Progressive Thinking

This week Sen. Kathleen Vinehout writes about recent visits from constituent citizen lobbyists who came to Madison to discuss a myriad of important concerns. These visits are a critical way for legislators to learn about issues of concern to their constituents.

MADISON - “I’ve never done this before,” the young woman told me. She came to my Capitol office for the first time to talk about issues important to her and her profession. She was one of about two-dozen groups that recently visited.

People imagine a legislator’s job as debating on the Senate floor. But much of my time is spent listening and learning. Here’s a sample of visits from a single day.

My day started working with my staff to distill the important decisions of the state budget into a PowerPoint for use at Town Hall meetings. Budget choices include what happens to local schools, the UW, health care, local government, public safety, state parks, our environment, agriculture, roads and bridges.

Soon into my budget work, my staff interrupted saying, “There’s a group waiting for you.”

The first group of almost 100 employees and retirees represented a local utility. The group leaders shared several concerns including federal guidelines that called for a reduction in carbon emissions. They worried Wisconsin was not given credit for prior lowered emissions. After the leaders explained utility concerns, I invited employees to speak. Their most important issue was protecting local schools.

“I’m very concerned about the Eau Claire school district,” a man shared. “I want my grandchildren to have a better education than my children, but how can the school do this with so many budget cuts?”

Back at my office I started adding up budget dollars spent on large road construction projects in Southeast Wisconsin. I was adding the third nine-digit number when my staff said, “The Optometrists are here to see you.”

An independent optometrist from Eau Claire told me about her new business and the problem she was having with insurance companies. “They won’t cover simple things I can treat, like pink eye,” she said. “Instead patients are required to go to the large healthcare system. The patient stays there and doesn’t come back to my office.”

She and her fellow optometrists wanted support for a bill to provide, as they called it, ‘patient equity and access to care’. The bill would allow optometric, chiropractic and podiatric (foot doctor) patients to choose their own doctor.

Shortly after this meeting I was visited by a nurse from Eau Claire who talked about creating a new law for independent nurse practitioners. Mid-level providers are a growing field. Research and patients alike support independent practice for nurse practitioners and certified nurse-midwives. But the law is slow to keep up with changes.

She also explained problems with a shortage of nurses and injuries to nurses in the workplace.

My next visitors were quite familiar with the job of citizen lobbyist. The Kwik Trip employees joked with me -“It’s Groundhog Day” - as they told me for what seems like the 6th time about big companies trying to repeal the Unfair Sales Act.

You might think of Kwik Trip as a big company but the La Crosse-based company is small potatoes in a big world. They are firmly behind protecting the mom and pop gas stations from unfair competition.

As the Kwik Trip folks left I hurried to another hearing room where nursing home administrators expressed concerns about budget cuts. “We just can’t continue,” one administrator said. “In 10 years, three nursing homes closed in our area,” said another. “We are competing with Wal-Mart and McDonalds for workers and we have to pay our workers more,” said a third. “Wisconsin must invest in caring for our elders.”

As I got back to my office, an Eau Claire man visited. He was helping the Amish keep their homes. Because of their religious convictions and culture, some Amish don’t follow laws related to plumbing, electricity and smoke alarms. The man shared stories of Amish being evicted in subzero weather. The loss of their home was devastating.

It was now quite late. I turned back to my desk. Waiting for me were finishing touches on health care legislation, the Department of Health Services budget briefing and an invitation to a Constitutional Officers reception.

I didn’t get far on my budget math, but I did benefit from the knowledge gained on issues of concern to my constituent citizen lobbyists.

Sen. Kathleen Vinehout is circulating a bill that would create a Wisconsin based Health Insurance Marketplace. Hard-working Wisconsin families will lose health insurance if the Supreme Court rules in favor of the plaintiffs in 'King vs Burwell', a case that challenges whether citizens who buy insurance through the federally facilitated health exchange are eligible for premium assistance.

