Here & Now

Health Sec. Designee Palm on Strategies For Medicaid

Zac Schultz:

A first look tonight. It’s back to school week in Wisconsin and while kids are making new friends, they’re also sharing germs and numbers from the State Department of Health Services show an increasing number of parents are opting out of immunizations for their children. More than 8% of all school children did not meet the minimum immunization standards, a number that has increased in recent years. County by county records show the number of kids who are protected from the measles varies from 70% to 90% and nowhere does it reach the recommended level of 95% immunization. Earlier this week, our guest on “Noon Wednesday” was Dr. James Conway. He explained why below 90% immunization puts Wisconsin at a greater risk for a measles outbreak.

James Conway:

The difference between 80% immunization coverage and 90% immunization coverage is enormous. And so that’s really what when we talk about vaccine initiative, for most diseases we want to be over 90%. For some diseases that are highly contagious, I mean measles which is what everybody’s talking about lately, is one of the most contagious diseases on the planet. And so for measles, you really want more than 95%, even 97% of the population protected because otherwise you’re very likely if cases get introduced that you will start into an outbreak situation.

Zac Schultz:

Joining us now is the Secretary-designee of the Department of Health Services Andrea Palm. Thanks for your time today.

Andrea Palm:

Thanks for having me.

Zac Schultz:

How much at risk is Wisconsin of a measles outbreak?

Andrea Palm:

So I think, like all states who don’t currently have a measles case in their state, it just takes one exposure to start an outbreak. So I think our folks at the Department of Health Services in partnership with our local health departments are very focused on making sure we are tracking and tracing any suspected case so if it ends up here in Wisconsin, we are prepared to limit its spread as quickly as possible.

Zac Schultz:

Democrats in the Legislature proposed a bill that would eliminate the personal exemption clause for parents. Republicans are not on board. How do you feel about a bill like that?

Andrea Palm:

So I think we need to use all the tools in our toolbox to increase immunization rates. I think one of the biggest challenges we face and it’s part of why you’re seeing an increase in personal exemptions is misinformation on the internet. So what we know about immunizations are that they are some of the safest and most tested medicines in the marketplace and they keep us safe. As Dr. Conway said, measles is highly contagious. The safest way to protect your family and to protect your community at that 95% rate is to get the measles vaccine.

Zac Schultz:

Given the importance of herd immunity and given the increasing number of personal exemptions, is that something that the state can risk or should we remove the exemption for public safety?

Andrea Palm:

So as you mentioned, there is a bill moving through the Legislature. We, like with all pieces of legislation, are absolutely interested in working with the Legislature to make sure it is as workable as possible. We obviously want to make sure that kids and families who have members who can’t be vaccinated because of medical conditions or other things, that those protections remain in place. But I think the more we lower the rate of personal exemptions, the more protected we all are.

Zac Schultz:

Speaking broadly about your department, Governor Tony Evers’ budget was originally built around a Medicaid expansion. That didn’t happen. What does that mean for DHS?

Andrea Palm:

It’s a great question. Medicaid expansion is a really important thing for us to do here in Wisconsin. 36 other states, 37 other states have done it. It would bring down, as you saw in our budget, a whole lot of new federal money that would allow us to make really important investments in other parts of the health care system. Not just in Medicaid, but in other parts of the system that would benefit all Wisconsinites. So we will continue to prioritize it, to push it. To bring that money home, that taxpayer money back to Wisconsin to spend on important things here. In the meantime, we’re very focused on making sure that folks who are eligible for BadgerCare know that they are, that they’re enrolled. That they get the services that they need and that we’re continuing to make improvements in the program so that it serves Wisconsin the best that it can.

Zac Schultz:

With the transition to a Democratic administration, we’ve seen other state agencies shift some of their priorities. Is that happening at DHS?

Andrea Palm:

So I think, as you suggest, all agencies are taking a look at where they’ve been, where they want to head to. I think we have a number of priorities at DHS. Things we will certainly continue to be working on are the opioid epidemic. The meth epidemic that we’re seeing in the northern part of the state. Those are really important things for us to continue to prioritize and try to get in front of. Reducing deaths from opioid overdose is a really important thing for us to do. I think we also are looking at things like the long-term care system, aging population, aging workforce. We know it’s coming. How are we making sure that we are responsibly and strategically ready to serve seniors as they age in their homes and their communities in the least restrictive setting that honors the choices they want to make about their aging. So that is a place we will be spending some time. As well as behavioral health. I mentioned the opioid and meth problems we have. I think mental health and behavioral health, substance abuse disorders, more broadly, are places where Wisconsin can really take a leadership role nationally. Integrating those kinds of services into health care so we’re reducing stigma. We’re encouraging people to seek the help they need and really making our health and wellness of our people better all the way around. So that’s another place where you’ll see some focus from us.

Zac Schultz:

Now we’ve seen news reports talk about Purdue pharma being in settlement talks with states over their role in the opioid crisis. How would you want to see Wisconsin spend any settlement dollars?

Andrea Palm:

The science on this is actually pretty good. We know, for example, medication-assisted treatment is the most effective method of treatment. So we’ve done, with federal and state dollars we’ve received over the last number of years, made real improvement in access to medication-assisted treatment but I think any sort of settlement that Wisconsin and other states might see, we’ve got to do more to increase access to treatment and medication-assisted treatment particularly. I think you see a lot of improvements in access to naloxone, which is the opioid overdose reversal drug. So if you’re actively in an overdose situation, administration of that will save your life. So while we need to get you into treatment, you got to make it through the overdose first. So increased access to naloxone would certainly be another place where we would want to see some ability to expand our resource allocation in that space. But I think there’s lots of work that can and should be done on the prevention side. That’s the ball game. If we can keep people from becoming addicted to these substances, you got less of a fight on the back end. So focus on prevention, on youth, on the demographics of folks who are more likely to become addicted. We need to focus prevention efforts there. And then once you make it through treatment, it’s a lifelong commitment and there are always moments where you need a little support. And so recovery and the services and the support that is necessary to help people maintain their sobriety over time are also important parts of the system that we could and should be focusing on to help people remain healthy and well once they get there.

Zac Schultz:

Under the lame duck laws, the Joint Finance would have to approve any settlement and they’d also have some control over how many of dollars were spent, whether they went back to the general fund. Have you had any preliminary conversations with Republicans about any potential use for those dollars?

Andrea Palm:

I have not, but again, I think there’s a really strong science base for the kinds of things that we could do to actually have real impact and that is certainly where I would want to start any conversation we have with them.

Zac Schultz:

So no member of the governor’s cabinet has had a confirmation vote by the Republican-controlled Senate. How has that impacted your ability to do your job?

Andrea Palm:

Different from the federal level, which is where I came from and am familiar with, I can serve in this role without being confirmed, without any sort of time limit. So I get up every day and I’m so happy to be at DHS and I’m grateful to have been nominated by the governor. I’ve tried really hard to build relationships with my colleagues in the Legislature, to be transparent, to be responsive, to make sure we’re doing good casework services for their constituents and talking to them about their policy priorities. So I am certainly hopeful that I will be confirmed and just get up every day and try to do my job the best that I can for the people of Wisconsin.

Zac Schultz:

In just a few seconds, do you think holding off confirmation gives Republicans any leverage over you?

Andrea Palm:

Well you know it’s never any fun to be called up in front of the Legislature to be accountable for x or y, but they have the ability to do that any day of the week. So I think building those relationships and having an open and transparent working relationship with them is the key to all of this.

Zac Schultz:

Andrea Palm, thank you for your time today.

Andrea Palm:

Thank you.