Progressive Thinking

The new Community Emergency Medical Services (CEMS) Program will allow emergency medical personnel to perform basic health care for people in their homes, reducing costly readmissions to the hospital. Program requires additional training for EMS personnel working under direction of the hospital medical director.

ALMA, WI - “We had a patient who called us at least once a week,” a local Emergency Medical Director told me. “We took him to the hospital, but, what if we could take care of him at home.”

A new law makes it possible for emergency medical personnel to perform basic health care for people in their homes. This new approach to health care delivery may soon be in your neighborhood.

“We’ve seen a big increase in calls,” a Jackson County emergency medical professional said while visiting my Capitol office. He told me the patients they see at home are much sicker than years ago. People need care but want to stay at home. In Jackson County, ambulance personnel are working closely with the homecare workers to help people stay in their homes.

We think of emergency medical personnel as helping us with acute problems: an auto accident or farm injury. Increasingly, the problems emergency workers see are related to chronic conditions. Diabetes, breathing problems and heart disease are common complaints.

Legislation recently signed into law created a new type of health professional through the new Community Emergency Medical Services (CEMS) program.

Gundersen Health System spokesperson Michael Richards testified in support of this legislation. He described a change in the way Medicare paid for hospital visits. Beginning in 2012, hospitals are penalized for patients who returned to the hospital if they were admitted less than a month prior. This “30-day readmission rule” encouraged hospitals and doctors to think hard about how to keep people healthier, in their homes, and not back in the hospital.

“To be proactive, Gundersen…diligently research[ed] the community paramedic program. …We envisioned the positive potential a comprehensive community paramedic program could provide to our patients and communities. …We aim to integrate the community paramedic program into the transitional care program as a ‘transition care coach.’”

Mr. Richards explained that a community paramedic would be trained in patient assessment, education and diagnostic testing, such as electrocardiograms (EKGs). The CEMS worker could help with review of medications, appointments and continue “strategies to reinforce compliance to [the] discharge plan of care and/or disease management. All this work will be done under the direction and guidance of the medical director.”

Making sure the patient received the proper care by a quality professional was the goal of the main authors of the new law – Representatives Loudenbeck and Shankland and Senators Moulton and Bewley.

The new law specifically forbids the emergency personnel from performing any services that require a license, certificate or other state credential. This requirement means the community emergency worker could not do the work of nurses or other health professionals. Under the new law, community emergency workers are forbidden from providing any services that are already being provided to a patient.

How will this new law work? Most emergency professionals will act as part of a hospital team. The Wisconsin Department of Health will approve both the ambulance provider’s plan for community care and the training programs. Hospitals will likely offer much of the training. The Department of Health or the medical director must establish care protocols – what the emergency responder does for the patient.

To work as a community emergency services practitioner, an individual must receive approval from the Department of Health, must have two years of experience and must complete required training.

The ambulance provider must have approval by the Department of Health for the type of care the emergency medical services professionals will deliver.

Mr. Richards summed up the new plan stating, “We believe community paramedicine best serves patients and community health. The extension of care beyond our walls is in line with the specific goal of reducing readmissions [and] is in the best interest of the patients and their families.”

This story is a fine example of how federal health policy – the “30-day readmission rule” – spurred innovation leading to a change that is both better for patients and helps lower health costs. And it’s a story of how a bipartisan group of lawmakers stepped up to the challenge to make innovation happen in Wisconsin.

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A guest column from Senate Jon Erpenbach on how Federal policies affect our lives and the state budget bottom line.

MADISON - For most of us, Washington DC and the politics of President Donald Trump and a Republican Congress seem a million miles away. But the reality is that our lives, and the lives of those we love, are impacted by the Federal government and decisions made in Washington DC every single day. Whether you drive to work on a road that gets Federal funds, receive or are building social security, qualify for Medicare, have a child in school, receive the child tax credit, eat food from a farm that is subsidized, take medication that is regulated; all of this and countless more daily operations of our lives are impacted by the decisions made in Washington DC.

The Federal tax bill, which will be reconciled soon between the Senate and the House, spends in deficit. That is an inarguable point because the bill enacts tax cuts that are not paid for. Because the bill has deficit spending, it is regulated by another Federal law that prohibits deficit spending. While tax breaks enacted for corporations and wealthy will remain in place, programs that benefit our elderly or low income individuals will be cut. It will be an automatic action unless Congress passes a bill to reverse their “Pay As You Go” 2010 law. The Medicare the cuts, although immediate, are capped yearly but will still be felt deeply simply because of the number of people that qualify for this Federal health care program for the elderly. For other Federal programs the cuts will simply come without regard for need.

