Progressive Thinking

With repeal efforts in Washington on hold for now, the biggest immediate threat to affordable health coverage may be sabotage by the Trump Administration, Congress, and states like Wisconsin.

STATEWIDE - In the aftermath of the implosion of the Affordable Care Act replacement plan late Friday afternoon, the biggest immediate threat to affordable health coverage may be deliberate sabotage by the Trump Administration, Congress, and states like Wisconsin where conservative politicians are bitterly opposed to the health care law. With the legislative vehicle for radical restructuring the American health care system closed for the time being, State Innovations Waivers with states like Wisconsin may become the new method for achieving the goals of repeal.

After House Speaker Paul Ryan pulled his replacement bill on Friday President Donald Trump said: “I’ve been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode. . . . It is exploding now.” But the Congressional Budget Office and independent researchers conclude that the Affordable Care Act (ACA) as currently constituted will be stable for years to come. This assumes that the Trump Administration does not use its substantial administrative power to undermine the health care law.

The willingness of conservative politicians to play politics with the health coverage of the American people has been in evidence since the original passage of the ACA. As Citizen Action of Wisconsin has continuously documented, the Walker Administration has sought to sabotage the ACA by encouraging healthy people to buy substandard policies outside of the market; refusing to enact robust rate review; turning down Medicaid expansion; hamstringing health care navigators, rubber stamping health insurance industry mega mergers, and seeking waivers that would allow insurance companies to take larger profits. Taken together the Walker Administration has aided and abetted the on-going effort of the national for-profit insurance companies to continue to insure healthy people and find ways to avoid people with pre-existing health conditions.

The conservative majority in Congress has also played a major role in sabotaging the ACA. For example, they dramatically cut risk adjustment payments to insurance companies who insure more people with health conditions. This hit insurers that were doing the right thing with huge unexpected costs, driving many out of the the ACA marketplace and many new health care Co-ops out of business.

Before the failure of the latest legislative attack on the ACA last week, there were already indications of an intent to sabotage the health care law by not enforcing the individual mandate, pulling public promotion in the final weeks of open enrollment, not defending against a Congressional lawsuit that could pull tax subsidies from moderate income Americans, allowing substandard health insurance policies to be sold, and by cooperating with with states like Wisconsin that want to undermine the law. Trump’s selection of the vehemently ideological Tom Price as Health and Human Services Secretary is also evidence of an intent to disrupt the ACA. Major media outlets such as the New York Times, Washington Post, and Politico are now reporting that the Trump Administration may double down on sabotaging the health care law.

If the Trump Administration adopts sabotage as the next front in it’s attack on the Affordable Care Act, the biggest opportunity for radically changing the health care law may be State Innovation Waivers which under the ACA can be negotiated starting this year. These waivers permit states to submit plans to dramatically restructure health coverage. The Walker Administration would be an ideal partner for Secretary Price to develop a State Innovation Waiver which undermined the purpose of the ACA.

With conservatives in charge of the government they have a solemn moral obligation to uphold the laws of the land and to protect the welfare of the American people. It is stunning that conservative politicians are so bent on getting their way that they are willing to play politics with the lives of their own constituents by throwing sand into the gears of the American health care system. The right of every American to have quality affordable health coverage ought not to be a partisan issue. Now that the American people have resoundingly rejected their disastrous replacement plan, it is time for conservatives to take on the responsibility of actually governing by working with Democrats to move beyond the divisive health care battle and improving and building on the Affordable Care Act.

While Congress did not repeal the Affordable Care Act, problems remain. Sen. Vinehout writes about options states could take to address some of these issues and provide affordable health insurance for people.

MADISON - “Obamacare is the law of the land,” House Speaker Paul Ryan told the nation. “We’re going to be living with Obamacare for the foreseeable future.”

The much-maligned Affordable Care Act (ACA) passed in 2010 will stay in place.

Self-employed older Americans and state budget directors breathed a sigh of relief. The Republican plan would have raised rates for older people on Healthcare.gov, shifted taxes away from the well-off, and shifted to states more costs for low-income, disabled and elderly (through Medicaid).

But the problems of the ACA – rising premiums, customers left with little choice and insurance companies leaving the marketplace in some states – still remain.

Why do these problems exist? Is there anything Wisconsin can do to improve things?

