Thursday, June 30, 2011

Coalition On Human Needs

Why is there so much emphasis on recording your views with the White House?

The other day we asked you to
call (1-888-245-0215 toll-free) now we’re asking you to write. We still want to ensure that a deficit reduction deal does not cut programs for low- and moderate-income people. We want a deal that protects American families in this difficult economic time. President Obama has been meeting with Congressional leaders this week and has been talking about a fair approach that asks millionaires and billionaires to share in reducing the deficit.  Faced with opponents who want to protect the wealthy at the expense of the poor, he needs our support now.  The Administration also needs to hear that you care about protecting low-income people, because threats to Medicaid, Medicare, SNAP, and other services remain very grave. If you haven't called yet, please call. If you prefer to write, please click the "submit a message" button below.
Click here to submit a message to the White House.
You'll be redirected to the White House comment form. Please share the following message with the President and Vice President – you can simply copy and paste it into the comment box; or of course feel free to put your message in your own words:

Please hold firm and prevent harmful cuts or caps to low-income programs in the negotiations to reduce the deficit. Please insist on fair increases in revenues to prevent reckless cuts to Medicaid, Medicare, food stamps, and other essential services.
Take action today by asking the White House to protect our families in the deficit reduction deal.

Call 1-888-245-0215 toll-free, and you'll be connected to the White House Comment Line.  Feel free to use the message above in blue - or put your own message into words.

Wednesday, June 29, 2011

Budget Bullets: Health Care

How to Trim Hundreds of Billions from Medicare and Medicaid Without Reducing Services

By Kristina Costa

The ballooning cost of health care is a major driving force behind the budget deficit. While the Affordable Care Act will reduce the deficit by $230 billion over 10 years, we can save hundreds of billions more by reforming the Medicare prescription drug benefit, and by reducing Medicare and Medicaid payment errors:
  • We can save $112 billion over 10 years by reforming the Medicare prescription drug benefit
  • We can save almost $70 billion over 10 years by reducing federal payments for graduate medical education
  • Preventing payment errors by Medicare and Medicaid can save tens of billions each year

Monday, June 27, 2011

$466 million in cuts could be coming to WI medical assistance programs
The budget Governor Walker intends to sign this Sunday also makes deep cuts to BadgerCare Plus and other parts of Medicaid.
Posted: 6:14 PM Jun 23, 2011
Reporter: Amelia Cerling
Email Address:
The budget Governor Walker intends to sign this Sunday also makes deep cuts to BadgerCare Plus and other parts of Medicaid.
Lawmakers gave Governor Walker more power to make these cuts without public hearings.
City County Health Director Richard Thoune says the $466 million in potential cuts will have a huge impact on both seniors and low income families.
Helen Knight is on BadgerCare and told us she worked for 50 years before retiring. The future of her health care dollars could lie in the hands of Governor Walker, and that’s making her concerned.
“Yes it is very scary. I think we work very hard, we have a lot to offer the community and if you take that away from us, that takes away what we have to offer,” Knight says.
And that's what several other senior citizens felt, concern over their future and their place in it.
“Because if people aren't healthy they can't work, and if they can't work they can't contribute to society,” senior and AARP volunteer advocate Lani Madis says.
Eau Claire City County Health Director Richard Thoune says the cuts are going to hurt the people who need health care the most.
“I think just in general we're disappointed to see these cuts occur in this state budget that's going to affect so many people that already have difficulty accessing basic services that help keep them healthy and well,” Thoune tells us.
But Republican Senator Terry Moulton disputes the cuts saying the budget, as he is aware of it, did not include any cuts to Medicaid or BadgerCare.
“The information I’ve received is we did not cut BadgerCare, we did authorize DHS to review some things, but restored BadgerCare and Medicaid as far as I’m aware in the budget,” Moulton says.
Thoune says if these cuts go through, local people will struggle to find a way to get the health care they need.

Politifact: Walker Said He Didn't Cut Medicaid But Added 1.2 Billion

The Truth-O-Meter Says:

Says critics who say he cut Medicaid are wrong; his budget added $1.2 billion to the program  

Scott Walker on Tuesday, June 21st, 2011 in a television interview

Gov. Scott Walker says he didn’t cut Medicaid, but instead added $1.2 billion

Gov. Scott Walker got a friendly reception during a June 21 turn on CNBC’s "Squawk Box," but he was asked to respond to the notion that his budget was balanced on the backs of the poor and schoolchildren.

In an exchange with Walker, the show’s co-anchor Becky Quick noted that critics say Walker cut Medicaid-funded health programs by $500 million and public education by $800 million.

The Republican governor disagreed, calling the critiques "Madison math" -- his shorthand for common-sense-defying arithmetic.

"This budget actually adds $1.2 billion more for Medicaid, to make sure the neediest, the poorest of the poor, seniors, needy families and children are the ones taken care of," Walker responded.

He also said his education cuts were offset by employee benefit savings his budget allowed.

But even as he spoke, the budget was on Walker’s desk after legislators gave approval to a 2011-’13 Medicaid plan that Walker’s own budget documents had pledged would "reduce expenditures by over $500 million in the next biennium."

That sounds like an open and shut case.

But, as you might expect, there is more to this story.

It’s as much a case of "Medicaid math" as "Madison math."

To understand both, you need to remember that Medicaid costs are driven by many factors, from how many people are eligible for the program to the cost of treatment and what recipients are asked to contribute in co-pays. So, when spending adjustments are made, it does not necessarily change the benefits to the individuals.

