In his State of the State address, Gov. Scott Walker proposed a Health Care Stability Plan to keep premiums down and create more choices for consumers in Wisconsin. Walker’s plan includes a $200 million reinsurance program and a pre-existing conditions exclusion bill. Other health care initiatives for 2018 include employer group plans, breast density notification, and minimum markup repeal.

Reinsurance

Rep. Todd Novak (R-Dodgeville), at Walker’s request, introduced legislation (AB 885) that would create the Wisconsin Health Care Stability Plan, a $200 million state-based reinsurance program for health carriers to help stabilize the market for individual health plans. The bill permits the Office of the Commissioner of Insurance to seek a 1332 waiver from the federal government allowing for the plan.

The Joint Finance Committee (JFC) held a hearing on the bill on Feb. 12. At the hearing, OCI said the bill would help stabilize markets and increase access to affordable health care in Wisconsin. Supporters of the bill include Wisconsin Medical Society, Marshfield Clinic, American Health Insurance Plans, Wisconsin Hospital Association, Children’s Hospital of Wisconsin, Alliance of Health Insurers, and Wisconsin Association of Health Plans.

Those testifying against the bill included Citizen Action of Wisconsin and ABC for Health, who said the bill should have more accountability provisions to ensure insurers’ savings would be passed on to consumers.

On Feb. 13, JFC voted to pass a substitute amendment to the bill on a 12-4 partisan vote. Among other changes, the sub:

• Deletes a provision allowing the secretary of the DHS to lapse up to $80 million from general purpose revenue appropriated for Medicaid for the program. Instead, under the amendment, the general fund will directly pay for the program.
• Gives JFC a 14-day passive review period on GPR transfers to the reinsurance program fund.
• Clarifies that legislative approval is needed for the state to accept Medicaid expansion under the Affordable Care Act.
• Prohibits OCI from spending more than $200 million on the reinsurance program in 2019 and in future years, unless approved by JFC.
• Requires OCI to submit recommendations to the governor by the end of 2018 on additional waivers to stabilize the Wisconsin markets in the long term. The sub directs the report to explore high-risk pools, health savings accounts, and catastrophic plans, among other ideas.
• Requires OCI to maximize federal funding for the program.

The full Assembly will vote on the bill next week.

Employer groups

Earlier this week the Assembly Committee on Health heard AB 920 related to employer groups for self-funded health care coverage.  The bill will allow employer groups to offer self-funded health care benefits to their employees in a health care benefit arrangement.  Two or more employers that are members of the same chamber of commerce or industry-based association may form an employer group.  The author’s intent is to allow employers another option to lower their cost of providing healthcare to their employees.  Wisconsin Medical Society and WPS Insurance joined the author in sharing their support for the legislation.

The Alliance of Health Insurers (AHI) submitted testimony cautioning the legislature against action on this bill prior to the finalization of federal rules regulating these plans, as to avoid a conflict between state and federal law. AHI encouraged lawmakers to strengthen the solvency requirements of such arrangements.

Chiropractors came out in strong opposition to the legislation as they were concerned that these new types of arrangements would exclude chiropractic care from their plans.  An amendment was approved to require coverage of chiropractic care.

Wisconsin Association of Health Plans and National Association of Social Workers are also opposed to the legislation.

The bill is scheduled for Assembly floor action Tuesday.

The Senate companion, SB 806, was introduced on Wednesday by Sens. Duey Stroebel (R-Saukville) and Sen. Tom Tiffany (R-Hazelhurst).  The bill was referred to Sen. David Craig’s (R-Big Bend) Senate Committee on Insurance, Financial Services, Constitution, and Federalism. Craig is also listed as an author on the Assembly version.  No hearing in the Senate has been scheduled at this time.

Preexisting Conditions Exclusion

Walker’s plan also called on the Senate to pass a preexisting conditions exclusion bill (AB 365), which the Assembly voted to pass in June. The legislation prohibits plans, when setting rates, premiums, deductibles, copayments, or coinsurance, from considering whether an individual (including a dependent) who has continuous coverage has a pre-existing condition. The Senate Committee on Insurance, Housing and Trade has not yet taken action on the bill.

Repeal of Minimum Markup of Prescription Drugs

Sen. Leah Vukmir (R-Brookfield) and Rep. Jim Ott (R-Mequon) have introduced legislation (SB 263/AB 359) that provides exemptions for prescription drugs and general merchandise under Wisconsin’s Unfair Sales Act.  Those exemptions would allow retailers to sell prescription drugs and general merchandise for the same price they can in other states.  This would save consumers money as make it easier for Wisconsin “brick and mortar” retailers to compete with online retailers.

The Senate Committee on Agriculture, Small Business and Tourism held a public hearing on the bill on Feb. 14. The hearing was highlighted by Walmart managers and pharmacists telling their stories about how the law negatively impacts their customers.  Some opponents of the bill were concerned that the bill relating to prescription drugs and household goods might somehow down the road affect their state government mandated markup on gasoline.

Later in the afternoon, Walmart, Rep. Ott, the MacIver Institute, and the Wisconsin Institute for Law and Liberty, held a press conference asking the legislature to move on the bill.

Breast Density

Although not included in Walker’s proposal, the legislature has also been moving on a bill (SB 543/AB 653) by Rep. Mike Rohrkaste (R-Neenah) and Sen. Alberta Darling (R-River Hills) that would require facilities performing mammograms to provide patients with dense breast tissue a notice stating that such tissue makes cancer detection more difficult and is associated with a slightly increased risk of breast cancer.

After passing unanimously from the Assembly Health Committee in December 2017, the bill passed the full Assembly on Jan. 16, via voice vote. The Senate Committee on Health and Human Services unanimously passed the bill on Feb. 9. The bill is now eligible for next week’s Senate calendar.

Follow developments in health care legislation this session with Hamilton’s Health Care Policy Issue Update.