Scott Walker:

I created a new acronym this week. I call it SINO, state-in-name-only. For any state who's running an exchange, it is state in name only. Because there's no substantive difference in terms of the requirements for a state-run exchange versus a partnership exchanges versus a federally mandated exchange.

Frederica Freyberg:

So we turn now to someone who is following this transition. He's the executive director of ABC for Health, a non-profit that helps people find healthcare coverage, Bobby Peterson. Thanks a lots for being here.

Bobby Peterson:

Thanks for inviting me.

Frederica Freyberg:

Governor Scott Walker says that there's no difference whether the feds do it, or the state partners with the feds, or the state does it themselves, except he points to the fiscal exposure to the state. Is what he's saying accurate?

Bobby Peterson:

I don’t believe so. I think there are opportunities for Wisconsin to put a little bit of a print on the exchange for states to address some issues that are unique to the state. And I think Governor Walker is wrong in his characterization. There is an opportunity for Wisconsin and an opportunity lost.

Frederica Freyberg:

People keep saying that. That we could put our mark on it. We could make it the Wisconsin way. But what does that mean exactly? What are you talking about?

Bobby Peterson:

For example, there has to be communication and linkages between the federal government and the state in terms of the Medicaid part of the exchange. Because, people that approach the exchange, that could be eligible for Medicaid, there has to be some cooperation and opportunities to make it as seamless as possible. Obviously, working together, they could make a very seamless link. The opportunity to brand this in a Wisconsin way for the exchange products that are on the exchange. I think it’s just– there are unique aspects that could be provided.

Frederica Freyberg:

So are you suggesting, for example, that if someone had a question they would be calling someone in the state instead of someone in Washington?

Bobby Peterson:

I’m hoping that the feds will set up, you know, a call center here in Wisconsin, and that we’ll have an opportunity still to influence it. I’ve talked to some federal officials that are encouraged and do want to work with local stakeholders yet. The details aren’t out yet, so we don’t know.

Frederica Freyberg:

I did wonder, too, don’t we trust the federal government to do this right by us?

Bobby Peterson:

Right. I think that at some point, you know, if the Walker administration doesn’t want to cooperate, doesn’t want to help build an exchange, doesn’t want people to access more affordable healthcare coverage in Wisconsin, then we ought to let the feds do it. And at some point it might end up being better.

Frederica Freyberg:

How costly might it have been if Wisconsin had decided to design its own exchange?

Bobby Peterson:

You know, federal money was available. In fact, Wisconsin turned back $38 million in money to help establish the exchange, to build the infrastructure, be a leadership state. So there were opportunities that were turned away. Consumer assistance dollars were turned away by the Walker administration. There may be some expenses. I think Governor Walker suggested 40 to 60 million dollars. I think that’s an overreach. There might be some expenses. But in the long run we’re looking at a system of creating an exchange where we concentrate on healthcare pooling, opportunities for coverage, reducing uncompensated care, and all that results in lowering uncompensated care and lowering healthcare costs. There's savings he isn’t looking on the back ends of things.

Frederica Freyberg:

Now there's another piece that’s out there that remains undecided, I understand, on the part of Governor Walker, and that is whether or not to accept additional federal Medicaid money going forward. He is concerned again that, you know, they’ll give you this money and then when it starts being reduced, it will end up exposing the state again to more costs than they anticipated. But if he decides not to take this money, where would that leave Wisconsin compared to other states?

Bobby Peterson:

Well, I think we would be at a big disadvantage, because there's 274,000 people that could benefit from this expansion. And those folks will continue using the emergency room. We have 144,000 people on a waiting list for the Core Plan, that are waiting in line for healthcare coverage. They’ve asked the state of Wisconsin to get into the Core Plan, stop sign is up. They need coverage, they need care. They can’t get it. So what happens, we all end up paying for a lot of those expenses anyway, through increased costs when unpaid emergency room care is provided. That’s expensive. That's, a lot of times, unnecessary. That could have been taken care of with prevention and primary care. So it’s short sighted on the governor’s– the governor’s thinking is short sighted and a real lost opportunity, not only for the state of Wisconsin, but for local taxpayers as well, because a lot of mental health services are paid for with local tax levy, and some of those could be covered by the new Medicaid expansion. So it has a statewide impact. Wisconsin gets very few federal dollars. This is a chance that could touch every county in the state, and it’s a real missed opportunity.

Frederica Freyberg:

Going forward, what will be your role as the Affordable Care Act continues to roll out?

Bobby Peterson:

Well, I think we are– none of us were ever entirely satisfied that the Affordable Care Act was perfect, but it is moving in a direction that is more positive for people. It is the concept of we, the people, working together to build something to get coverage, versus me, the individual, in an individual risk pool or puddle. You’re not going to have effective costs in care. We’re going to be out there doing education, outreach, and to the degree we can, any consumer help pointing people in the right direction. Hopefully, as the exchange develops and the feds develop a navigator system, we can help in the process of building a better system to make sure people get the care when they need it and what they need.

Frederica Freyberg:

When your phone rings, who is it that’s mostly seeking affordable care?

Bobby Peterson:

It’s people that are confused out there right now, looking for an option. They may have a disability, they may not be quite disabled. They may be laid off from a job. They’re looking for coverage. They’re searching for answers. And we try our best to find options for them and if we can, we’ll find it. But for a lot of folks, it’s a waiting list. Or it’s just– theres not a lot out there.

Frederica Freyberg:

All right. Well, Bobby Peterson, thanks very much.

Bobby Peterson:

Thank you.