According to the Associated Press, “The program that would be most affected by the automatic cuts is Medicare, whose budget would be slashed by more than $25 billion a year. Other programs that would experience deep cuts include vocational training for individuals with disabilities, block grants for foster care and Meals on Wheels and federal funding for historically black colleges and universities.”

There are consequences for decisions made in Washington DC and sometimes they are not so obvious. If you are lucky enough to make an income three times the Wisconsin median income, the tax plan being decided in Washington DC will likely benefit you. But if you are like the rest of us who are the proven fuel in the US economy, those that spend all the income they receive on cost of living, it will be harder to find a benefit. If you are over 65, disabled, a foster child, a farmer, a construction worker, an addict in recovery, a Meals on Wheels recipient, or living on a fixed income, be ready for cuts to your income, health care and services; not only as the primary action of the tax plan but the mandatory secondary action of current Federal law.

Wisconsin will have lots of tough choices in the upcoming budgets because of less revenue from the Federal government and fewer block grants to support our state budget. I stand ready as a member of the Joint Committee on Finance to help navigate Federal cuts and to work to help make the best decisions we can for the people of the State of Wisconsin given this fiscal shortfall.

You can contact my office at 608-266-6670 or toll free 888-549-0027 or via email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Research shows the need for people to work in middle skill jobs, the largest share of jobs in Wisconsin. Sen. Vinehout’s proposal will give residents the opportunity to get an education and give Wisconsin a pool of skilled workers.

MADISON - “Every Wisconsinite should have access to education or training past high school… To be pursued at whatever point and pace makes sense for individual workers and industries,” wrote researchers at the Center on Wisconsin Strategy (COWS) eight years ago.

Long before the current shortage of skilled workers, COWS anticipated the need for additional training. In 2009, the Center teamed up with the Workforce Development Board, Skills2Compete and others to study “Wisconsin’s Forgotten Middle-Skill Jobs.”

Middle skill jobs are those jobs that require more than a high school diploma but less than a four-year degree. The study I quoted above, found “Middle skill jobs still represent the largest share of jobs in Wisconsin – some 54 percent – and the largest share of job openings into the next decade.”

Georgetown University just released a study that found similar conclusions. “Across the nation, good jobs have shifted toward Associate Degree holders and away from workers with a high school diploma or less.”

In response to the demonstrated need, I am proposing free tuition for Wisconsin residents at our Technical Colleges and University of Wisconsin two-year campuses.

Expanding our skilled workforce is the surest way to grow our economy and raise wages. Raising wages in Wisconsin should be a top priority. We are ranked 18th worst in the nation in average wages and salaries.

My proposal, Freedom to Learn, allows students to learn at their own pace and choose their own course of study.

Long ago, I worried about how to pay for college. My only option was a two-year campus. I know firsthand what it’s like to not know how to make ends meet and also go to college. Many see tuition as an insurmountable obstacle. I want to eliminate any hesitation someone might have in pursuing his or her opportunities and dreams.

I want to make it possible for someone who is already working or has family obligations, doesn’t have the cash and can’t afford to take time off, to get the education and training they want. Freedom to Learn, in allowing students to attend school part-time, and learn at their own pace, goes further than tuition programs in other states.

In 2014, Tennessee became the national leader in eliminating tuition and fees for incoming full-time students. Since then, several states followed including most recently, California.

Like other states, my proposal uses state tax dollars as the last dollar scholarship. This means students apply for financial aid. Free tuition grants kick in after all other federal and state aid are used. Wisconsin already has a similar last dollar free tuition program for our veterans.

My program is modeled after Tennessee. Republican Governor Bill Haslam showed the nation what works. As Tennessee added dollars for tuition, the number of students applying for student loans dropped by 17%. In addition, the number of students enrolled in two-year and tech colleges increased by 30%.

Under the proposal I recently released, the cost of free tuition at two-year and tech colleges is funded by repealing the manufacturing portion of the Manufacturing and Agriculture Tax Credit. This tax credit is one of 43 different tax credits claimed by businesses in the past year. The effect of this specific tax credit is to reduce state taxes owed to near zero.

Corporate profits and corporate cash reserves are at an all-time high, while wages are stagnant. Companies have the money. They don’t have the workers. Trading one manufacturers’ tax break for a pool of skilled workers is a good exchange.

Freedom to Learn is a great opportunity to invest in the potential of our own Wisconsin workers and grow our economy from the inside out. It makes more sense than trying to lure workers from other states or giving billions to one foreign corporation.

