Here & Now

What Do Lame Duck Bills do for Medicaid?

Zac Schultz:
The lame duck bills include dozens of changes to state law. “Here and Now’s Marisa Wojcik tells us about a few more in this week’s edition of “Fast Facts.”

Marisa Wojcik:
Last week Wisconsin’s legislature passed three bills during an all-night lame duck session. A lot of attention has been focused on where the legislation gives more power to the Republican-controlled legislature. But there was plenty more put in that eventually passed both chambers. Among the many measures tucked into the three bills, one would eliminate the Office of the Solicitor General. A high-level position within the Department of Justice that’s appointed by the State Attorney General. Additionally the legislature could intervene when the Attorney General challenges the constitutionality of a law. And they can hire separate attorneys at taxpayer expense. Another measure would change how federal dollars are distributed for major highway projects and potentially bypass wage requirements for certain project labor. Another measure limits early voting in Wisconsin to two weeks prior to an election. Early voting in this year’s mid-term elections hit record levels. In a year where there were Democratic gains. Because of this, many are viewing it as a political maneuver. And courts found past attempts to limit early voting by Wisconsin Republicans as unconstitutional on grounds of discrimination. One large provision in these bills would eliminate the governor’s authorities to make changes to federal waivers without legislative approval. Specifically, a waiver Wisconsin was recently approved for that will require adults making less than $12,000 a year to pay monthly premiums and work 80 hours a month in order to receive Medicaid benefits. Governor Walker signed all three bills into law without any vetoes earlier today. For these and other fast facts, visit wpt.org.

Zac Schultz:
The changes to the Medicaid program have more than 30 healthcare groups from around the state saying the bill could, “impact healthcare delivery in Wisconsin.” The groups range from hospitals, insurance companies and member associations representing doctors, nurses and dentists. Joining us now to talk about these concerns is Dr. Molli Rolli, president of the Wisconsin Medical Society. Thanks for your time today.

Molli Rolli:
Thank you.

Zac Schultz:
So Republicans in the legislature have said these bills just codify existing practice, putting Governor Walker’s executive orders into law and you’re saying this goes much beyond that.

Molli Rolli:
Yes. In addition to the way that they’re codifying, what’s already the bills that Governor Walker had presented in the legislature past, is that they limit our ability to modify those bills. So, for example, the waiver program that’s going into effect soon related to co-pays for people on Medicaid is something we’ve never done here in Wisconsin before. There may be logistical problems for other reasons why that needs to be modified but in order to modify it now, instead of just going to the Offices of Medicaid Services, we have to actually go back and convene the legislature and pass a bill to modify it. So we feel like there is a big impediment to the ability to change and do things on the fly, to be nimble.

Zac Schultz:
In your letter to the legislature, the group’s voicing direct opposition to the changes in theory but more to the speed of the process, the lack of input. Because of some of these issues. Now that we’ve had some time with the bill language, have you found more things you’re concerned about?

Molli Rolli:
Well, I think there are specific areas where we are concerned. For example, there’s the provision to require community service from Medicaid recipients. So Medicaid recipients are now required or will be required to put in 80 hours of work or job search or community service. That is philosophically something that we were opposed to but also something that has never really been tested. In June of 2018, Arkansas started making this requirement of their Medicaid recipients and unfortunately about 12,000 Medicaid recipients lost their Medicaid coverage because they didn’t properly report the 80 hours of service. What we are concerned about then is that we suddenly have a large amount of uncompensated care and that’s always a bad thing for us.

Zac Schultz:
Now, if these changes do create unintended consequences or when some of those things pop up, do you have any confidence in the legislature and governor-elect Evers being able to work together in good faith to figure out a solution?

Molli Rolli:
Well, we don’t have any signals that things are going to go well. I mean I guess it’s hard for me to predict what’s going to happen. I certainly hope that they find a way to work together. But that is not in evidence at this point that they have a working relationship. Things have not gone well from the start, I think. So we’re concerned about that.

Zac Schultz:
Now, the lame duck bills also restrict the ability of the governor to directly negotiate with the federal government on waivers. They now need legislative approval. What do you see as far as a concern in that area?

Molli Rolli:
Well, what if there was a great program that was introduced in another state that was working really well and had good benefits for patients? It just slows us way down. We can’t get in line to try new programs as quickly as we could have before because we can’t even start to apply until everybody has deliberated about it and approves it.

Zac Schultz:
Currently the negotiation is between the administration and Washington. Do you think the best method now is going to be an internal deliberation about whether they even want to ask for it or would you want the Evers administration to talk to Washington and then bring an idea back here? What’s the best way to even do that?

Molli Rolli:
I don’t know that I have a really good answer to that. I think that the idea of discussing and having a decision before there’s even an inquiry just seems backwards to me and like it’s gonna slow things down. And take us out of the running for things that we could do, you know, innovations that we could implement faster.

Zac Schultz:
We had Governor Doyle on the program last week. And he talked about how in some cases, the federal government may not even want to work with Wisconsin because it’s such an encumbered process. They may say if we’re going to try something out, we’ll go to somewhere where we know we can actually put it in place.

Molli Rolli:
Yeah, and he would be the person in the know about that. I’m just a doctor. But you know, I understand his concern. And I would echo that concern personally that I think why would the federal government choose to do something with a state that takes a long time to make a decision versus one that could decide fairly quickly if they were going to put resources toward a decision?

Zac Schultz:
We’ve only got a few seconds left but do you expect this coalition of healthcare groups to stay together to keep working with the legislature on these issues?

Molli Rolli:
Definitely. Definitely. We — this is a group of — this coalition is a group that has worked on a number of issues related to the health of the people of Wisconsin, which is our primary concern. And so definitely I believe that we will continue to work together to try to improve the health of the citizens of Wisconsin.

Zac Schultz:
Dr. Molli Rolli. Thank you.

Molli Rolli:
Thank you.