In this case, projections called for a need to spend at least $1.8 billion more in the two-year budget to keep the program running as it currently does. The Medicaid funding gap amplified the size of the overall state deficit Walker said he was facing, but ultimately he did not put all of the money into his plan.

The budget Walker introduced did increase baseline spending for Medicaid by $1.2 billion.

But it also made cuts -- though little is yet known about their impact on the state-federal program that cares for low-income families with children under 19, the elderly, disabled and others.

Charles Morgan, the top expert on health services at the nonpartisan Wisconsin Legislative Fiscal Bureau, explains it this way:

"They first fully funded it but then reduced it. It depends on what you are comparing it to, the gross funding or the base. Total funding is up, but there is a funding reduction."

Many Medicaid-funded health services are an entitlement, and enrollment soared as the economy cratered.

Therefore, the normal "cost to continue" the program would have required an increase of $1.8 billion to $2 billion compared to the $1.2 billion that Walker and legislators added, according to Fiscal Bureau figures, outside analysts and our own calculations. Part of the challenge was that federal stimulus funds for Medicaid have dried up.

In the end, Walker, trying to plug that shortfall, won approval from the Legislature for his Health Services Department to find $466 million in budget savings over two years through as-yet-unidentified changes. Many of the changes likely will need approval by federal authorities.

Some other states have made or proposed dramatic across-the-board cuts, limited enrollment or dropped certain medical procedures.

But it’s not clear yet whether Wisconsin’s actions will go that far, or rely on more cost-sharing by clients, tighter enrollment rules, less money for hospitals, doctors and other health care providers, or other moves.

The details will determine which group views the moves as "cuts."

The impact of one Wisconsin cost-saving move is clear, however: The budget approved by legislators caps enrollment in Family Care, the long-term care program that gives seniors options rather than nursing-home living. That could save $265 million by blocking new enrollments.

Dennis Smith, Walker’s Health Services chief, put it this way after Walker’s budget came out: "Despite a historic 23% increase to the Department's budget, Wisconsin's Medicaid program still faces a serious fiscal challenge over the next two years as we identify over $500 million in cost savings. To meet our goals, and balance the Medicaid budget, we have to find ways to be more efficient and cut costs."

In future years, those savings would continue to grow, totaling $1.2 billion in all funds by fiscal year 2016-’17, according to the governor’s original budget plan, which was adjusted only modestly by legislators.

How have similar moves been portrayed in the past?

Two years ago, Democratic Gov. Jim Doyle, Walker’s predecessor, made a very similar move -- increasing the Medicaid budget but trimming $600 million from the "cost to continue" price tag. His top budget administrator bluntly called it  "cuts of over $600 million to Medicaid."

Media accounts called it "cost cutting," as did some major actors in the budget drama, such as the Wisconsin Medical Society.

We give a lot of weight to the independent Fiscal Bureau and history.

But there are well-informed partisan voices on this topic -- and previous PolitiFact rulings on a somewhat similar claim to consider as well.

As we have already seen, "cost cutting" did not equal a real-dollar decrease in Walker’s Medicaid budget proposal. (The 2011-’13 budget, as adjusted by lawmakers, was sent to the governor’s desk  on June 16, 2011.)

George Lightbourn, a former top administration official under two Republican governors, said the bottom line was the program would receive a big funding increase, a remarkable reality in a budget that made actual deep cuts in other areas.

It could only be a "cut" if the state had been in a position to take a business-as-usual approach to the budget -- and it wasn’t, said Lightbourn, president of the conservative Wisconsin Policy Research Institute.

Jon Peacock, a Medicaid expert at a liberal advocacy group, the Wisconsin Budget Project, agreed with the Fiscal Bureau -- he said the two statements could accurately co-exist.

Peacock said it was appropriate for Walker to use realistic projections of the Medicaid "cost to continue" in his budget -- and appropriate for his budget to be judged on not fully funding that.

"As an analogy, imagine that Social Security spending was going to increase by 5 percent because the number of people eligible was increasing 2 percent and the average benefit per person was increasing 3 percent (tied to the cost of living)," Peacock wrote. "If the President or Congress decided to provide a total spending increase of 1 percent, by cutting the benefits by 1 percent, rather than increasing them 3 percent -- lawmakers could correctly argue that they were increasing spending, and seniors could correctly argue that the program was being cut."

Finally, we turned to PolitiFact National and PolitiFact state sites, which have dealt with a claims regarding a similar program, Medicare, which like Medicaid is an entitlement program.

PolitiFact consistently has rated as Barely True Republican claims that federal health care reforms supported by President Barack Obama and Democrats "cut" Medicare.

Here was PolitiFact’s rationale: "It's important to note that the law does not take $500 billion out of the current Medicare budget. Rather, the bill attempts to slow the program's future growth, curtailing just over $500 billion in future spending over the next 10 years. Medicare spending will still increase..."

It’s not a totally clean comparison to the Wisconsin situation: Walker’s cut is in two years, not 10, and it’s not clear yet here whether benefits will be cut to get the savings. But it’s in the ballpark.

Let’s get to the bottom line.

In the wake of his controversial budget proposals, Walker co-hosted a CNBC program and disagreed with a critique that he made cuts to the state’s Medicaid program. Walker ridiculed the idea as "Madison math."

Experts are not united on this one, but Wisconsin’s nonpartisan official budget scorekeeper thinks both the cuts and the increase are accurate claims. Media accounts have portrayed past moves as cuts, as well. What’s more, when Walker introduced his budget, he also described the changes as cuts.