MADISON - On Wednesday, I unveiled a plan to create a state-based Health Insurance Marketplace as United States Supreme Court Justices opened arguments on a case that could strip Wisconsinites of their health insurance premium tax credits.

Hard-working Wisconsin families will lose health insurance premium credits if the Supreme Court rules in favor of the plaintiffs, and Wisconsin can avert this crisis by creating its own state-based Marketplace.

The U.S. Supreme Court took up a case (King vs Burwell) that challenges whether citizens who buy insurance through the federally facilitated health exchange are eligible for premium assistance. Nearly 90% of the over 200,000 Wisconsinites who signed up for insurance through the federal exchange are receiving assistance.

Over $58 million going to our hard-working families is at risk. "On average, the benefit to Wisconsin families is about $300 a month in credits to cover about 70% of their premium" according to Misra, A. & T. Tsai in  “Health Insurance Marketplace 2015: Average Premiums after Advance Premium Tax Credits through January 30 in 37 states using the HealthCare.gov platform”. ASPE Research Brief. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation, February 9, 2015, p. 5..”

The bill captures those aspects of Wisconsin’s health care industry that are unique to our state and builds off work already in progress by Wisconsin health plans and providers to create a balance between health quality, costs and access.

The Badger Health Benefit Marketplace is a one-stop shop for small businesses and people who buy insurance on their own. This will give folks a truly competitive market for health insurance and help drive down health costs for everyone.

This week Sen. Kathleen Vinehout writes about the proposal in Governor Walker’s budget related to the combining of WEDC and WHEDA. Her concern is that as the dollars for economic development grow, the ability of the public to determine how well their public dollars are used does not.

MADISON - “I’ve heard about the cuts,” the Buffalo County man said. “But this budget spends more. Who’s getting more money?”

Folks are concerned about big cuts to the UW; cuts to local schools; scaling back of health programs for the disabled; public radio and TV losing state support.

But the new budget spends $3 billion more than the last. Where is that money going?

One place to look is the Wisconsin Economic Development Corporation (WEDC). Despite its name, WEDC is a part of state government; in fiscal year 2012-13 it received over $62 million from the budget (including about $4 million in federal funds) and the agency can authorize potentially millions more in tax credits.

The Governor’s flagship program turned troubled when auditors found procedures weren’t written down, loans were lost and Wisconsin was penalized. Three Chief Financial Officers left – one after only a day on the job.

I described the creation of WEDC four years ago as putting the cookie jar in a dark pantry with a sign on the door that says, “Trust Us”.

In this budget the Governor combines WEDC with another agency that administers loans: the Wisconsin Housing & Economic Development Authority.

The Governor creates a new board. He kicks off the board the legislators who ask too many questions. The new board will only be private sector folks chosen by the Governor.

The budget adds more money into the mix: $55 million in a revolving loan fund and almost another $10 million in tax credits. Governor Walker then proposes taking existing business tax credits and converting them into refundable tax credits. What does that mean?

Think about the refund you might receive when you file your taxes. The refund comes because you paid in more than you owed. It’s your money coming back.

What if the rules were changed so you didn’t owe any taxes? You still filed your tax return but you owed nothing. A refundable tax credit would still give you a refund check signed by the people of Wisconsin. That’s what’s going on.

Imagine you’re the CEO of a multi-national company that reported sales in billions. You’re making a lot of money. But the tax laws are changed so the company owes very little or nothing at all.

When your accountant files your company’s tax returns instead of paying on what you owe (which is nothing) the people of Wisconsin pay you. This is a refundable tax credit.

And then the budget proposal takes away a few of the rules.

For example, under the ‘qualified new business ventures’, your company would not have to comply with one or more of the current rules: you would not have to be a Wisconsin company, you would not be required to have 51% of your workforce in Wisconsin, and you would not have to commit to keeping your business in Wisconsin.

Reminder: the public purpose of the current rules is to grow good paying Wisconsin jobs.

The public wouldn’t know if you followed the rules or even received the grant because the budget changes the open records laws so the company can never be identified. No data in the agency’s record keeping software can be made public.