Insurance companies act to share risk. Inevitably, healthier patients subsidize the less fortunate sicker patients. This has been the case since Benjamin Franklin invented the first American insurance company (that I’m aware of) when he created a “mutual fire aid society” to help defray the risk of fire.

Insurance companies are betting you will stay healthy, you are betting you’ll get sick.

When companies entered the healthcare.gov market place, they kept premiums low. Conservative columnist David Brook wrote in 2015 “Health care inflation has been at historic lows.” Quoting expert Jason Furman, Brooks wrote prices were growing as an annual rate of 1.6% since 2010, “the slowest rate for such a period in five decades.” Federal government health expenses slowed too.

For a number of reasons, the low inflation was not sustainable. Young people were not buying their own policies but staying on their parents plan as long as possible. Many people who got insurance for the first time had numerous costs due to delayed care. Insurance companies didn’t make the money they expected, and decided to either drop providing coverage in the exchange or raise premiums to cover the higher costs.

Covering self-employed or small businesses (known in the insurance industry as “individual coverage”) has always been expensive. Administrative costs are high; risk is high. The ACA protected consumers in many ways, such as not being charged more if you had cancer but are now healthy. However, the rules left fewer ways for insurance companies to recoup costs. So, they raised premiums or completely left the individual market.

The result is higher cost insurance, less choice and in some cases no choice.

Wisconsin historically has a competitive insurance market with many competing plans, especially in the southeast. Many players should give us lower costs (however, the health care market does not follow normal economic patterns), but seeking an unprofitable venture does not make a good business model.

Which may lead us to one option. Some insurance companies are not-for-profit; some have very low overhead. Everything else being equal, these companies should be better at competing. However, so much depends on the luck – or lack of it – in taking care of a high cost patient.

We could return to a successful plan that helped health insurance companies manage risk. In 2013, Governor Walker eliminated the state’s “Health Insurance Risk-Sharing Plan” known as HIRSP. This was a mistake.

The HIRSP plan was paid for with funds from insurance companies. We could create a similar plan to allow people with conditions that require expensive care to continue under their own insurance plan. Their insurance company could use a plan like HIRSP to share risk with other companies. Basically HIRSP 2.0 could work seamlessly in the background to help manage high-risk patients.

A recent National Governor’s Association briefing suggested states could save up to 15% on insurance premiums if they created such a plan. Other state innovations could include promoting enrollment in the healthcare marketplace, and focusing on methods to reduce the cost of care.

In a 2015 report, Citizen Action of Wisconsin proposed several changes that could bring down health insurance premiums. Medicaid expansion could cover an estimated 81,000 Wisconsinites through existing federal law and bring many high cost patients into a less expensive system. Creation of a Wisconsin-based marketplace, state scrutiny over premium hikes, use of state purchasing power to gain value – lower costs and better care – are all options that merit investigation.

Healthcare policy is complex. But solving problems is possible. If those in Washington have given up, let’s consider new ideas at our state Capitol. We might land on an idea that really works.

Don't let baseless fear and lies stand between us and our new neighbors and friends.

HOWARD - These days there are so many “alternative facts” being generated for the sole purpose of making people afraid. Especially troubling to me is the fear of foreigners. The belief that refugees and immigrants are dangerous. Although fears are not new, they are based on misinformation and lies. It’s untrue that refugees are not screened before entering the country, and that banning them will keep the U.S. safe from terror. Refugees undergo more rigorous screenings than any other individuals the government allows in the U.S. As a matter of fact, we know that in the past 30 years not a single death in the U.S. has been attributed to people from the countries covered by Trump’s unconstitutional executive orders banning Muslims.

It’s untrue that immigrants are violent or criminal. In actuality, immigrants commit crimes at lower rates than native-born citizens. Research shows higher levels of immigration may even have contributed to the historic drop in crime rates. It’s untrue that immigrants don’t want to learn English. Over 50 percent of first-generation immigrants speak English “well” or “very well,” and more immigrants want to learn English than classes can accommodate.

It’s untrue immigrants and refugees are somehow not like us. They’re students in search of an education. They’re families trying to make ends meet. They’re our neighbors, our friends.

They’re Americans.

Governor Scott Walker talks a lot about jobs, but the real record does not back up his rhetoric.