MADISON - Over the last couple weeks, the influence of the Koch Brothers and Wisconsin Manufacturers & Commerce (WMC) has been on display, if you were looking.

And we were looking!

First, we discovered that two senior officials at the Koch-funded Americans for Prosperity suddenly resigned to do campaign work for Michael Screnock, the Walker ally who is running for Wisconsin Supreme Court:

Court candidate hires former Koch group executives as campaign advisors

Then we saw that Koch groups were the only ones that registered in favor of another bill that Walker just signed which will deregulate several occupations:

Walker approves Koch bills to loosen licensing

WMC and the Kochs were behind yet another bill Walker just signed that’ll let landowners do just about anything with their property, even if it wasn’t zoned for such a purpose:

Walker signs lax land-use bill backed by big boys

And WMC, along with a veritable polluters’ lobby, is backing a bill to do away with Wisconsin’s regulations that protect our clean air:

WMC behind Republican bill to repeal state air pollution rules

This is why I say that the Koch Brothers and WMC are the folks that really run Wisconsin – not Walker or Fitzgerald or Vos. They’re just the hired help.

You can count on us to keep showing you who the real powers are in Wisconsin – and what effect they are having on all of our lives!

Best,

Matt Rothschild
Executive Director
This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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Conversations around the Thanksgiving dinner table reveal people are confused about health care, spending more and unhappy about health insurance coverage. Approaching deadlines are adding a sense of urgency.

ALMA, WI - “My family conversations over Thanksgiving were all about health care,” Mary shared with me. “It’s all so confusing.”

Mary’s family is not alone. From recent conversations, I’m betting that health care dominated talk at many Thanksgiving gatherings.

Premiums are too high. Young people worry about finding money to buy insurance. Older people are trying to figure out Medicare. Many are struggling with unpaid or surprise bills.

Everyone has a health care story.

“My employer pays $3,000 for my HSA [health savings account]. What happens if they decide not to pay?”

“My premium is almost double what it would be if I lived across the river in Minnesota. Why?”

“The insurance company told us the doctor was covered. Then we got a bill for $2,800. Insurance said he was NOT covered. How can this be?”

“Becky turned 26. We can’t keep her on our plan. The company offered to cover her – alone – for another $876 a month. Can you believe it? They are not charging us any less now that Becky’s not on our plan. How can that be?”

“Do I stay on my individual plan or do I move my small business to a ‘small business health options’ Obamacare plan? Can I deduct my insurance as a business expense?”

Great uncertainty this fall about the future of health insurance has fueled confusion. Efforts to repeal and replace Obamacare at the federal level and the Governor’s plan to have the state self-insure state workers, left insurance companies uncertain about the future. Some left the market.

Previously available plans, through the healthcare.gov marketplace, are no longer available.

Six plans previously offered to state employees, no longer cover them. My plan was one of them. I researched options, trying to find a covered doctor within an hour’s drive. I couldn’t find one within two hours’ drive! I called the Human Resources person. He spent several days researching my problem. Eventually, he came to my office.

Both of us worked on different phone lines. While waiting on hold for a long time, we chatted. The HR people were very busy. I learned 20-30 lawmakers lost their coverage and their providers. Many other state workers lost their providers. The information provided on the websites was not accurate. One plan offered a provider on the website but told us the provider was NOT covered on the phone. Another plan told us on the phone they DID offer a provider, but that provider was not listed on their website.

I represent about 172,000 people. I’m worried, if I can’t figure health care out, how can everyone else?

Norman, my brother-in-law, echoed the same concern. After a long discussion of the problems facing our family members, he exclaimed, “I am a doctor turned accountant, who’s now retired. I’ve got the time and the knowledge. And I can’t figure this out. How can anyone else understand it?”

One source of confusion is different deadlines. All of them rapidly approaching.

For those who buy insurance for themselves, the sign-up period is much shorter than prior years. By December 15th, people need to sign up for individual health insurance at healthcare.gov. Sign up is important for everyone who buys insurance on their own. It’s especially important, for adults in their late twenties, who may have previously been able to stay on their parents’ plan.

Small business owners may have a choice to also use the Small Business Health Options Program. This deadline is also December 15th. If you work with an agent, be sure to contact them much sooner. Agents are very busy helping folks talk through decisions.

Medicare recipients have until December 7th to make their choices for the New Year. Others have differing deadlines depending on your employer.

The more insurance companies invent their own rules, the federal government waffles on its commitments and the state fails to provide leadership, the less the public has sympathies for government, insurers or providers.

Confusion over health coverage is driving many I’ve spoken with to throw up their hands and tell me, “I’ve never said this before, but can’t we just have some kind of National Health Insurance?”