Here & Now

On the Issues: Healthcare

Frederica Freyberg:
Healthcare, and specifically coverage for people with pre-existing conditions, figures prominently in the U.S. Senate race in Wisconsin. Republican candidate Leah Vukmir is a nurse and wants to repeal the Affordable Care Act, the law that includes prohibiting insurance companies from refusing coverage for people with pre-existing conditions. The law also prohibits charging more or limiting benefits. The incumbent, Democrat Tammy Baldwin, is running hard on her support for the ACA and its protections for pre-existing conditions. She cites her own childhood illness that blocked her for getting coverage for her personal understanding of the issue. A Kaiser Family Foundation poll released this month showed that nationally 75% of those surveyed want to keep provisions prohibiting insurance companies from denying coverage because of a person’s medical history. And 72% don’t want insurers to be able to charge sick people more. In Wisconsin, more than 850,000 people have pre-existing medical conditions according to Kaiser. Health Policy Programs Director at the UW-Madison Population Health Institute, Donna Friedsam.

Donna Friedsam:
At least about 25% of adults in Wisconsin have some kind of excludable pre-existing condition.

Frederica Freyberg:
What do those include?

Donna Friedsam:
They could include — we think of the significant things like diabetes or heart disease, but they could include asthma. They can include fairly common conditions.

Frederica Freyberg:
Wisconsin, through State Attorney General Brad Schimel, is taking a lead along with 19 other states in a lawsuit to overturn the Affordable Care Act, which would of course get rid of its protections for people with pre-existing conditions. Here’s Tammy Baldwin.

Tammy Baldwin:
Right now one of the biggest concerns on the minds of Wisconsinites is healthcare. In particular they’ve seen a fight last year where they almost saw their healthcare ripped away and the protections ripped away. And right now, after we narrowly defeated that legislation, we’re seeing the administration try to unravel it as well as the case that’s going up to the Supreme Court, ultimately, to take away protections for people with pre-existing conditions. I am leading that fight in the Senate of the United States. I know what it was like to have a childhood illness and then be labeled as a child with a pre-existing condition.

Frederica Freyberg:
Baldwin’s challenger Leah Vukmir.

Leah Vukmir:
I support protecting people with pre-existing conditions. We did it here in Wisconsin before it was even part of Obamacare. I support bring healthcare decision-making back to the states. I’m a strong proponent of the principle of federalism. States know best how to take care of their own and before the Affordable Care Act was put in the place, Wisconsin had one of the lowest uninsured rates. We had a robust insurance market and we had a program for people with pre-existing conditions. And we had to get rid of that because of the one-size-fits-all Obamacare. I firmly believe that we can do better in Wisconsin and we should and we would take care of people with pre-existing conditions.

Frederica Freyberg:
Vukmir refers to a program made defunct in Wisconsin by the ACA. It was a high-risk insurance plan for people with pre-existing conditions. According to Friedsam, it doesn’t really compare.

Donna Friedsam:
It’s important to recognize that it was a very limited program. It covered at its peak 20,000 people in Wisconsin. And we’re talking about compare that to the Affordable Care Act enrolling 200,000 people in the state.

Frederica Freyberg:
As for Wisconsin taking care of people with pre-existing conditions, Governor Scott Walker is also highlighting his moves to pass a new law to do that.

Scott Walker:
I propose that we enact a law in Wisconsin that will guarantee coverage of pre-existing conditions.

[applause]

Frederica Freyberg:
A bill did pass in the State Assembly last year that prohibited exclusion of people with pre-existing conditions.

Donna Friedsam:
The idea that has been introduced in our state is to, thus far, is to assure that insurance companies offer coverage for pre-existing conditions, but not excluding the underwriting provisions. So insurance companies could offer that coverage at any price they determine that is reasonable for covering that particular individual’s risk. And so while they may get an offer of coverage, that coverage may be unattainable in terms of the pricing.

Frederica Freyberg:
The Assembly bill never made it to the Senate or the governor’s desk. But he and his running mate are pledging to bring back legislation if something were to change. A change like the repeal of the ACA in a lawsuit championed by Wisconsin Republicans.

Rebecca Kleefisch:
Today in Wisconsin, people with pre-existing conditions are already covered.

Donna Friedsam:
The ACA, many people don’t realize, affects virtually everybody who has health insurance in Wisconsin, even people with employer-sponsored insurance. That happens in several ways. One of the most important ways is in terms of protecting people with pre-existing conditions, or providing prohibition on lifetime limits of coverage and annual limits in coverage. And this again is for people even with employer-sponsored insurance.

Frederica Freyberg:
Providers and insurers are bracing for potential change. For example, the healthcare plan of Marshfield Clinic in Wisconsin says, “The current legal efforts to invalidate the Affordable Care Act are concerning because there are not state-based backstops or federal guidance to prevent the market from reverting to pre-ACA conditions.” While Governor Walker pledges to change that if the ACA is repealed, the temperature on the issue continues to rise, from the race for governor to the campaign for U.S. Senate. We are joined here now by Laurel White from Wisconsin Public Radio and thanks for being here with us.

Laurel White:
Absolutely. Thanks for having me.

Frederica Freyberg:
Well, it does appear that this race pivots a lot on the issue of healthcare. And national polling at least would seem to support Tammy Baldwin’s position on pre-existing conditions. Latest overall polling, just to put this in there, has — in Wisconsin has Baldwin win up 11 points on Leah Vukmir. Again, no idea where the healthcare issue, you know, is in all of that. But again, a pivotal issue.

Shawn Johnson:
Yeah, and it’s not just isolated to Wisconsin, either. I mean, if you look nationally, in this election cycle, Democrats are talking about healthcare more than Republicans are. And really, that’s the first election cycle we’ve seen that happen going back to 2010, when repeal of the Affordable Care Act or repeal of Obamacare has been a fundamental element of every Republican campaign. They have run on that. This time it’s Democrats that are running on the ACA but running on protecting it.

Frederica Freyberg:
This is the politics of healthcare at this point.

Laurel White:
That’s right. And I think it’s important to note that people aren’t talking about the entirety of the Affordable Care Act on these campaigns. They’re really focusing on the pre-existing condition issue. But there are other elements of healthcare and insurance in particular that have come up in this race quite a bit. So Tammy Baldwin has had a couple different ads talking about Leah Vukmir’s votes in the state legislature on requiring insurance companies to cover certain procedures. So a couple of those that Baldwin has pointed out was one vote that Vukmir took that would not require companies to cover oral chemotherapy. And another one was a vote on cochlear implants and surgery for hearing for children.

Frederica Freyberg:
How does Leah Vukmir reconcile that? She talks a lot about being a nurse. How does she reconcile those votes? Those “no” votes on those?

Laurel White:
She says that she understands healthcare and she believes that requiring insurance companies to do that is going to raise premiums for everyone.