[Madison, Wisc...] Wisconsin Governor Scott Walker said Wednesday he will ask lawmakers to lift enrollment caps for Family Care and expand the program to all counties in the state.

The current state budget included a $1.2 billion increase to Medicaid.  Walker’s new proposal would cost $80 million for the remainder of the biennium. He said with the funding increase included in the 2011-2013 budget and recent efficiencies implemented by the Department of Health Services, his proposal would require no additional funding.

Gov. Scott Walker

“It was really built off the fact that we put an unprecedented amount of new funding into Medicaid, more than $1.2 billion was added this budget,” said Walker. “That’s one of the largest increases of any state in the country,” Walker said at a press conference Wednesday.

Family Care is a program that provides long-term care focused on helping senior citizens and disabled individuals stay in their homes.

Earlier this year an enrollment cap was placed on Family Care in response to a Legislative Audit Bureau (LAB) evaluation which found a number of areas the program could be improved and made more efficient.  After a briefing on the work done by DHS over the past couple of months Walker announced a plan to lift the Family Care cap. Governor Walker’s plan also calls for Family Care to be expanded to additional counties.

“I am confident that Family Care can continue to be implemented efficiently and cost effectively,” said Governor Walker.  “Lifting the cap will be done in a way that respects taxpayers and is mindful of their investment, while at the same time providing care for those who are truly in need.”

The Governor’s hopes for legislative action and DHS implementation  of the Family Care expansion by this spring. He said the pause in the wake of the audit helped stabilized the program for the future.

“It really put us in a position where we could support many of the other programs we have and through these changes and improvements, ensure that not only we could lift the cap for Family Care, but also to do so in a way that is sustainable long into the future, long beyond just this current budget cycle we’re in,” Walker said.

About 14 counties currently do not offer the program, mostly in the northeastern part of the state.

Walker hopes the legislature will take up his proposal in the coming weeks, and expects broad bipartisan support.

Also at the announcement today to support the lifting of the enrollment cap was Lynn Breedlove from Disability Rights Wisconsin, Heather Bruemmer Executive Director of the Board on Aging and Long Term Care, Kim Marheine from the Board on Aging and Long Term Care, Beth Sweeden from the Board for Persons with Developmental Disabilities, Maureen Ryan with the Wisconsin Coalition of Independent Living Centers, Michael Blumenfeld representing several MCOs, Teri Buros from Southwest Wisconsin Family Center, State Senator Terry Moulton (R-Chippewa Falls), and State Representative Dean Kaufert (R-Neenah).

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[Madison, Wisc..] In their latest report, HCTrends is highlighting more evidence that Wisconsin’s public labor compensation reforms are working.

According to their analysis, taxpayers will save approximately $155 million next year due to changes in the benefit design for health plans offered to state employees.

“While most of the public debate over Act 10 focused on collective bargaining and health plan contributions, the budget-repair legislation also mandated that the benefit design be changed to achieve a 5-percent reduction in premium costs based on actuarial analysis,” says Dave Jensen, editorial director of HCTrends. “This is a significant step for the state, even though the cost-sharing remains significantly below private-sector averages.”

Jensen notes that most of the savings, approximately $90 million, will be realized as state employees pay a greater share of the premium costs; however, taxpayers will save an additional $65 million due to a new requirement that state employees pay 10 percent of their medical costs up to an out-of-pocket maximum of $500 for individuals and $1,000 for families.

HCTrends’ latest Greater Milwaukee Employer Health Care Benefits Survey showed that health plans offered by large employers typically have a 20 percent coinsurance requirement and out-of-pocket maximums of $2,500 for single plans and $5,000 for family plans.

While the public sector plans remain far more lucrative then the average benefits offered in the private sector, the new state plan design reduced 2012 premiums for the 26 health plans offered to state employees by an average of 2 percent, the first year-to-year decrease in more than 10 years.

HCTrends Notes that health plans serving southeastern Wisconsin, northern Wisconsin (Wausau) and Western Wisconsin (La Crosse) lowered their premiums by an average of 4 percent, while plans serving northeastern Wisconsin and south central Wisconsin lowered their premiums by 3 percent.

HCTrends is a forum committed to promoting meaningful dialogue on the health care challenges facing the provider and business communities.

HCTrends’s mission is to be the premier forum for market-oriented health care solutions in the Milwaukee Region and beyond. In addition to its website, HCTrends publishes a newsletter that is available in both digital and printed formats at HCTrends.com.

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“It is important that people have confidence in the integrity of their doctors,” said Grothman.  “If a medical provider provides phony excuses for friends and political allies, how do we know these same doctors are not making up fraudulent excuses for cases involving workers compensation, personal injury claims, or falsely prescribing prescription drugs?”

