s in the governor’s plan now to what existed in Wisconsin before the Affordable Care Act?

Bobby Peterson:

Well, before the ACA — and I was a practicing attorney and I represented people — it was pretty bad because pre-existing condition was a limiting factor for people to secure coverage. Insurance companies did reviews of your health status. If you didn’t reflect your information, what they considered to be accurately, you could be denied. So it was pretty bad back then. This will be a step in the right direction. The ACA was a major step in the right direction. What Governor Walker did is just create a backup to the ACA, but it’s not even as good as what the ACA provides.

Frederica Freyberg:

So could it end up if in fact the ACA were repealed and the state decided to go along with this plan, would it or could it cost consumers more?

Bobby Peterson:

It could. It could just because there’s gaps and you have to maintain coverage, continuous coverage, for it to apply. So it’s not a blanket pre-existing condition limitation. There are some holes in the process.

Frederica Freyberg:

And yet I would imagine that people herald it in the event that ACA is repealed.

Bobby Peterson:

Right. It was not originally proposed by the Democrats. The Republicans tweaked it a little bit. It passed the Assembly, not the most satisfactory version of it, but this is what Governor Walker is proposing that we extend.

Frederica Freyberg:

On SeniorCare, the governor would seek to make it permanent instead of having to apply for this waiver to extend it every four years. But it should be mentioned this comes after he twice tried to reduce SeniorCare by about 40%. What do you know about the mechanics of being able to make it permanent?

Bobby Peterson:

Doesn’t appear at this point that there is a mechanism under federal law to make it permanent. So he would have to go through some extra hoops I think to make it permanent. It’s unclear at this point. But it is interesting that he fought against the program two separate times and now he’s become a fan of it, which, you know, he should because it’s a good program for Wisconsin seniors. It helps a lot of seniors receive affordable prescription drugs. It’s got strong bipartisan support. So I'm not surprised that the governor is endorsing it now. A little late, but he is endorsing it.

Frederica Freyberg:

Tremendously popular program. How would you rate it in terms of its popularity of programs?

Bobby Peterson:

I think it’s very popular. I think it’s one that a lot of people need. Prescription medication is an increasing part of people’s lives. The expense of drugs is important and SeniorCare provides a buffer to help folks with that.

Frederica Freyberg:

As to the $200 million reinsurance program to hold down premiums, the governor talked about a Wisconsin woman who saw her premiums go up by almost $2,000 a month under an Obamacare individual plan. What kind of person or what kind of plan could that be, could you imagine?

Bobby Peterson:

Hard to say. It’s very based on county, based on age, based on, you know, your status. So it’s really hard to pin that down. But I think the reinsurance mechanism that Governor Walker is proposing, again, is probably something that we can use. It addresses the cost of health insurance, but not the cost of health care. That’s an important distinction. Because health care costs can keep going up. You subsidize insurance companies against this risk it doesn’t mean you’re dealing with the cost of health care. It’s state money. And interestingly, he’s going to be accepting federal money. That is something he has opposed in the Medicaid expansion area, where he could secure a lot more federal money if he accepted the Medicaid expansion.

Frederica Freyberg:

Right. And so this money goes to insurance companies. I’ve read elsewhere that there’s no guarantee that those insurance companies would then pass that along? Or would that be something that would have to be part of that plan?

Bobby Peterson:

It will be interesting to see the legislation when it comes out how they propose to implement it. But insurance companies are under a variety of different pressures, including marketplace pressures to make their products competitive in the marketplace. So there could be market pressure that helps as well to keep some of the prices down.

Frederica Freyberg:

Speaking of market pressure and upward pressure, the governor said that Affordable Care Act premiums are averaging increases in the 36% range. Is that what we’re seeing in Wisconsin?

Bobby Peterson:

It's close to that in some situations. But I think that — again, it’s different depending on where you live and the competitive pressures within your region of the state.

Frederica Freyberg:

And with those increases, I mean, we’ve been doing some kind of research on the latest numbers in the ACA marketplace in 2018. My understanding is that subsidies still in place within the ACA help offset those increases.

Bobby Peterson:

That's right.

Frederica Freyberg:

How accurate is that?

Bobby Peterson:

That's true. That — for lower to moderate income folks those subsidies or tax credits are still available. They’re very helpful. They mitigate a lot of the increases that we see for health insurance rises in the marketplace for that population.

Frederica Freyberg:

And yet it could be people that are kind of outside the eligibility income ranges for those tax credits or subsidies that get hit the hardest?

Bobby Peterson:

Correct. Right. Those are the folks that may be affected by increases that are not eligible for the tax subsidies because of their income. So they’d bear the brunt of those increases.

Frederica Freyberg:

Now, just lastly, and with about a half a minute left, how in your mind does all of this square with Governor Walker’s previous inclinations when it comes to the Affordable Care Act?

Bobby Peterson:

It's a 360 in some ways because he viewed the Affordable Care Act as radioactive so anything related to it he was opposed to. He was opposed to consumer protection to help people navigate the system, which is an important element in terms of helping people get the coverage they need. Cost is one factor, but navigating the system is really important. And not helping with that is a major deficit in his plan. It’s an about-face. I’m encouraged that at least he seems to be listening more. I think he has to listen harder now to the folks out there that are struggling to connect to the coverage and get those services.

Frederica Freyberg:

All right. Bobby Peterson, thanks very much.

Bobby Peterson:

You're welcome.

Frederica Freyberg:

With health care and specifically the Affordable Care Act top of mind, multimedia journalist Marisa Wojcik brings us these fast facts on 2018 enrollment in Wisconsin now that the open period to sign up has closed.

In Wisconsin, 15,291 fewer people selected plans on the healthcare.gov marketplace in 2018 versus 2017. Federal funding will no longer go toward the cost-sharing reduction program, which is causing premiums to rise. But other federal subsidies increase as premiums increase for those who are eligible. A Wisconsin consumer on the benchmark plan will pay an average of $201 more per month before subsidies in 2018 versus 2017.

Expert Donna Friedsam says despite increases in premiums because the federal government ended cost-sharing payments last year, consumers eligible for subsidies were largely protected because their subsidies increased.