So, Walker made a generally accurate statement about the increase, but by dismissing the talk of cuts he left out a lot of context and important details on his budget move.

That’s a Half True.

41 Senate Democrats Stand Up For Medicaid

Earlier this week, The New York Times ran an editorial discussing letters sent by 41 Democratic Senators to President Obama, urging him to continue to stand tough against calls to block grant Medicaid. The most notable contribution was a letter orchestrated by Senator Rockefeller of West Virginia, which was signed by a total of 37 Senate Democrats. A link to the opinion article and the text are pasted below.

Be sure to also see the brief letter submitted to the New York Times yesterday regarding the Editorial. The letter is pasted further below the editorial.

Leonardo D. Cuello
Staff Attorney
National Health Law Program
1444 Eye Street NW, Suite 1105
Washington DC,  20005

June 18, 2011

Signs of Life Spotted in the Senate

Sitting in a defensive crouch for months at a time can get a little uncomfortable, and several Senate Democrats are finally starting to rouse themselves. In the last weeks, there have been some tiny but tantalizing hints that at least a few senators want to offer an alternative to the Republican cost-cutting frenzy and talk about ways to cut sensibly and help put people back to work.
Last week, 41 Senate Democrats wrote letters to President Obama urging him to resist the Republican effort to sharply cut and transform Medicaid, the joint federal and state health program that primarily benefits poor children and pregnant women, disabled adults, and nursing home residents. Several senators have also broken through the wall of fear in Washington that prohibits discussion of stimulus spending.
These actions might seem unremarkable by Democrats in an ordinary year, but those in the Senate have largely been invisible in the current Congress, cowed by a noisy Republican majority in the House and afraid of losing their three-vote edge in the 2012 elections. Senate Democrats will not even put their priorities on the record by producing a budget, leaving it to the White House to negotiate with the House on matters like the debt ceiling.
The Republicans are desperate to show Tea Party voters that they can land a blow on an entitlement program. Medicare cuts are a political loser, but Medicaid — serving a far less powerful clientele than the middle class — has become highly vulnerable to their ax. Paul Ryan, the House budget chairman, has proposed turning Medicaid into a block grant program, giving states lump sums that could not possibly keep pace with rising costs, and allowing states the flexibility to drop coverage for millions.
With the White House eager to cut a deal, 37 senators, led by John Rockefeller IV of West Virginia, wrote President Obama last week urging him to stand firm against these Republican proposals, saying they would not let the government “walk away from Medicaid’s 68 million beneficiaries, the providers that serve them, and the urban and rural communities in which they live.” Similar letters were sent by four other senators.
At the same time, Mr. Rockefeller, Tom Harkin of Iowa, Kent Conrad of North Dakota, and a few other Democratic senators are urging the administration to stimulate hiring by spending billions to improve infrastructure. Speaking on the Senate floor last week, Mr. Harkin said the Republican focus on spending cuts would kill millions of jobs, and called for new spending to prevent a double-dip recession. Though Republicans will immediately ridicule the idea by repeating their mantra that the 2009 stimulus “failed,” Mr. Harkin and others have found their voice enough to respond that it actually saved or created at least four million jobs and probably many more.
These signs of a stirring in the Senate should inspire the rest of the caucus — and a reluctant White House — to their feet again. What’s the point of having a majority if you don’t use it?

NYT Letter:
June 23, 2011

Protecting Medicaid

To the Editor:
It is a hopeful sign that 41 senators have spoken out in favor of sustaining the Medicaid program (“Signs of Life Spotted in the Senate,” editorial, June 19).
The middle class should not be lured into thinking that Medicaid is a program for the poor. Medicaid provides an important safety net for middle-class families when parents and grandparents need long-term services and supports.
At a cost of as much as $100,000 a year, it doesn’t take long to wipe out a lifetime’s worth of savings. Without Medicaid, adult children would have to take on these costs — often just at the time they are digging deeper to pay for college for their children.
And severely cutting Medicaid will most certainly hurt our nation’s ability to provide health coverage to America’s poor — including low-wage, direct-care workers who provide long-term services and supports but ironically often do not have health coverage themselves.
Protecting Medicaid is essential to the economic security of the vast majority of Americans.
Bronx, June 20, 2011
The writer is national policy director of PHI, formerly the Paraprofessional Healthcare Institute.

Help Support The Work Of Save Badger Care Coalition

We've done amazing things over the last few months to help speak out for Wisconsin's BadgerCare program.  We're 2,000 supporters strong and we're gearing up for our post-budget fight to protect BadgerCare within the Wisconsin Department of Health Services.  If you or your organization can, please consider making a contribution to help support our important work. We're aiming to raise $5,000 by the end of the summer to help support a variety of activities and resources we'll be organizing to help BadgerCare supporters stand up and speak out to protect eligibility, benefits and affordability of this vital program.  Please take a moment to visit our online campaign and to help spread the word -
Thank you!

Tuesday, June 21, 2011

Will You Be Affected By The Walker Budget?

I'm curious, those of you that are following along, will you be affected by the Walker Budget cuts to medicaid? I would like to hear from you. I want to compile as many stories as possible and submit them to major news outlets and to the White House Website. We need to let the country know what's happening here in WI. as regards to medicaid. We will have to wait awhile to feel the full effects of the budget and how people will be affected by it. If you receive any information about your coverage, please let me know, I want to compile as much information as possible. People need to see that this budget will have real consequences on the peoples health care in our State. Thank you in advance for participating.