GREEN BAY - From the day he took office as Governor, Scott Walker has been talking about jobs. He wants to be seen as the jobs governor, taking credit here for the economic turnaround nationwide after the disastrous crash of 2008. It seems that every time somebody hires more than three workers in Northeastern Wisconsin, Walker shows up to give a speech.

When he ran in 2010, he promised to create 250,000 new jobs in Wisconsin during his first term, and it was an elusive goal. His strategy was tax cuts for the rich and union busting, with his own state employes and public school teachers his favorite targets. Now, well into his second term, Wisconsin still flounders behind our neighbor states and his jobs goal has not been met.

So, what is the real record on Walker and jobs? Below is a brief history of Gov. Scott Walker's record on job creation, courtesy of Brandon Weathersby of the Democratic Party of Wisconsin.

Wisconsin 2nd in U.S. in job losses last month, new estimates show
Wisconsin was second in the nation in total job losses last month, a somewhat surprising development considering the state’s unemployment rate has reached its lowest level since November 2008. Employers in Wisconsin shed an estimated 9,500 total public and private sector jobs in February, the Bureau of Labor Statistics reported late last week. Along with North Carolina (11,300 job losses) and Alaska (2,300 job losses), Wisconsin experienced a “statistically significant” decline in employment, according to a press release from the BLS.

Wisconsin suffers fourth-highest monthly job loss under Scott Walker in August
Even as its unemployment rate dipped to its lowest level since 2008, Wisconsin lost 4,300 private-sector jobs in August, according to preliminary estimates. It's the fourth-largest monthly jobs loss since Gov. Scott Walker took office in January 2011, according to figures from the U.S. Bureau of Labor Statistics' Current Employment Statistics program. The unemployment rate fell two-tenths of a point to 5.6 percent in August, but that figure and the monthly jobs change often can be disconnected.

Frustrated Wisconsin business owner moving company to Minnesota
The owner of a Wisconsin construction company said he's taking his business to Minnesota thanks to the passage of right-to-work. The Hoffman family has been in the Wisconsin construction business for a long time. "We like to say our company got started 100 years ago this year in 1915 when my great grandfather got his first road contract,” Jim Hoffman said..."I'm happy to offer the state of Minnesota a better alternative," Garofalo said. That alternative is a state that has no right-to-work law Hoffman said the move will keep his workers well paid and well trained.

Oscar Mayer plant in Madison will close; headquarters to move to Chicago
Madison’s Oscar Mayer plant — a fixture on the East Side for nearly 100 years — will close and its headquarters will move to Chicago, putting 1,000 employees out of work, parent company Kraft Heinz announced Wednesday. 
The loss of one of Madison’s signature companies is part of a plan by parent company Kraft Heinz to close seven factories in the U.S. and Canada, four months after the two food giants merged.

Wisconsin ranks dead last in startups
According to a report issued last week by the Ewing Marion Kauffman Foundation, Wisconsin is now last in the nation in new startup activity. The state fell five spots, from 45th to 50th, the report said, putting it behind West Virginia, Minnesota, Pennsylvania, and Alabama among the bottom five states. The top five states on the Kauffman list were Montana, Wyoming, North Dakota, Colorado, and Vermont.

Uncertainty growing after several Wisconsin companies announce job cuts, relocation
Almost 200 jobs are about to leave a company that has been a staple in Racine for generations. S.C. Johnson announced, Thursday, it is relocating 175 positions to Chicago. This comes after a number of other companies across the state recently announced layoffs. Joy Global in West Allis announced in September that more than 100 union and non-union workers would be temporarily laid off. Oscar Mayer is cutting nearly 1,200 jobs in Madison and General Electric announced in September it's plan to cut hundreds of jobs. When you have job loss anywhere, it's always a little uncomfortable at the onset. While not everybody is losing sleep, they may be feeling a little uncertain. Some of that uncertainty is growing in Racine after people learned of the jobs at S.C. Johnson moving to Chicago.

Wisconsin layoff notices topped 10,000 in 2015
Wisconsin employers notified the Department of Workforce Development (DWD) of 10,104 planned layoffs in 2015, a new high for Gov. Scott Walker's administration and the most in the state since 2010.

