Affordable Health Care

The employer-based health insurance system we currently have is in everyone’s best interest. When it becomes too expensive for employers to provide coverage, workers are often shifted to costly government programs, increasing the financial burden on taxpayers and further threatening provider reimbursements.

The state should oppose efforts to expand Medicaid, and thereby increase the number of Wisconsinites receiving taxpayer-subsidized health insurance, and exacerbate the corresponding cost shift to employees and their health plans. Federal Medicaid dollars will decline over time, leaving state taxpayers responsible to pay for a large unfunded entitlement.

Wisconsin should work to discourage health care services that provide little or no value for patients. These include unnecessary and duplicative tests, branded drugs when generics are available, and unnecessary diagnostics before low-risk surgery. These procedures drive up the cost of healthcare and can expose patients to increased risks for harm.

Employers that establish onsite or near-site clinics for their employees and their families are able to provide high quality care at a lower cost. We should support tax incentives for employers that provide this benefit to their employees.

Although often well intended, mandating specific items that health insurance plans must cover increases insurance costs and should be avoided. This includes stopping legislation that would:

• Ban the practice of white bagging, which allows an insurer or an employer to use a specialty pharmacy to ship clinician-administered drugs directly to providers since hospitals are on average marking up
  these drugs 200-500% over acquisition cost.
• Mandate health plans and employers apply amounts paid by third parties (drug coupons or drug assistance programs) to any calculation of an enrollee’s cost sharing responsibilities, including out-of-pocket maximums and deductibles.
• Mandate that a health insurance policy may not require prior authorization for coverage for the first 12 visits for physical therapy, occupational therapy, speech therapy or chiropractic services, or for the
  first 90 days of treatment for chronic pain. Or, any other mandates that erode this cost-saving strategy.
• Restrict mail order pharmacies, which can be lower-cost and more convenient for patients.

Like many industries, the health care industry is facing workforce shortages that will only get worse in the coming years. If not addressed, the quality of care in our state could suffer. As Wisconsin addresses the overall worker shortage and skills gap, attention needs to be given to health care fields to ensure a continuing pipeline of talent.

Allow health care providers to practice at the top of their scope, giving cost effective options for consumers. Highly trained providers, like advanced practice nurses, nurse midwives, and physician assistants, face statutory barriers that do not allow them to practice to the top of their training. In addition, Wisconsin should allow pharmacists direct prescribing authority based on the results of rapid diagnostic tests. Removing unnecessary barriers will allow these providers to do more work across the state, especially in rural areas where we face physician shortages.