Monday, June 20, 2011

Fear Of The Unknown

Budget bill gives Walker more power over Medicaid programs

Advocates fear effect on programs for about 1 million Wisconsin residents

By Guy Boulton of the Journal Sentinel
June 19, 2011 |(216) Comments
The new state budget bill grants broader power to Gov. Scott Walker's administration to remake BadgerCare Plus and other state health programs with little legislative oversight, a situation that worries advocates for the roughly 1 million people covered by those programs.
The major question: how the governor's Department of Health Services will use that authority as it cuts a projected $466 million in costs from the programs over the next two years.
"We don't know exactly what will be coming down the pike," said Bob Jacobson, a spokesman for the Wisconsin Council on Children & Families. "And we don't know how we can have a voice in those decisions when the Legislature has been taken out of the picture."
The pending cuts work out to about 3% of the $14 billion in state and federal dollars allocated for the programs over the biennium.
The federal government pays about 61% of the cost of BadgerCare Plus and other Medicaid programs.
The budget-repair bill passed earlier this year gave the Department of Health Services the authority to make changes in the programs without legislative approval but required the department to hold public hearings.
The budget bill passed last week dropped the public hearing requirement. The exemption would remain in effect throughout the governor's term.
The pending changes in the programs could range from new rules on eligibility and cost sharing to managing care for people with severe mental illnesses.
The goal is to find ways to save money without limiting eligibility by making the programs more efficient, said Kitty Rhoades, deputy secretary of the Department of Health Services.
She stressed that the department is committed to being transparent and open about changes in the programs.
"There's a conspiracy theory that we have a plan in our drawer and we are going to bring it out on July 1," Rhoades said. "That's not true."
The Department of Health Services also won't have complete freedom.
It still must give notice to the Joint Finance Committee - the legislative budget-writing committee - of pending changes in the programs. The committee then has 14 days to decide if it wants to hold hearings.
In addition, Medicaid programs are jointly financed by the state and federal government, and Wisconsin must receive federal approval to significantly change the programs.
The national health care reform law requires states to maintain eligibility for Medicaid programs until 2014, and whether the Obama administration would approve significant changes is a question. Last week, Walker was among 29 Republican governors who asked Congress for more flexibility in how they structure their Medicaid programs.
The federal restrictions haven't lessened advocates' concerns about the authority given to the governor and Department of Health Services.
"It's a terrible precedent," said David Riemer, director of Community Advocates Public Policy Institute.
State legislators, he said, basically have given the governor the power to undo laws on books for the programs.
"The Legislature just sort of capitulated," Riemer said.
It also enables state legislators to sidestep some potentially controversial decisions.
"This makes it very difficult for the public to hold their elected officials accountable for these decisions," Jacobson said.
The Legislature approved a similar proposal during the Doyle administration when it instructed the secretary of the Department of Health Services to find more than $600 million in budget cuts. But Jacobson and others contend the authority given to the department then was more limited.
In the backdrop of all this is that no one knows how the department plans to find the $466 million in savings over the next two years.
Walker significantly increased funding for BadgerCare Plus and other Medicaid programs in his proposed budget. The joint finance committee subsequently added about $100 million to the governor's request.
The increased funding proposed by the governor was needed to replace federal money that up to now helped states avoid severe budget cuts to their Medicaid programs during the economic downturn and weak recovery. The additional federal money - $535 million in the state's current fiscal year - ends on June 30.
Enrollment in the programs has jumped as people lost their jobs during the downturn.
Nearly every state faces similar challenges.
But Jon Peacock, research director of the Wisconsin Council on Children and Families, said that six months into the governor's term, people still don't have specifics on what the administration will propose.
"Let's be open about what the options and alternatives are," Peacock said. "Tell us what is the plan."
Riemer said the Walker administration could put forth excellent proposals on how to make the programs more efficient.
"We just have to see what the specifics are," Riemer said. "Nobody knows. I'm not even sure they know."
Rhoades doesn't dispute that.
"We are finding our way," she said. "We are going to have a long summer of intensely hard work."

Another Nugget Of Wisdom From The Heritage Foundation: Entitlement Reforms

They can't talk about this subject without calling people lazy, slackers, baby producing fatherless slobs, sucking up all the taxpayer money. And yet they have no problem receiving corporate welfare. I sense hypocrisy at work here.

Poverty As Defined By The Heritage Foundation

According to the Heritage Foundation those living in poverty never had it so good!

Friday, June 17, 2011

Calling Out A Legislator

Open letter to Rep. Kathleen Bernier in response to her remarks on Assembly Floor (June 15)