The doctors reprimanded Wednesday and who issued fake sick notes to anyone who wanted one, with only a cursory question and answer ‘session’ are:

Adam H. Balin
Mark B. Beamsley
Hannah M. Keevil
Bernard F. Micke
Kathleen A. Oriel
James H. Shropshire
Louis A. Sanner

Ronni L. Hayon and Patrick A. McKenna had received administrative warnings and were involved in the same incident.

The MacIver News Service broke this story and has video evidence of many of the ‘examinations’ that show the brevity of the interactions and the questions asked. Dr. Sanner even chastized our reporter for violations of patient privacy laws by taping the exams which took place in front of tens of thousands of people on a public sidewalk across from the Wisconsin State Capitol.

These fraudulent esick notes were not without financial damage to employers, Grothman noted. Further, many school boards and taxpayers, who perhaps had to pay for substitute teachers or parents who were forced to pay for daycare or miss work when schools were needlessly closed the Senator said.

“I would have expected at least a month’s loss of license for so brazenly making up excuses for people who wanted a day off,” said Grothman.  “It is also disappointing the University of Wisconsin has not independently suspended doctors under their purview.  This will only perpetuate a stereotype that the UW is just concerned about keeping their well-paid employees getting a paycheck and the Medical Examining Board is more concerned about protecting the paychecks of unethical and unscrupulous doctors than maintaining integrity in the medical profession.”

The Medical Examining Board is currently made up of 12 members, only three of which are not members of the medical community.

“It is clear the Good Old Boy Network is too prevalent on the Medical Examining Board and the State Legislature should act to include more private citizens who will express greater concern for fundamental ethics in medicine and restore the public’s confidence in this state licensing board,” said Grothman.  “Perhaps two new members that are employers who have to suffer the consequences of doctors who frivolously approve sick claims will help provide some semblance of balance to the Board.”

Read the original MacIver News report and watch the video that instantly turned this incident into national news in February.

• The health care reform legislation raises the costs of employer-sponsored health insurance;
• The new financial regulations make accessing capital difficult for smaller businesses;
• The pending Environmental Protection Agency (EPA) regulations of carbon dioxide and coal-fired power plants will raise the cost of energy;
• The promised tax increases on successful businesses discourage entrepreneurs from taking risks on new ventures; and
• Obama’s activist National Labor Relations Board (NLRB) seeks to foist unions on employers and employees, despite the fact that unionized businesses create fewer jobs.

Sources: InsiderOnline.org and The Heritage Foundation

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A press release last week from our friends at Citizen Action of Wisconsin notes a disturbing trend. The press release refers to a study by the Robert Wood Johnson Foundation showing that the number of Wisconsinites covered by employer-sponsored insurance (ESI) has declined, especially for small businesses:

“The dramatic decline in the number of small Wisconsin firms providing health insurance to their employees reveals a system under tremendous stress from health insurance hyperinflation,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin.  “This new research underscores the critical importance of Wisconsin fully implementing national health care reform.

“The Affordable Care Act guarantees affordable coverage for people who do not have access to health insurance at work and provides affordable coverage options for small employers.”

Frankly, fact of the matter is that the economy, despite the billions spent on stimulus, continues to sputter. If the economy is struggling, small businesses are struggling to stay afloat. Another reason there has been a “dramatic decline in small businesses providing health insurance” may be the fact that there has been a dramatic decline in the number of small businesses that have survived. Keep in mind, you can’t offer your employees health insurance if you go out of business.

But let’s examine WCA’s claims and proposed solution.

This is like noting there is a shortage of ice cubes on the Titanic and deciding to speed up towards the iceberg.

To be fair, the report by the Robert Wood Johnson Foundation does not make any specific policy recommendations. The report, “establishes a state-level baseline for monitoring key trends in ESI into the future,” and is a, “baseline for monitoring how the Affordable Care Act (ACA) will affect key ESI indicators at the state level.” It does not endorse the ACA, but provides a snapshot of where we are now.

The prescription of ACA is Citizen Action’s. But in Citizen Action’s enthusiasm for President Barack Obama’s ACA, they are forgetting that employees of small businesses will likely see a further decline in ESI, and that more people will be moving to government-run health insurance as a result.

For example, the report notes an increasing number of dependents of employees losing coverage nationally:

“Nearly three-fifths (57%) of the decline in ESI was in dependent coverage (Figure 6), and most of the erosion of dependent coverage occurred in moderate-income families (Table 5). Among families with any ESI coverage, the percentage that had all family members enrolled in ESI declined; not surprisingly, since employee contributions to premiums are typically much larger for family coverage than for employee-only coverage, this decline in “whole-family” ESI coverage was larger for low and moderate income families.”