I wondered how the auditors would do their work. But then I learned the budget also says the watchdog Legislative Audit Bureau (LAB) won’t complete a program evaluation audit until 2017 and won’t complete a financial audit at all.

An independent private auditor will be hired in 2016. But an outside auditor won’t give us the information we receive from the LAB.

To perhaps add an incentive to companies to play nice with the people in charge of the cookie jar, the Governor takes away any oversight on the creation of a nonprofit company to accept private gifts and grants.

It’s not a big stretch to see companies giving gifts to the nonprofit arm and receiving tax credits from the other arm.

I explained all this to my constituent in Buffalo County. He said, “They took the cookie jar from the dark pantry and put it in a dark castle with a moat around it!”

The sign in front of the moat reads, “Just trust us.”

Senator Kathleen Vinehout writes about drastic changes to Family Care and IRIS included in the Governor’s budget. If these changes become law, many frail elderly and disabled persons would be put at risk of losing the services that help them stay in their community and out of expensive institutions.

MADISON - “You have got to be kidding!” a Chippewa Valley advocate responded when I told her about a plan to potentially turn Family Care over to a for-profit insurance company.

Family Care and its fee-for-service sister, IRIS, provide thousands of Medicaid-eligible frail elderly and disabled people the help they need to remain in their homes. Services could include help getting places; keeping a job; managing money; preparing meals; keeping healthy; bathing and dressing.

People who benefit from Family Care or IRIS might easily end up in an expensive institution. Personal care and other workers help them stay in their own home – and many times – stay gainfully employed.

If the current version of the governor’s budget becomes law, it will mean big changes to care for frail elderly and disabled people of modest means. For the rest of us, it could mean many more of our neighbors and family members end up in expensive institutions. Worse yet, folks could be stranded at home without the services they need to independently live and work.

Buried in the mammoth state budget is the elimination of IRIS as we know it. IRIS serves more than 11,000 people statewide. The philosophy of the program is in its name: Include, Respect, I Self-direct. People hire their own workers who perform many tasks including meal preparation, bathing, and getting people to work.

As Jason Endres of Eau Claire told me, “Without these services, the way IRIS provides, it would prevent us from being part of our community.”

Also eliminated are local centers to assist elderly and disabled people find services. Known as Aging and Disability Resource Centers (ADRCs), these publically run centers would close and their citizen oversight boards disband. They could be reopened by a private company but with no requirement to be conveniently located or to tell people about all the services for which they may qualify. For example, the woman I wrote about in last week’s column who is served by SeniorCare, said without the help of local ADRC staff she would not have known about SeniorCare.

Family Care is a managed care program serving over 40,000 elderly, physically disabled, and developmentally disabled folks. A large number of developmentally disabled people use Family Care in the Chippewa Valley because of the closure of Northern Center. Services such as residential homes, mental health services and job coaches help folks stay in the community. Local providers work with non-profit Managed Care Organizations that oversee service delivery.

Services are tailored to the needs of the individual as determined by an independently completed functional assessment. This way services are based on the needs of the individual and not on what the provider has available.

Changes in the budget would eliminate most of the Managed Care Organizations. Their job could be taken over by a very large for-profit insurance company. Budget language gives the state Department of Health (DHS) authority to hire the insurance company in a no-bid contract and removes any legislative oversight of the contract between DHS and the insurance company.

This new insurance company could become the gatekeeper for all medical, rehabilitative, personal living and employment services for over 50,000 people (DHS enrollment numbers from 2014).

In essence, every service needed by the disabled or frail elderly person of modest means would need approval by potentially one for-profit insurance company.

“This takes the personal choice right out of it,” an Eau Claire woman told me.

It also makes it more likely people will not receive the care they need. Insurance companies are very good at denying care and shifting the cost of care to patients and families.

Jason said to me, “One for-profit, national insurance company in a no-bid contract? It makes me very sad. It’s no longer about local choices. It’s about big business making decisions about very personal things.”