Rep. Kathleen Bernier
68th Assembly District
Rep. Bernier,
I joined the Assembly budget debate last night (through Wisconsin Eye) as you were arguing your case with colleagues regarding changes to BadgerCare. In that testimony, you used your own experience of being a young person at college, paying for insurance through the university system, and having to struggle with the out-of-pocket costs related to back surgery.  Your story was used as an example of having struggled, and having overcome the challenges of obtaining medical care.
Having spent 20+ years working with low-income individuals and households in both urban and rural communities in Wisconsin, I feel compelled to respond to your comments. As real as your struggle was in your life, the circumstances of people facing cutoff from BadgerCare are not equivalent. And it concerns me that you are comparing your personal struggle with their circumstances and using that comparison as a justification for your position on BadgerCare funding.
You were a young woman in difficult circumstances, but with prospects. As a University student, you were already a high school graduate working toward a four-year degree. While the cost of your University-based insurance was daunting, I am sure, it was available to you. By your own testimony, you paid $50 a month for the out-of-pocket expenses. In recent years, you have been a public official, who I am assuming was able to receive health insurance through the county government in which you served. My guess is that you have not gone for any significant period of time in your adult life without health insurance coverage.
In contrast, my experience with adults eligible for BadgerCare, and especially those who have benefited briefly from the expansion of BadgerCare,  is that they are chronically low-income with few real prospects for higher wages in the future. Many have been chronically uninsured, and have chronic medical issues that have been left untreated for long periods of time.  In many, perhaps most cases, these untreated medical conditions interfere with work and life.
You had back surgery. Often such surgery is the result of conditions that cannot be resolved otherwise and that cause significant pain to the patient. Imagine if you had not been able to get that surgery? What if you had lived for years and years with the condition that was treated surgically?  How would living with chronic pain have impacted your life? 
Every person I have ever worked with who became eligible for BadgerCare, including the expansion program, had no other options. They were not candidates for insurance in the individual market because they couldn’t afford it, and the coverage available to them was inadequate. People who have been untreated for long periods of time often end up sicker, more expensive to treat, needing more medications…the cost of individual insurance for such people is prohibitively expensive if available at all.  And for EVERY person I worked with who had chronic untreated illnesses and conditions, the negative impact on their ability to work consistently had been an issue for years and years. Illness and pain had caused lost jobs, periods of unpaid unemployment, evictions, credit problems, problems for their children and on and on.  The relationship between lack of insurance, and therefore medical care, and employment, family and financial problems cannot be disentangled.
There is no reasonable alternative for the people being dumped back into a life without medical insurance or care.
My wish is that legislators like you, who want to solve fiscal problems, would actually get out there and look closely at the reality of human lives before making decisions about policy.  What I sensed in your remarks was a prejudicial assumption about the poor and low income working families. I heard your moral judgment at work when you noted that you wanted everyone to get out there and do what you had to do.  I tell you, people would take advantage of what was available to you if it was available to them. But in my long experience – those options are not available.
You can stick by your vote, but please do so honestly.  People will go without medical care because of your decision – they will suffer and they will potentially die.  We have an amazing medical care system in Wisconsin – but you and your colleagues have made the decision that certain people can and will be shut out of that system.  At least show these human beings the respect of being honest about what you are doing to them.
I would welcome the opportunity to discuss this matter further.
Wendy Cooper, MSSW
M.Div candidate (2012), Chicago Theological Seminary

Budget Bill Will Be Signed

The devastating Budget Repair Bill and Budget Bill is on it's way to Walker and he promises to sign it quickly. From the comments I have read on, online local newspapers, people are thrilled about this. My response to that excitement is..... wait til this budget smacks you in the face! There is something in this budget for everyone including is ardent supporters. If I hear another republican talk about 'shared sacrifice' I am going to unleash all of the anger that has been building up since this began in Feb.

What frightens me the most about this budget is the unlimited control Smith now has over Medicaid. He has been granted total control over the health and well being of the entire state. That is to much power to give to a unelected official. Well, even if they have been elected, they are still doing what they want regardless of public opinion.

 Faulty Theory

The consequences of this budget will be felt for years to come. Many people will suffer needlessly so corporations and the top 2% can 'create jobs'. No one really believes that they will create jobs with all of the tax breaks and incentives they receive, they are sitting on that money. If I understand the theory, they get tax breaks, they create jobs and provide insurance, we get the income and insurance the jobs provide so we don't need medicare/medicaid and we support the economy by buying things. It seems to me that this is not a good return on our 'investment'! We definitely do not get quality jobs that provide stability and the benefits we need, besides they have not 'created' any jobs for the past decade. Republicans believe that the majority of us make bad decisions and that's why we need entitlements. WRONG! The majority has to deal with and endure their bad decisions and we are further punished for their beliefs and policies. I find it hard to believe that all republicans are independently wealthy and always make the right decision, that, not one of them ever needs assistance programs to survive. Are they really that much smarter than the rest of us?

Thursday, June 16, 2011

Message From Sara Finger

Sorry to be the bearer of bad news the health care amendment in the Assembly tonight was defeated.  The individual votes on this amendment are listed below.
The Dem health care amendment would have: removed the Family Care enrollment cap; prohibited $466 million in unspecified cuts through reductions in services; maintained the BadgerCare Plus program; and required all Medicaid changes to be approved by the Legislature, not the Joint Finance Committee.
Thank you to all for your incredible efforts trying to get through to our legislators.  Your efforts were not futile.  For every time you raised your voice, told your story and elevate these important health issues among all the other attacks again working families, you made a difference.  Even though it appears that what you've doesn't didn't matter - it truly did.  You made everyone think twice and think outside themselves.  There is a major disconnect between our legislative leaders and the real families that face real challenges everyday - you helped bridge that gap and started a very important conversation that most legislative leaders have not had before.  Keep speaking up, keep standing up for what's right - don't make it easy on them.  Don't let them forget that there are 2,000 of us who have come together for to Save BadgerCare and because Medicaid Matters.  The fight will continue and we will work to push for improvements in the budget until the bitter end.  And even once Walker signs a budget bill, we will organize to make sure DHS Secretary Smith hears us and our concerns loud and clear.
Stay strong and keep standing up for what is right!

