Follow-up letter to Johnson staff

Hi, Tom.

 

Thanks for your time Friday with Beth and me to talk about Senator Johnson’s position on the AHCA. It was great to have a chance to discuss with you. I appreciate that Senator Johnson wants to do the right thing and protect those most vulnerable in our state.

As you know, Beth and I have concerns about how Medicaid reforms will impact the most vulnerable people in Wisconsin. While we still don’t have a Congressional Budget Office report on the bill that passed the House, the previous report shows that Wisconsin will lose an estimated $1 billion. Because we have a very efficient program, there’s very little to be done to make our program sustain a 25% reduction in buying power.  As a result, our Medicaid program will need to cut benefits, limit eligibility and reduce reimbursements if reforms are passed that resemble the House bill.

Medicaid is critical to the futures of Wisconsin’s children and families, as well as people with disabilities. I have a few requests for you and Senator Johnson:

  1. Will Senator Johnson examine the drivers of rising costs in health care as part of his work on the Senate bill?
  2. Will the Senator have a public meeting on health care with stakeholders who use the programs to consider user input and consideration before a final version of the Senate bill is developed?
  3. Will the Senator take a tour in Wisconsin to see how Wisconsin has developed innovations and how Medicaid impacts people with disabilities and their families?

I would be more than happy to be a part of these ongoing discussions and help to coordinate community involvement in this important issue with you and Senator Johnson.

Thanks again for your time and interest, Tom.

Looking forward to talking again soon.

Jeff Burkhart

 

Talking points on the AHCA

Here are the talking points I assembled for my 5/19 meeting with Sen. Johnson’s staff.

Medicaid is vital to our state: WI could see a 25% reduction or $1 billion reduction in Medicaid. AHCA does not address the drivers of health care costs — one of the major complaints about ACA. It only cuts funds, guaranteeing there would be a significant reduction in the number of people covered. Wisconsin Hospital Association estimates more than 300k people will lose coverage or Wisconsin taxpayers would be hit with a huge bill to cover the hole in Medicaid funding. That would increase the taxpayer burden. We know that Senator Johnson didn’t run to raise taxes to his constituents or to make coverage inaccessible to our most vulnerable citizens.

  • One in five Wisconsin residents rely on Medicaid — that’s 1.18 million people.
  • More than one in three kids (35%) relies on Medicaid.

CBO said AHCA would result in about 24 million more Americans uninsured by 2026, and $880 billion over 10 years would be cut to Medicaid.  Avg deductibles in non-group market will increase $1,550.  We want patients and families in charge of healthcare, and increased choice. But hundreds of thousands of people in this state will be left with no choice.

Workforce: Access to preventive health care keeps people with chronic conditions in the workforce and out of hospitals. Medicaid-funded supports allow family caregivers to keep their jobs instead of being forced to leave the workforce to care for family members.  Medicaid supports the health care sector and provides tens of thousands of jobs to help support Wisconsin’s economy, and the health care infrastructure and services we all need.

Gov. Walker talked last week at a workforce conference about the pride that people with disabilities gain from work, but those with disabilities often require supports paid for by Medicaid. Without these supports, such as job coaches and transportation, the house of card of employment will crumble.

The cuts will hit our economy. We have $5 billion in Medicaid reimbursement through 75,000 certified Medicaid providers. Taking a large amount out of that system will result in job losses that will not be absorbed in other sectors of the economy. AHCA repeals small business tax credits and increases the burden on employers who drive economic production in our state.

WI is efficient: The Senator may think that we can be more efficient in our administration of care. In Wisconsin, we are already very cost effective. For many years, Wisconsin has been on the forefront of healthcare innovation. Wisconsin has the lowest cost per capita in spending on kids. When we moved to the FamilyCare model, we realized $300 million in savings annually and have among the lowest costs per capita for elderly and people with disabilities. We’ve moved many more people to managed care plans. We’re already well run and efficient.

Adding per capita caps and/or block grant for Medicaid would have a devastating impact on children and elderly in Wisconsin, the largest users of MA. We would be one of the biggest losers in the country because we already spend less than most states per capita.

