Frederica Freyberg:

Health care systems and physician groups in Wisconsin have been vocal about their concerns over possible negative impact of the Senate health care bill. Concerns for both providers and for patients. For more perspective on the Senate health care bill we turn to Bobby Peterson, executive director of ABC for Health, a public interest law firm that helps connect Wisconsin families to health care coverage plans. Thanks for being here.

Bobby Peterson:

Great to be here.

Frederica Freyberg:

Right now, out of Washington there is this discussion of just repealing the ACA and not replacing it. What’s your reaction to that?

Bobby Peterson:

Short-term, maybe it’s a win, but it’s a loss for the people, I think. We don’t get to a situation where we actually make things better. Just repealing the Affordable Care Act doesn’t get us to the right place.

Frederica Freyberg:

On the Senate bill, there are many constituencies, as you know, sounding the alarm over the proposed reduction in Medicaid funding. Who in your mind would this hit the hardest?

Bobby Peterson:

Well, there’s 1.2 million people in Wisconsin on some form of Medicaid. It affects a lot of people. A lot of family, friends and relatives. So seniors in long-term care, children with disabilities, young children that need health care coverage, low-income adults, people with disabilities. So it has a broad impact. And I think that’s why there’s been such vocal opposition. These Medicaid changes are significant and alarming for a lot of folks.

Frederica Freyberg:

Now is Wisconsin hurt more than states that expanded Medicaid because it would be capped to what was spent in 2016?

Bobby Peterson:

Sadly, yes. I think that’s one of the bad outcomes of the bill because Wisconsin is penalized. A lot of us thought Wisconsin should expand Medicaid and we’ve lost a lot of money. We’ve left a lot of federal money on the table that we could be using, replacing GPR funds. We could fix a lot of roads and improve K-12 education with those funds. But it’s going to be a significant amount. Missouri Hospital Association came out with a report that said over the next, till 2026 it’s over $30 billion that Wisconsin loses out on.

Frederica Freyberg:

And yet here we sit and having perhaps the governor was right when he said, “Well, I don’t want to expand Medicaid because I'm afraid the feds won’t be good for that money” and kind of here we are.

Bobby Peterson:

Right. But you always — the feds — we take $12 billion a year in federal money. So what category of federal money are we going to say they’re good for and they’re not good for? So that argument didn’t carry a lot of weight with me because we’re heavily dependent on federal money in the state of Wisconsin for a variety of things, our roads, our education system. So it was a bad decision and I think most people agree with that.

Frederica Freyberg:

What are you hearing from clients that you help with health care coverage about all of this?

Bobby Peterson:

Well, the volatility, the dynamic of what’s going to happen. Am I going to lose pre-existing condition coverages that I've had. Are we going to go back to high-risk pools where I feel like I’m in health care segregation? Those are some real concerns people have. Are they going to cap Medicaid? Is it going to lead to health care rationing? Which you have a sum sufficient of money, and it ends, that could be an outcome.

Frederica Freyberg:

Do you feel as though the policymakers in Washington are hearing all of these concerns?

Bobby Peterson:

I think they will over the break. I think they need to get out of Washington to get back and talk to their constituents and realize I think for a long time Medicaid has just been considered a welfare program for poor people, but it has a much broader impact. It has expanded its spread at some point. It’s a fundamental core of our society and cares for a lot of people.

Frederica Freyberg:

Isn’t that one of the issues, though, that it’s just expanded so much and it’s so expensive?

Bobby Peterson:

Well, it’s expensive, but in some ways it can be more efficient than some of the other programs out there. It depends on how it’s operated. But Wisconsin runs a very efficient Medicaid program in many respects. We have public/private partnerships with Badgercare that extend coverage through managed care organizations, that provide Badgercare plus commercial coverage. I think there’s some innovations in Wisconsin that are worth looking at that make the program run more efficiently.

Frederica Freyberg:

So let’s take a look at a potential Medicaid recipient. You choose whom that might be. What are they looking at? I mean, they’re not looking at immediately losing their coverage.

Bobby Peterson:

No. And I think it’s time to speak up and say how important your coverage is. But I think the people we represent. And we’ve been representing people on Medicaid for the last 23 years. Navigating systems, difficult coverage situations, people with pre-existing conditions, the fear is that they’re going to lose important coverage or services that they have that have helped them stay in their community, stay in their home, work, transition into jobs. So those are things that people are very concerned about that we’re hearing from.

Frederica Freyberg:

Now, framers of repeal and replace talk about Wisconsin going back to its high-risk kind of insurance plans and you mentioned that it was called HIRSP. What’s your reaction to putting people with pre-existing conditions into that high-risk plan?

Bobby Peterson:

Yeah. It’s going backwards. In Wisconsin we like to move forward. This is not the right direction. We’re segregating people with pre-existing conditions. It’s difficult to manage in some ways because self-funded plans don’t have to pay into the pool. It’s a small group of insurance companies, as it was set up previously, that help support the pool. And premiums were very high for people. You had a six-month waiting period to get into it, so people end up dying before they become eligible for coverage. It’s an anachronism of the past. I think most people have moved on from that to say we’re going to find a better way to cover people with pre-existing conditions than to segregate them.

Frederica Freyberg:

We need to leave it there. Bobby Peterson, thanks very much.

Bobby Peterson:

Thank you.