Speaker Fitzgerald

AB 40

AYES - 60     NAYS - 38     NOT VOTING - 0     PAIRED - 0



































































































Healthwatch Newsletter Update June 16th

The Assembly Starts Debate on the State Budget, Supreme Court Rules on Act 10!

June began with a political bang! Wisconsin's Joint Finance Committee finalized amendments to the state budget, preparing for debate in the full legislature. Rep. Jeff Fitzgerald announced that the legislature would be in an "extraordinary session" when hearing the budget, limiting amendment and debate in a move to expedite the passage of the bill. In the meantime, the Wisconsin Supreme Court, with unusual speed, reinstated the "Budget Repair Bill," or "Act 10," set to be effective law on June 29. Read more inside today's Update!

Wisconsin's Budget Timeline

Supreme Court Rules on Act 10

Wisconsin's Joint Finance Committee finished executive sessions on the state budget last week, leaving the fate of the document threatening the health care options of Wisconsin's middle-to-low income families in the hands of the state Legislature. After Joint Finance tweaked the Senate version of the budget bill, the full Assembly was the first to take up the state's fiscal budget document for the biennium, beginning its work on Tuesday, June 14. (The Assembly actually recessed at 10pm after waiting for amendments to come back from the drafters, deciding to begin budget debate Wednesday morning.) The Senate will take up the budget after the Assembly is done, expected to fall on Thursday, June 16. The entire process will be most likely completed in time for a July 1, 2011 effective date of the budget. On Tuesday, June 14, in an unprecedented move, the State Supreme Court's Majority decision was to overrule Judge Maryann Sumi and enact the changes of Act 10, also known as the "Budget Repair Bill" or "Collective Bargaining Bill."
See more on the Supreme Court Opinion below.
Health Coverage Issues in the Budget:
  1. The Status of Medicaid. The Joint Finance Committee followed Governor Walker's recommendation to cut more than $466.6 million from Medical Assistance. The details of the cuts are unknown, being identified as "various unspecified changes" in the budget papers. The Legislative Fiscal Bureau gave examples of what they thought the Medicaid cuts might look like, largely, increasing cost sharing, dropping higher income children from BadgerCare Plus, "bringing the coverage of working families back in line with employer-sponsored insurance," and making changes to eligibility criteria.
  2. Power Shift to DHS: The budget gives legislative authority to unelcted leaders of the Department of Health Services to make changes to BadgerCare and Medicaid programs with very limited oversight and no public input. Joint Finance implemented a passive review process for future BadgerCare and Medicaid changes. This means that the budget committee, not the full legislature, will oversee future review processes. Joint Finance also repealed a budget repair bill provision that previously required DHS to go through normal rulemaking processes. The budget simply eliminates the requirement that the department hold any meetings and there is no requirement for publication of whatever changes DHS makes to the programs, including changes in benefits and eligibility for Medical Assistance programs. (See more in the "Analysis" section below.)
Behind the Curtain: How the Budget is Being Passed
  1. Extaordinary Session. Republican Assembly leaders called for an “extraordinary session” on Tuesday, impacting how the state budget will be heard and voted on in both legislative houses. This move will limit debate and amendments. Under this “extraordinary session,” the Legislature is free to suspend most rules regarding bill notification, debate, and may consider the entire budget, as the purpose of the Session dictates. The Legislature may also expand the extraordinary session to whatever other business it chooses upon completion of the budget. The entire State Budget being taken up in extraordinary session is unprecedented. This type of session has only occurred six times since created in 1977. Assistant Assembly Minority Leader Donna Seidel (D-Wausau) commented, “It appears to be part of their strategy that anything can happen and anything can be rushed through with little or no scrutiny."
  2. The Governor's Veto Power. Governor Walker can veto the entire budget, approve it, or use a partial veto power when the budget gets to his desk. Partial veto is different than line item veto power in that Governor Walker can veto individual words and phrases he does not like in the final budget. The power to cross out words is a long-standing right of the Wisconsin Governor for any bill that includes an appropriation--adopted in 1930 by amendment to the Wisconsin Constitution. No other state in the nation gives its governor this much discretion.

HealthWatch Public Hearings: The Human Impact of Medicaid/ BadgerCare Cuts in Wisconsin

HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
View the public testimony footage online

Medicaid Infusions into States End June 30

It was just over two years ago when President Obama infused more than $90 billion of federal money into Medicaid. In just a few days, the money runs out, meaning cuts for millions of people, cuts to Medicaid payments to doctors and hspitals, reduced services, increased cost sharing and increased costs in other parts of the health care system. Patients will turn to the emergency rooms for care, spreading the expense and debt more widely.
In his June 15 article, "States Brace for End of Extra Payments for Medicaid," New York Times Columnist Robert Pear writes, "Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.

HIRSP Premiums to Increase July 1

First reported in Wisconsin Health News, the state's HIRSP Authority is said to be increasing premiums by 15%, effective July 1, 2011. The increase is necessitated by an almost 40% jump in medical expenses in recent months and a state law that requires HIRSP members to carry 60% of the plan costs. One of the key factors impacting plan costs is the increased prices of top-selling brand name drugs.