Home and Community Based Services: More than half of Medicaid spending is in HCBS (about $80bil in 2014). Cuts will negatively impact the choice, freedom and independence elderly people and people with disabilities have and deserve. These are the optional services that we have built in our state. In Wisconsin, people with disabilities will go without employment supports, durable medical equipment, personal care attendants, transportation and case-management services. We have waivers for people with institutional level of care that help them integrate into the community (FamilyCare, IRIS). This impacts about 60k people and is very cost effective. Medicaid covers 20 other optional services… personal care, job coaching, day services.

We are one of the few states that is on the way to no waitlist because of FamilyCare expansion. We have almost all of the optional services available. Cuts would almost certainly force states like WI to eliminate these services, as we’d lose that 60% federal match which allows us to maintain these programs. When kids have an IEP, school-based services can be billed to Medicaid (abt $100m/yr.) Rural schools often pool resources to pay for a single speech therapist. With cuts, kids will likely not continue to have these services.

MacArthur Amendment: Health status underwriting could be introduced by states with a waiver. “Underwriting waiver” would allow states to charge more and could make the costs prohibitive for people with pre-existing conditions.

Allows states to redefine essential health benefits, and allow states to reduce or eliminate benefits covered under plans, introduce lifetime and annual limits. Half of all Americans (including an estimated 2.5 million people in Wisconsin) have pre-existing conditions, so the new language in the bill is potentially devastating to private insurance consumers as well, as the amendment would allow states to redefine benefits.

High Risk Pools: ACA reforms helped millions of people with pre-existing conditions. In WI, HIRSP worked as an “insurance” of last resort, with a 6 month wait to get insurance for some, proof of two private insurance rejections, and higher premiums and cost sharing in small, unhealthy risk pools. When we eliminated discrimination against those with pre-existing conditions, we ended of HIRSP.

The proposed $15 billion invisible high risk pool is inferior to current reinsurance under ACA:

  • It would only cover costs of certain conditions and would place a new administrative burden (more red tape) on insurers and doctors to access reimbursement. There would be additional burden on insurers to demonstrate that the covered costs related to an existing condition and would not cover something like a sudden heart attack.
  • It would have a negligible impact on premiums. Over 9 years and millions of enrollees, $15 billion would reduce premiums by only 2% per year.  Because ACHA reduces subsidies and shifts costs onto patients, the overall impact is still an average increase in premiums by $3000 per enrollee by 2020.

Providers will have a higher burden under AHCA: Since the ACA’s marketplaces opened, and WI added childless adults to the BadgerCare roster, uncompensated care in Wisconsin dropped by over $500 million dollars (2013-2015). The combination of AHCA and Wisconsin’s new Sec. 1115 waiver (which will remove childless adults from BadgerCare Plus) would mean a return to uncompensated care in Wisconsin reaching over $1.5 billion – and the cost of uninsured patients being socialized and redistributed to everyone else.

My meeting with Senator Johnson’s Wisconsin Legislative Director

A lot has happened in the last week since I posted about my attempt to talk to a staff member at Senator Ron Johnson’s Oshkosh office on May 9.

On Monday, May 15, I got a call from Tom Petri, Senator Johnson’s Wisconsin legislative director. I knew Tom 10 years ago when he worked at the Wisconsin Primary Health Care Association and I worked at the Wisconsin Department of Health Services as the outreach director for the BadgerCare Plus program.

I called Tom back on Monday, and we set up a meeting on Friday, May 19. After talking and emailing with a few knowledgeable people this week, I invited Beth Swedeen to join me. Beth is the executive director of the Wisconsin Board for People with Developmental Disabilities.

