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.

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