Recent HIRSP Notices and Premiums:

HIRSP Federal Plans
HIRSP Medicare Supplement
HIRSP Premium Rate Tables
For effective dates July - Dec 2011
2011 HIRSP Federal Plan Rates
Effective January 1, 2011
2011 HIRSP Medicare Supplement Rates

Effective January 1, 2011
2011 Plan Options 2011 HIRSP Federal Plan Options Important Notice About Your Prescription Drug Coverage and Medicare
HIRSP sent a letter to its policyholders explaining the changes this month. In the meantime, if you have any questions, the general phone number for HIRSP is 1-800-828-4777.
What about the HIRSP "expansion" recently articulated by HHS Secretary Sebelius? The Department of Health and Human Services is making it easier for people to qualify for federal high risk pools, called Pre-existing Condition Insurance Plans (PCIP) and established by the federal government though health reform law...but only slightly easier. Applicants no longer need a letter of rejection to qualify, but can instead use a letter from their doctor indicating that they have an existing medical condition. In addition, the federally run PCIPs are lowering premiums based on a revised actuarial analysis. For the HIRSP plans in Wisconsin, the HIRSP authority has stated that the premiums are as low as they can be while still meeting the requirements in the federal law.

Enrolled in HIRSP and Seeking Care Out of State?
Summer vacations are upon us! For those people enrolled in Wisconsin's State Health Insurance Risk Sharing Plan (State HIRSP), individuals can have care services covered if they are outside the state of Wisconsin. A State HIRSP plan member can receive services outside of Wisconsin, however you may be responsible for some portion or some unpaid balance of the bill. In urgent/emergency care situations, both State HIRSP and Federal HIRSP plan members can receive services out-of-state, but they may also be balanced billed. Not able to pay the balance? In some instances, you can work with a HIRSP representative to negotiate with the hospital/service provider. You may also seek a charity care application to remove the balance of the bill. 

Member Profile
Mimi Farber, Government Programs Counselor, UW Hospital and Clinics
Mimi helps connect uninsured and underinsured patients and families to state programs like BadgerCare Plus. She and fellow UW Hospital Government Programs Counselor Josh Salazar work closely with social workers, case managers and community resources to do so. Having worked at the hospital for the past eight years, Mimi recognizes and understands the hardship these patients and families are going through. “Having a family member in the hospital is often unexpected and very stressful,” she said. “Added to that is the financial burden of medical bills.”
She evaluates a patient’s or family’s situation, finds out what programs they might be eligible for and assists them in the application process. Some of these patients are routed to Mimi through the hospital’s admissions department, which makes note of uninsured patients who check in, some walk in through outpatient care, and some are referrals from outside organizations.
Although she and Josh have a steady queue of patients to help each day, the options for these patients are dwindling. “The shrinking options particularly evident this year have been extremely disheartening and challenging,” she said.
As a Dane County HealthWatch Coalition and Steering Committee member, Mimi knows how important it is to stay educated and up-to-date on today’s rapidly changing policies, and to join like-minded individuals to protect our vital government health programs. “Joint advocacy is so important in these unfortunate times,” she said.
Mimi uses her membership not only to attend meetings and conferences, but also to educate staff members at the hospital about state programs. “Not only do I assist patients and families, but also important is educating hospital staff in being knowledgeable about and creative with the programs in our toolbox,” she said. “HealthWatch is truly my lifeline.”
Like many health care advocates in Wisconsin, Mimi is concerned about how the Walker administration’s budget and recently passed legislation will affect her clients. “It already has meant and will mean fewer options for access to health care,” she said. “Combined with the economy, it’s going to be very hard on people.”
But despite these setbacks, Mimi remains resolute in her conviction to help patients and families get and maintain health coverage. “Connecting patients to resources is vital; maintaining their eligibility is also imperative,” she said. “Healthcare for all is a no-brainer.”

CKSN Corner
Covering Kids with Special Needs
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.
September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit
September 22. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 5:30-8:30 p.m. Topic: Parents and partners on a journey; public support systems avaialble to assist you and your child; private insurance and your provider. To register, call 877-568-5205 or email
October 1. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 9 a.m.-noon. Topic: More about Medicaid; advocating for systems change. To register, call 877-568-5205 or email

