Health care advocates are calling Gov. Scott Walker’s budget repair bill an attempt to dismantle the health care system after learning the bill would change the way the state’s health department makes rules and give the state increased authority to modify medical assistance programs.
Walker’s budget repair bill, introduced last Friday to address the state’s current $137 million shortfall, has been criticized by union workers for terminating their collective bargaining authority. But the bill also authorizes the Department of Health Services to make rules and changes to programs like Medicaid and BadgerCare, which alarmed advocates.
“This is terrible policy,” said Bob Johnson, spokesperson for Wisconsin Council on Children and Families. “A power grab of this magnitude is unprecedented.”
The bill would allow DHS to change requirements, modify benefits, revise provider reimbursement models and develop standards for eligibility, which could result in lowered eligibility limits, according to an analysis from the Legislative Reference Bureau.
Walker said the provision is necessary to stop Medicaid costs from rising.
“Medicaid costs have increased dramatically due to the recession and expanded program eligibility,” Walker said in a statement. “In order to reduce the growth in costs, the bill authorizes the Department of Health Services to make program changes notwithstanding limits in state law related to specific program provisions.”
Currently, the Legislature is responsible for making changes to medical assistance programs. However, the budget repair bill would terminate the Legislature’s role in debating health care rules and only require proposed rules promulgated by the DHS to be heard by the Joint Finance Committee.
Democrats said they would rather have important changes to medical assistance programs be sent through traditional legislative channels for approval instead of relying solely on the Republican-controlled Joint Finance Committee.
“Currently any changes have to go through both houses of Legislature before taking effect,” said Julie Laundrie, a spokesperson for Sen. Jon Erpenbach, D-Middleton. “But with this bill we could make massive changes to the BadgerCare program with just a legislative committee.”
The Joint Finance Committee has 12 Republican members and four Democratic members, which Johnson said proves the committee would not be as good of a check on executive power as the Legislature.
The bill also allows the DHS to make emergency rules, which would be immediately implemented. Although Johnson said emergency rules would go through the oversight process quickly and with limited debate, the Legislative Reference Bureau said emergency rules receive essentially the same amount of oversight as non emergency rules.
The bill does require the DHS to conduct a study to find potential changes that would increase the cost effectiveness and efficiency of care for medical assistance programs, but Johnson said the study would not be worthwhile.
“They’ve been doing those studies in the last several budgets; every agency does that,” Johnson said. “They’re fairly meaningless. The low-hanging fruit is all gone. While there’s no harm in it, this is no reason to believe significant savings are going to take place.”
Johnson said he is not sure if Walker intends to gut Medicaid or BadgerCare completely, but the bill’s provisions would make it possible to do so and Walker pointed to entitlement programs in his State of the State address as programs that break the bank.
The state currently funds Medicaid and Medicare with $1.6 billion of general fund money, and the federal government pays $4.7 billion. Miscellaneous segregated fees and program revenue make up the rest of the $6.78 billion that pays for medical assistance, said Jon Peacock, Wisconsin Council on Children and Families research director.
The Legislature is scheduled to debate the budget repair bill later this week.
