Wisconsin State Capitol Building Rotunda

Healthcare continues to be a hot topic in Wisconsin and nationally and has very recently jumped to the forefront. Both parties are recognizing the general public’s insecurity about affordability, and stability of healthcare coverage. There is also a fear regarding pre-existing conditions.

In order to address these dynamics, as well as the instability of the individual insurance market and the federally facilitated marketplace (exchange), Wisconsin Governor Scott Walker outlined three key proposals to address healthcare concerns in his annual State of the State Address:

1332 Waivers (pursuant to the Affordable Care Act). This process would be used to establish a reinsurance program to address dramatic growth in premiums in the individual market and on the exchange (for example, rates for 2018 doubled in one rate region in Wisconsin, while some insurers dropped out entirely). Such waivers have been approved by the federal government for Minnesota, Oregon, and Alaska. The Wisconsin waiver is likely to be modeled similar to that of Minnesota, where premiums were reduced by 20%, according to materials from the Walker Administration. The Governor has proposed a $200 million program, with $150 million funded by the federal government and $50 million in state funds from the Medicaid program, which is experiencing a healthy surplus. As such, no new state funds are required. The Affordable Care Act (ACA) requires the state legislature to authorize the waiver request.

Legislation to ensure consumer protections for those with pre-existing conditions. While the ACA currently provides such protections, efforts to “repeal and replace” the ACA have spotlighted pre-existing conditions as a key concern for the public. A state law in this regard would ensure the continuation of such protections if the ACA were to be repealed, or if federal administrative actions modified current protections. Legislation to implement such a change, Assembly Bill 65, passed the Assembly in June 2017. However, that was during a heated floor debate with both sides playing “insider baseball” with this bill. Therefore, many acknowledge this bill would need amendments if it is indeed to become law and reflect the governor’s intent. Governor Walker has indicated he is flexible regarding the vehicle for addressing pre-existing conditions.

A permanent waiver for SeniorCare prescription drug assistance program. SeniorCare is a state-based prescription drug assistance program for Wisconsin residents who are 65 years of age or older and meet certain income and other requirements. It is the only program of its kind in the nation and has been highly successful and popular. The Legislature has rejected two previous budget proposals to phase out the program in favor of Medicare Part D; the governor is now proposing to eliminate the need to continually seek extensions. It is unclear if the federal government has the authority to approve a permanent waiver, although there is a fast track process for waiver extensions.

Beyond these specific initiatives, other 1332 Waiver items could be pursued, such as high-risk insurance pools, as well as broader Medicaid reforms through the 1115 Waiver amendment process. Uncertainty over congressional and Trump Administration action regarding the ACA further complicates such initiatives, despite newly allowing work requirements as part of Medicaid.

Michael Heifetz
Bio Link Michael specializes in healthcare reform, policy implementation, and government relations and advocacy, focusing his work in the following areas: Medicaid optimization, state healthcare policy, federal healthcare reform, and helping clients navigate the Centers for Medicare and Medicaid Services (CMS). In his recent role as director of Wisconsin’s Medicaid program, Michael led the agency responsible for healthcare coverage and services for 1.1 million Medicaid members and an annual operating budget exceeding $9.6 billion. Expertise: Healthcare Reform, Medicaid, Medicare, Government Relations, and Public Policy


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