What hasn’t happened in health care

In the legislative floor session that ends Nov. 12,  health care — a topic that ranks as a top concern for Wisconsinites — has taken a back seat to contentious battles over Gov. Tony Evers’ powers and even his cabinet choices.

But the subject was not entirely a no-show. 

The Assembly on Thursday will take up a bill extending Medicaid coverage to “telehealth” — health care provided remotely, via the Internet or other form of technology. The Senate version, SB-380, passed the Senate on Tuesday on a voice vote with broad bipartisan support and is now before the Assembly.

“Good health care policy in Wisconsin is more often than not achieved with bipartisan support,” said Wisconsin Hospital Association President Eric Borgerding in a statement late Tuesday after the Senate vote. 

The measure, which also had the backing of other health care lobbying groups,  was one of four cited by a hospital association spokesman, Mark Grapentine. The other three included bills maintaining Wisconsin’s membership in the Interstate Medical Licensure Compact; enhancing the penalty for causing harm to a health care worker on the job; and allowing non-physicians to be a part of the process in carrying out a patient’s documented wishes.

“At the moment, we’re pleased with the bipartisan support on the bills we’re promoting,” Grapentine said via email Wednesday. 

Other organizations focused on health care were less enthusiastic about the legislature’s 2019 record on the topic, however.

ACA protections

“Health care was the top issue by far in the last state election,” Robert Kraig, executive director of Wisconsin Citizen Action, said Wednesday. “People are really struggling with the incredibly high cost of health care, prescription drugs, high deductibles and co-pays,” Kraig said. The absence of any legislative action on those, he added, “just sets this up so that it’s going to be another big electoral issue in 2020.”

Kraig drew a contrast between what GOP leaders vowed late last year — to pass a bill protecting patients with pre-existing conditions from being discriminated against when seeking health insurance — and the outcome. While legislation did pass the Assembly, it stalled in the Senate, Kraig pointed out.

Meanwhile, he said, there’s been no action to ensure that key provisions in the Affordable Care Act, which remains under threat from a lawsuit by Texas and other states, will be  preserved if the act is struck down by the courts. Wisconsin was originally a plaintiff in the lawsuit, but Attorney General Josh Kaul withdrew the state from the litigation after he took office in January. 

Evers’ original budget sought to reverse the refusal by his predecessor, Scott Walker, to expand Medicaid with federal support, as provided for in the ACA. The Republican majority in the legislature rewrote the budget and stripped that out. Democrats have since introduced a stand-alone Medicaid expansion bill, but the GOP leadership hasn’t advanced it. “No major bill even got hearings,” Kraig said — including that one.

Prescription drugs, dental therapists

Attempts to rein in the high cost of prescription drugs, including drugs used to help treat opioid addiction, also have been ignored, he added. “You’d think that at least there’d be hearings on this, but, crickets.”

Another stalled bill is AB-81 and SB-89, which allows for the licensing of dental therapists as another profession that could expand the availability of dental care.

That is despite broad support across party and ideological lines. “It’s a shame that that hasn’t [advanced],” said William Parke-Sutherland, Health Policy Engagement Coordinator for Kids Forward.

Pulled from budget

Other items that got pulled from the Evers’ budget include extending coverage for postpartum care to mothers on BadgerCare, Wisconsin’s version of Medicaid, and using Medicaid dollars to pay for doula services in some rural counties. Doulas are trained non-medical companions who support mothers and members of their family through pregnancy and childbirth.

The postpartum BadgerCare coverage is included in a standalone bill, AB-346 and SB-324. The Doula coverage hasn’t been revived in stand-alone legislation, Parke-Sutherland said.

Another item cut from the budget and not revived would have funded a community health pilot project using Medicaid funds to address housing, food, and nutrition — “social determinants of health,” Parke-Sutherland said. 

There are a handful of legislative floor sessions scheduled for the first part of 2020, and Parke-Sutherland said that he expects to see some legislators seek to advance the Medicaid expansion bill — but that its passage appears unlikely. 

“Until there’s a real sort of change in direction or outlook in the legislature, I don’t think it’s realistic to assume that Medicaid expansion, or the other things that were taken out of the budget, are likely to pass as stand-alone legislation,” he said.

“I’m less clear about the fate of dental therapy,” he added — in part because of the broad coalition that has gotten behind that bill. 

“It’s got the best chance, but I really don’t know,” Parke-Sutherland said. “I think with something like that, there’s always hope.”