Here is a brief summary of our conversation:

  • Tom thinks the Senate will vote on AHCA 2-4 weeks after Memorial Day.
  • Sen. Ron Johnson (RJ) sees “Medicaid reforms” as essential to health care reform, but feels that Medicaid should be there to help people. RJ has no intention of impacting/hurting the disability and frail elder communities, or harming children and mothers. He wants to ensure that they “get it right.”
  • RJ sees cuts as  “bending the cost curve” — that there will still be increases to Medicaid funding in future years, but acknowledges that proposed reforms will mean that funding will not keep pace with the increases in cost for healthcare. I emphasized that this bending of the cost curve will still mean that many people will lose coverage — the Wisconsin Hospital Association estimated more than 300,000 people. We should emphasize that this number includes many of the people RJ wants to protect.
  • RJ sees high-risk pools as an answer to the cost issue.
  • RJ is a pragmatic “numbers nerd” — an accountant and CEO. He wants to see hard numbers. He wants CBO scores. RJ will be putting out regular progress reports on how the Senate work group is moving on this.
  • RJ wants to focus on what we can do in 2017 to avoid having insurers pull out of the marketplace and is concerned that insurance companies will not continue to offer coverage. RJ’s biggest concern is about making sure the insurers want to continue in any new system.
  • We asked him whether he is concerned that the current bill doesn’t address cost drivers in health care. He said yes, but also said that topic “would be covered in later efforts” and not in this bill. There seems to be a lack of will for government to be involved in managing health care cost.
  • Tom thinks the Senate will “kick the can down the road” to preserve marketplace coverage, and that Senate Republicans will apply a patch to help us get through what they see as a crisis in the marketplace.

Thoughts on future contacts:

  • Provide data about how vulnerable people will be impacted by AHCA.
  • Emphasize that when times get lean, optional services are the first to go and this will impact the people who are most in need of services.
  • Focus on how Medicaid provides supports to ensure that people can keep their jobs and keep the economy moving.

Here are the talking points from our meeting.

What happened at Senator Johnson’s office

Like many people, I’ve been calling and writing my senator regularly to express my concerns. US Senator Ron Johnson (R-WI) has three offices — Washington, Milwaukee and Oshkosh. I’ve left messages on the phones at all three offices about three times a week for most of the year. Once, I talked to a staff member who said that she would record my views for the senator. Other than that one time, I haven’t ever heard back, despite leaving my phone number and address on the voice message each time I call, and despite my request for the senate staff to inform me about the senator’s views and about upcoming town hall meetings.

So last Tuesday,  I happened to be driving past Oshkosh and thought I’d stop by to see if I might be able to talk to one of Senator Johnson’s staff in his office. When I walked in at just before 9 am, the receptionist was busy answering the phone. When she was done with a call, I told her that I would like to talk to one of the staff members about some concerns I had. She told me that I would need to fill out a form with my contact information and summary of my concerns.  I did so. Then she came outside of the locked area and said, “Well you’ve got me, so what can I help you with?”

“It looks like you’re very busy with the phones. Is there someone else in the office I can speak with?”

“Nope, you’ve got me. So what is your concern?”

“My concern is with the health care bill that is going to be on the senator’s desk soon. Are you sure I can’t speak with someone else in the office?”

“Our office only deals with veteran’s affairs and social security.”

“Are you sure that there’s not someone else I can talk to?”

“No. We’re done here.”

And with that, she turned and entered the locked door. I was shocked. I looked in and there were three people sitting at desks facing the door. I put my foot in the door and said to them, “I would like to speak to someone in your office about my concerns about the health care bill.” I repeated myself. I got blank stares from everyone.

At that point, I decided that I would start recording the interaction.

After I realize that everyone in the office is hiding in the back office, I recorded a video with the intent of sending it to Senator Johnson’s office to share my disappointment about the way I was being treated by his staff.

At some point my phone stopped recording. I might have accidentally stopped recording and then realized it, and started recording while outside with the officers.

Eventually, my phone ran out of storage, so what you don’t see is the angry police officer with his hand on his gun several minutes after our interaction began, and while I’m clearly not being a threat to anyone. I asked him why his hand was on his gun, and he fumed and said it was standard procedure, and then said, “I’m out of here!” and then stormed off. In fairness to the Oshkosh police, the lead officer was understanding and pleasant, and when I asked him if I was being removed from the senator office, he said, “They don’t want you here, they don’t think they can help you.” He empathized with the frustration I felt about not being heard.

I walked away, still really emotional. I don’t expect Senator Johnson to agree with me. I do expect him to listen when I come to his office to respectfully express my concerns. So I’m willing to do this again until I am heard.

What are your thoughts?