Under the ACA, this trend will only accelerate. A small business owner will face higher insurance premiums because of the ACA mandates. These mandates include coverage for “dependents” up to age 26 and no waiting periods for pre-existing conditions. If the small business owner’s insurance plan loses it’s “grandfathered” status, then the ESI will have to include coverage of 100% of a number of mandated preventative care measures.

Rather than pay the increased family premium costs, the employer may elect to drop dependent coverage entirely, or the employee may not be able to afford his or her share of the increased premium cost. Either way, the total ESI will decline even further.

It gets worse for the small business owner and the employees. The ACA also increases the Medicare hospital insurance part of the payroll tax on wages and self-employment income in excess of $200,000 ($250,000 joint) by 0.9 percentage points. This will actually affect small businesses because the hospital insurance tax applies to “flow-through income” of small businesses filing taxes as individuals, almost $16 billion of the total $18 billion of revenue expected from the new tax. This new tax will directly affect the business’ bottom lines, and likely result in fewer employees hired, and those that are hired will likely have lower wages.

The ACA does provide a credit to small businesses to contribute towards their employees’ premium costs. But that credit is short-lived – only six years at the most. The credit also provides a perverse incentive to hiring because of a reduction in the credit with a larger number of employees.

Two recent surveys indicate that ACA will accelerate the trend of employers moving away from ESI. Consulting firm McKinsey & Co. did a survey and discovered that almost a third of private-sector employers will drop their employee insurance coverage when the ACA government-managed insurance exchanges start in 2014. While the survey has been attacked as an outlier, a report by PricewaterhouseCoopers in May showed nearly half of employers will drop coverage for employees, putting them into the government-run exchanges.

While we can suspect that Citizen Action would not mind a trend towards a greater government role in providing health care coverage, policy makers at the state and federal levels concerned with tightening finances might not be so sanguine about such an outcome.

But it’s also a betrayal of one of the basic promises by Obama regarding his health care plan. As a candidate for president, Obama promised Americans that if they like their health insurance plan, they would get to keep it. Citizen Action may not mind this broken promise by the president, but the American public will.

Wigderson is a veteran participant and observer of Wisconsin politics. He and his family live in Waukesha County and his commentary can also be found at Wigderson Library & Pub.

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The 2011-2013 Budget for the State of Wisconsin is the most fiscally responsible two-year Badger State spending plan in at least a generation. It pays the bills, is short on accounting gimmicks, restrains spending and includes measures that will improve government efficiency and invigorate the private marketplace in order to help individuals and businesses here create jobs.

It is a good budget.

That being said, it could be better.

The document forwarded by the legislature still contains onerous interference into the private market. Program cuts that could have been made were modified for political expediency. And, although it has a dramatic decrease in earmarks over budgets past, is not pork free.

In a perfect world, we would see vetoes on the following items:

1. Craft brewers are gaining market share because they are meeting a consumer demand. The Legislature has no business restricting the production and marketing of a good or service on the basis of the size or scope of the actors involved.

2. On SeniorCare, the governor got it right the first time. The legislature’s moves added unnecessary expense to the budget. There is no sound reason Wisconsin’s seniors enrolled in the program shouldn’t first exhaust federal remedies, such as Medicare Part D. We are the only state in the nation with a stand-alone drug entitlement program for the elderly.

3. At a time when we are empowering management in their dealings with government labor, tying the hands of the Milwaukee Police Department makes neither fiscal nor ideological sense. The proposal that mandates that suspended officers receive pay during termination appeals has no place in state law, or this budget.

4. The legislature meddled when it decided to create an individual income tax deferral for investments in Wisconsin businesses. Why do they insist on picking winners and losers? Does the Legislature really believe an investor will commit his/her retirement savings to a Wisconsin business because the government will hand out a modest break on the capital gains? Investment of capital flows to attractive projects and businesses regardless of geographic boundaries.

5. The recycling mandate and its 19 million dollar price tag should end up back on the scrap heap. If a government entity believes a service is necessary, it should pay for it.

6. State taxpayers should not subsidize high-speed broadband internet access. WiscNet should not be a government priority. Private service providers are fully capable of meeting this need without government competition.

7. We would have preferred to see zero dollars in bonding authority for the purchase of more land via the Stewardship Fund. The legislature significantly cut Walker’s request but they should have eliminated it all together. The state owns enough land.

8. And while it will not happen, you would not hear us howl if the veto pen was used to make the School Choice plan available to all families statewide. We need an education system whose sole focus is the education of the child, not artificial boundaries or the status quo.

9. This budget modifies state law to make it easier and less expensive for government to exercise eminent domain in a few specific cases. It’s a needless increase in the ability of the state to interfere with property rights. If changes to the state’s eminent domain law are truly warranted, they should be considered as a separate piece of legislation, not in the budget.