Manitowoc Company Moving To Pennsylvania, 528 Jobs Leaving Wisconsin
A major employer is closing its plant in Manitowoc, putting more than 500 employees out of work when it moves its crane manufacturing operations out of the state. The closure of Manitowoc Crane is the latest in a string of factory shutdowns that have affected the city. The company will remain open until it completes its current projects. It’s expected to close the manufacturing facility in stages beginning this year until it fully closes in 2017 when it moves. The company said it can save up to $30 million a year by leaving. It has been in Manitowoc since 1902.

Wisconsin lost 8,500 private sector jobs in September
Wisconsin lost more than 10,000 non-farm jobs in September, including 8,500 in the private sector. But the state’s unemployment rate also declined to its lowest level since early 2001, according to data from the U.S. Bureau of Labor Statistics. The state lost a seasonally adjusted 10,500 nonfarm jobs in during the month, including both the public and private sectors. Many of the jobs lost were in the leisure and hospitality industry with a drop of 4,000. The non-seasonally adjusted figures show the state losing 22,100 jobs in that sector alone as the summer tourism season came to an end. Labor force participation increased slightly to 68.4 percent with 3,132,300 people in the civilian labor pool. The unemployment rate was down from 4.2 to 4.1 percent, the lowest level since February 2001, according to the state Department of Workforce Development.

Why does Wisconsin lag at job creation?
It's a question that's dogged Scott Walker for years, and one that's sure to keep nipping at his heels as he runs for president: Why is Wisconsin in the bottom third of states when it comes to creating jobs? It's a perplexing question, and one that has had many observers scratching their heads. Unemployment is down, labor force participation is in line with other states. But despite his promise to create 250,000 jobs during his first term, Walker was only able to deliver about half that, leaving the Badger State with a dismal 35th place in private sector job growth rankings over the course of his first four years in office.

Wisconsin ranks 38th in private-sector job growth in 2015
Wisconsin has fallen to 38th in the country in yearly private-sector job growth. Preliminary, seasonally adjusted estimates for December, released Tuesday by the Bureau of Labor Statistics, showed that Wisconsin added 23,600 private-sector jobs in 2015 for 0.96 percent growth. By percentage, 37 states did better between December 2014 and December 2015, including all but two other Midwest states. Only Illinois at 45th (loss of 2,800 jobs, minus-0.06 percent growth) and North Dakota at 50th (loss of 18,700 jobs, minus-4.8 percent growth) were lower among the 10-state Midwest group.

Wisconsin ranks last again for start-ups
According to the report released Thursday by the respected Ewing Marion Kauffman Foundation, start-up activity in the U.S. overall rose in 2016 for the second year in a row. But among the 25 largest states, Wisconsin came in either last or second-to-last in each of the three categories the foundation evaluated.

Wisconsin ranks 33rd in job creation
As employment in Wisconsin's massive manufacturing sector switched into reverse, the state continued to lag the nation in the latest quarterly census of job creation. Wisconsin added 37,166 private-sector non-farm jobs in the 12 months from March 2015 through March 2016, a tally that includes non-manufacturing as well as manufacturing positions, amounting to a 1.58% increase that ranks the state 33rd among the 50 states in the pace of job creation during that period.

MILWAUKEE - It was one of the greatest victories for American democracy in years when Donald Trump and Paul Ryan were forced to pull their dangerous health care replacement bill just minutes before the scheduled vote.

Against all odds, and without power in Washington, average citizens stopped Trump and Ryan dead in their tracks!

A few short months ago, pundits thought that the repeal of the Affordable Care Act was a foregone conclusion. If it was not for the unprecedented democratic resistance in Wisconsin and across the country, they would have been right.

Right-wing talk show hosts are already spinning that the crash and burn of Trump-Ryan Care had nothing to do with grassroots protests. But it is well known the Republican leadership was trying to rush the bill through because they were afraid of coming home to face their own constituents during the next Congressional recess.

While this victory should renew our faith in the potential of American democracy, we need to understand that we won a major battle, but have not yet won the war.

I am proud to say that Citizen Action of Wisconsin is leading the charge against the unthinkably cruel attack on health care rights. We turned up the pressure on House Republicans this week by holding 10 major organizing actions across Wisconsin.

This is far from over. We must gather our energies for the next stage of the fight. We need to keep on fighting until we have established health care as a fundamental right in America--once and for all.

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