State & National News Analysis and Comment

Wisconsin Supreme Court Swoops In

Supreme Intervention.  Initially, legislators wanted to add the elements of the March 2011 "Budget Repair Bill," also known as "the Collective Bargaining Bill" and "Act 10," back into the budget. HealthWatch Wisconsin tracked the Budget Repair Bill and the potential consequences for individuals and families on BadgerCare Plus and Medicaid programs in Wisconsin. Act 10 was in front of the state Supreme Court to determine if open meeting laws had been violated when the bill was quickly passed by conference committee. On Tuesday, June 14, in an unprecedented move, the State Supreme Court's Majority decision was to overrule Judge Maryann Sumi and enact the changes of Act 10. The process for the Secretary of State publishing Act 10 will most likely start today, June 15. The process for full publication usually takes the full 10-day statutory limit for doing so so the anticipated "effective date" of the law is June 29. For complete coverage of Act 10 through Tuesday's ruling, visit the Wheeler Report's Comprehensive website.
Unprecedented. Unusual speed. Hasty. Rash. The headlines this morning captured the unsettled feeling of many that the Wisconsin Supreme Court swooped in, issuing an alarmingly quick opinion on Wisconsin's Act 10, the "Collective Bargaining" or "Budget Repair Bill" that had been enjoined from implementation by Dane County Judge Maryann Sumi. In the majority opinion, the Court stated, “The court’s decision on the matter now presented is grounded in separation of powers principles,” the justices wrote. “It is not affected by the wisdom or lack thereof evidenced in the Act. Choices about what laws represent wise public policy for the State of Wisconsin are not within the constitutional purview of the courts. The court’s task in the action for original jurisdiction that we have granted is limited to determining whether the legislature employed a constitutionally violative process in the enactment of the Act. We conclude that the legislature did not violate the Wisconsin Constitution by the process it used.” Chief Justice Shirley Abrahamson critized the majority. As reported by WisPolitics, Justice Abrahamson accused the majority of reaching a hasty decision that’s "light on legal analysis," opening them up to the unnecessary charge that they “reached a pre-determined conclusion not based on the facts and the law, which undermines the majority's ultimate decision.” She believed the case should have followed the normal appeal route rather than the court taking original jurisdiction and issuing a decision that gives the case “short shrift.” “In rendering a decision, a court is to provide not merely an answer but also a reasoned, accurate explanation,” Abrahamson wrote. “A reasoned, accurate explanation is not an inconsequential nicety that this court may disregard for the sake of convenience or haste. It is the cornerstone of the legitimacy of judicial decision-making.”
Credibility at Stake. The Court swooped in and issued an opinion on the eve of the Assembly debate, instead of letting the legislature "redo" the process of implementing a bill, damaging both the credibility of the court and legal precedent in the state of Wisconsin. At issue in front of the Supreme Court was the way in which Act 10 was forced through the legislature, subverting open meeting rules and access to the process, not the substantive content of the bill. The Republican led legislature had already drafted amendments to the budget to include Act 10 as an element of the state budget, thus going through the motions to "properly" pass the bill. Whether you disagree with the content of the bill or not, at issue is the process. The Supreme Court still intervened, instead of letting the legislature fix its own processes. As of the time this newsletter was published, a coalition of unions that represent public employees filed a federal lawsuit challenging the collective bargaining changes on the grounds that they violate the U.S. Constitution.
Still Unclear. What is unclear is how Act 10 and the new budget will fit together. In fact, elements of the budget bill revise, clarify or conflict with Act 10, such as the new budget's passive review grants to DHS to subvert normal rulemaking processes. We will know more after the final version of the budget emerges.

More on the Budget: Things to Watch

In addition to the unspecified "cuts to Medicaid and BadgerCare programs" and the authority granted to DHS to change rules and laws without scrutiny, HealthWatch is following additional items in the budget that impact the care and coverage of our residents. Below are a few more:
  1. Family Care: Joint Finance passed a motion prohibiting DHS from enrolling more people in Family Care. The motion states that no more people can be enrolled into Family Care, Family Care Partnership, PACE or IRIS programs than the total number of persons participating in all of those programs in that ADRC region.
  2. Income Maintenance Centralization. In an audit letter released June 2, the Legislative Audit Bureau expressed grave concerns about the Department of Health Service’s Enrollment Services Center, the agency charged with enrolling childless adults in the limited BadgerCare Plus Core Plan and FoodShare programs. The Audit was released on the eve of the Joint Finance Committee addressing Budget Paper 355, the Centralization of Income Maintenance. The bitter taste the audit left in legislators’ mouths may help explain why Joint Finance opted for a compromise position, establishing a partnership between the state and counties to administer the income maintenance program instead of the more centralized approach Walker recommended. Now, little is known on how the "compromise" solution will work. The plan is to require all counties other than Milwaukee County to organize into no more than 10 multi-county consortia no later than Oct. 1 to administer BadgerCare/Medicaid programs.
  3. Family Planning. The Joint Finance Committee voted to remove men from BadgerCare Plus-Family Planning Only services. It also included provisions that require parental consent for all patients under 18 years old, reduce the eligibility limit down to 200 percent of the federal poverty line and cut more than $1 million dollars in state funds to Planned Parenthood. Dropping men from the family planning services would require the approval of the federal government. Those watching the budget process are concerned that making this change without federal approval may jeopardize federal funding.

How High (or Low) is Too High for Health Insurance Costs

A June 8 article appearing in the Milwauke Journal Sentinal ran the headline "Area health insurance costs remain higher than Midwest average." HealthWatch Wisconsin will be digging into this issue in more detail over the coming weeks, looking at the elements of insurance costs from the creation of insurance rates, rate  increases, and rate review. Behind the numbers the insurance companies are posting, are conflicting factors, increasing medical costs, fragmented individual markets--and the drastic lack of risk pooling, and inflated cost projections. Add to these, low medical loss ratios along with adverse selection and lax oversight, all issues the Affordable Care Act is trying to change. Stay tuned to future editions of the Update, the HealthWatch Reporter and HealthWatch WatchDog to learn about Wisconsin's rate review, medical loss ratio, and the federal grant Wisconsin's Commissioner of Insurance received to improve both of these. We'll check on their progress and suggest new strategies for Wisconsin.
States Brace for End of Extra Payments for Medicaid
Robert Pear, The New York Times, 15 June 2011
"Faced with a deepening recession two years ago, the Obama administration injected billions of dollars into Medicaid, the nation’s low-income health program."
FamilyCare enrollment cap in budget starts June 30
Stephanie Jones, The Racine Journal Times, 11 June 2011
"Anyone wanting to enroll would have to wait until there is an opening. But to help avoid a waiting list in the future, the county is being proactive and getting out the word to enroll more people now, said Racine County Human Services Director Jonathan Delagrave."

Who will be the H&R Block and TurboTax for health insurance?
Larry Levitt, The Kaiser Family Foundation, 3 June 2011
"Interestingly, what’s been largely absent from this discussion so far is what kind of help consumers may need with the financial aspects of buying coverage in a newly configured insurance market, where starting in 2014 small businesses and individuals will be able to purchase insurance through new state-based purchasing exchanges."

Click here for more health care news!