Advocates are working hard to save these important programs. People can learn more at www.saveiris.org. Jason reminded me to thank Amber and Nancy for this awesome website. Check it out. You’ll see Amber, Jason and read many more amazing stories.

This week Senator Kathleen Vinehout writes about Governor Walker’s proposed changes to SeniorCare. She is hearing from people who are very concerned about the proposed changes which may cause seniors to pay huge increases in the cost of their prescription drugs.

MADISON - “Please do what you can to keep SeniorCare as is. It is critical to those of us on it.” wrote a rural Buffalo County woman.

“I will be 70 years old in a couple of months and not on any prescription medicines. SeniorCare is perfect for me as I very seldom require a prescription for illness or injury, usually going for a year or more without needing one. I should not have to pay the outrageous high cost of Medicare Part D which I would very seldom use and it would cause a terrible financial burden for me that I could not handle on my fixed income.”

The rural woman I’ll call ‘Dawn’ signed her letter, “Thank you from a very satisfied SeniorCare participant.”

Slipped into the Governor’s state budget is a requirement that seniors sign up for Medicare Part D before they sign up for SeniorCare. The program is a substitute for Part D.

To justify his action, the Governor told the Wisconsin State Journal “It’s not about changing benefits; it’s ultimately about changing who pays for it.”

According to Dawn that is the problem.

She figures under the Governor’s new plan she’d pay $60 a month. Now she pays $30 a year. “I shouldn’t have to pay an outrageous bill for something I won’t use,” she said in a recent phone conversation.

SeniorCare is truly a Wisconsin invention. It is the only state-based alternative to the complicated maze of plans comprising Medicare Part D – the drug benefit for seniors.

To participate in SeniorCare, people must be Wisconsin residents, over age 65, and meet an income requirement. The program has a simple one-page enrollment form and requires a $30 annual fee. Folks pay a deductible and small co-payment of $15 for brand name and $5 for generic prescriptions.

Seniors love the program, as do health care workers, pharmacists, nursing homes and elder advocates. Not only is the program simple, it is also less expensive. In 2011, the Legislative Fiscal Bureau (LFB) estimated that SeniorCare saves the federal government $85.8 million a year.

SeniorCare is a state-run program while Medicare Part D involves the sale of private insurance policies under federal government rules. Part D plans differ quite a bit with different formulas for coverage, different deductibles, different coinsurance and different lists of drugs covered. In addition, plans offer different levels of coverage in the “doughnut hole” — gap in coverage.

Part D plans require seniors to pay a monthly premium, in addition to the per-prescription copayment and the deductible. Seniors tell me the Part D premium alone could easily be 24 times the annual $30 cost of SeniorCare.

SeniorCare depends partly on federal Medicaid funds. To continue to get federal funds, Wisconsin must periodically prove to the feds through a waiver request that they are saving taxpayers’ money. Unlike Part D Medicare, one way that SeniorCare saves money is to negotiate with drug companies.

This is the second time the governor proposed doing away with SeniorCare as we know it. In 2011, a statewide petition drive saved the program.

Spearheading the petition drive was Representative Andy Jorgenson. He was recently quoted in the Milwaukee Journal Sentinel: "What is wrong with Governor Walker? Did he not get the message the first time, or doesn't he care? … Governor Walker is pushing a plan that will hurt seniors financially."

In 2011 people collected over 15,000 signatures. Moments after the signatures were delivered to lawmakers, Republicans pledged their support for SeniorCare.

Dawn knew about the success of the first petition drive and was already at work.

“I spent all day Saturday and Sunday sending emails,” she told me. “Most [lawmakers] sent a letter back saying they were not accepting emails. It was frustrating. Don’t you think if they represent Wisconsin they should accept my email?”

When I complemented Dawn on her persistence she said, “What scares me is that $60 a month,” she paused and nearly whispered, “I’m not going to be able to buy groceries.”

You can get a copy of the SeniorCare petition by calling my office toll free (877-763-6636) or sign the SeniorCare petition at my Senate website.