10. Finally, the pork and earmarks remain a thorn. As we said earlier, this is hardly a pork-laden document like the Doyle budgets of the last decade. Nonetheless the habit has proven hard to break. And while this list is not comprehensive, worthy or not, these projects deserve to be line-itemed out.

• The elimination of the state per diem limit for sewerage district officials
• The new position at Crex Meadows Wildlife Education Center
• The $10,000 for the Sheboygan Aerospace port
• $300,000 for the Bay Area Medical Center in Marinette
• $25,000 for the Copper Falls State Park in Oconto

The State Budget is a solid plan. The best this state has seen in decades. It eliminates the structural deficit that has plagued this state for the last three administrations. But why settle for good?

Governor Walker will announce his vetoes on Sunday. Clearly he could make the plan even better.

[Milwaukee...] In March, it was announced with much fanfare that the Milwaukee teachers’ union was dropping it’s controversial Viagra lawsuit against MPS.

However, the MacIver News Service has learned that the effort to force MPS to provide coverage for erectile dysfunction treatments has arisen again, albeit in a different venue.

The Milwaukee Teachers Education Association’s (MTEA) decision earlier this year came just eight months after filing their August of 2010 suit in Milwaukee County Circuit Court wherein they argued  that the board’s policy of excluding erectile dysfunction drugs from their health plan coverage was discriminatory against men.

In December of last year MPS employee Henry Sampson filed a complaint with the Equal Rights Division of the State of Wisconsin’s Department of Workforce Development, arguing that excluding coverage for the gender-specific diagnosis of erectile dysfunction violated the Wisconsin Fair Employment Act (WFEA).

At this time it is unknown whether union officials were aware of Sampson’s pending complaint with the State when they dropped their lawsuit in Milwaukee County Circuit Court.

On May 4th, the Equal Rights Division found that there was probable cause to believe the Milwaukee Board of School Directors violated the WFEA and discriminated against Sampson on the basis of his sex.

“The Equal Rights Division found reason to believe there is sufficient information to hold an administrative hearing,” the DWD wrote in their determination letter.

A hearing before an Administrative Law Judge is pending in the matter.

The 49-year-old Sampson is a teacher at MPS who, according to the WIOpenGov.org online database, saw his compensation package rise by more than $9,000 this past year. Sampson made $72,913 in 2010. Along with a benefits package valued at $46,411 his total annual compensation is $119,324.

According to the probable cause determination, MPS argued that the ED drugs are marketed to enhance sexual performance, rather than to treat underlying physiological conditions.  Further, MPS argued that both men and women can have sexual dysfunction so not covering drugs for that condition does not show bias.

The stakes are high for Wisconsin’s largest school district.

Documents on the case show that MPS claimed that their costs more than doubled for ED related medication between 2002 and 2004. By that year the Milwaukee Public School District was spending in excess of $200,000 a year on the drugs for its employees, a cost they said they couldn’t afford to keep up.

MPS is currently in the process of laying off upwards of 400 teachers for budgetary reasons.

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[Milwaukee, Wisc...] School districts in southeastern Wisconsin are paying twice as much for health insurance as private sector companies in Milwaukee, according to a new study by HCTrends. That’s just the beginning of what the group found in its study of school district health insurance expenses in 2010.

“Health plan costs for the region’s teachers are 63 percent higher, on average, than the plans offered at private-sector companies with some union representation, and 80 percent higher than the average single-coverage cost for all private-sector plans,” according to the study.

“This combination of above-average plan costs and below-average employee contributions significantly increases the school district’s health care costs. While the average teachers’ plan costs 80 percent more than the average private-sector plan, the per-employee cost borne by the school district is twice as much as the cost borne by the average employer.”

HCTrends also debunks the public-sector union argument that they have foregone competitive pay increases in exchange for better benefits. The group found that since 2003 teachers’ pay has increased by 33 percent, while wages in the private sector have only increased 26 percent in Wisconsin.

“Teacher health plan costs are no longer comparable to the benefits being offered in the private sector, even at many larger firms with labor representation,” said Dave Jensen, Editorial Director of  HCTrends. “As a result, school districts are paying twice as much as other employers for health care.”

Jensen said public officials can help alleviate their budget crunches by offering competitive, not exorbitant benefits.

“Bringing plan designs and employee contributions in line with the private sector would allow school districts to achieve significant savings even as they continued to offer competitive health benefits,” Jensen said.

Right now, schools in southeastern Wisconsin are paying about $1,400 per student on health insurance for their teachers.

The study also found that Milwaukee Public Schools could save $221 million a year by bringing teacher benefit plans more in line with the public sector. Even if the district were to merely enroll its teachers into the state health plan, it would save $64 million annually.

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