Progressive Thinking

School districts have not recovered from the historic cuts to state aid for schools included in Governor Walker’s budgets, forcing school superintendents and boards to make very difficult funding decisions as they deal with the needs of students.

ALMA, WI - “Welcome back to school,” the newsletter proclaimed. The Superintendent welcomed all with a cheery letter describing the amazing team at the school.

As students walk toward the school doors, they see from the outside that everything looks great. My local school district is proud of the new asphalt on the parking lot.

Inside the building, teachers worked hard to create a welcoming environment. For weeks, teachers, administrators and staff prepared a friendly and positive atmosphere for students, including cheerful posters decorating the walls and bright colors adorning the halls.

But, metaphorically, pulling back the blinds and peering deeper into our local classrooms shows a different picture.

Parents looked through the school supply list and made a shopping trip to prepare their children for school. Many teachers made lists and purchased needed supplies with their own checkbook.

To meet student needs, teachers stock their shelves with food for children who come to school hungry. Or hygiene supplies for children who need help keeping their young bodies clean. Often, it means creating a clothes closet for children who need coats, hats, shirts or shoes.

Peering into the schoolroom window we see children in poverty, children suffering from mental illness and/or trauma. Schools are helping more students with special needs. Many schools have more students who are English Learners.

Schools take on the challenge of meeting the needs of all students. However, children in poverty need more resources. They can succeed, but they need more help to do so.

Schools grapple with finding resources to help children with special needs. The federal government requires certain services for special needs students. Regardless of the tight school budget, schools must offer those services.

Unfortunately, Wisconsin only provides twenty-six cents for every dollar schools spend on special needs services. As a consequence of this policy, school boards and superintendents are forced to cut services for general education to meet the federally required special needs services. In essence, all children sacrifice to help fill the gap in the special needs budget.

A similar pattern emerges with the education of children who are English Learners. In 1990, the state paid 63 cents of every dollar a school spent on bilingual/ bicultural programs. Now, the state pays about eight cents of every dollar. As children’s needs increase, resources must be shifted from other programs to make up for the shortfall.

Likewise, mental health needs of students are increasing. For example, a recent survey of students reported nearly half of all girls and thirty-percent of all boys surveyed reported anxiety, along with higher rates of sadness, hopelessness and thoughts of suicide. Students are also increasingly facing trauma, especially students in poverty. Trauma affects students’ cognitive abilities as well as their behavioral and impulse controls. Schools need resources to help these children.

Declining enrollment in more than half of our schools is creating perpetual budget crises and leading to approval of a high number of school referenda just to pay for operations.

In real dollars, state funds flowing to schools are less than a decade ago. Wisconsin public schools suffered historic budget cuts under Gov. Walker. Despite increases in his Election Year budget, schools have not recovered from the massive cuts in 2011. In real dollars, public schools are getting less this year than they received in 2008-09.

Following enactment of Act 10, and the historic cuts to schools, teachers left the profession and fewer college students are becoming teachers. Budget cuts forced rural schools to cut support staff and courses in art, music, ag, along with advanced placement classes. Now, schools across the state are experiencing difficulties filling vacancies.

I serve on the Legislature’s Blue Ribbon Commission on School Funding. We heard public testimony from schools around the state that experience serious budget challenges. Often the problems facing rural and inner-city schools are cited as reasons to change the state’s current course on school funding. However, I learned even suburban schools, like Kettle Moraine, are facing program cuts.

When we couple the increasing needs of children with historic budget cuts to schools, we can see through the school room window that challenges cannot be solved by our local school districts alone.

Wisconsin must reverse course and return to making education our top funding priority.

Sen. Kathleen Vinehout writes about recently released research that points to benefits of Medicaid expansion, under the Affordable Care Act. Unfortunately, Wisconsin leaders did not opt to expand Medicaid.

ALMA, WI - “The dramatic decline in the share of children without health insurance over the past two decades is an American health policy success story,” wrote Alan Weil, the Editor in Chief of the journal Health Affairs. The journal is widely seen as a leader in reporting research related to health policy.

Medicaid (MA), known in Wisconsin as BadgerCare, and the Children’s Health Insurance Program, are credited with an astounding ninety-four percent participation rate of eligible children. This is the highest level of health care coverage since researchers began measuring children’s coverage.

With one in six Wisconsin children living in poverty, and an increasing rate of childhood poverty, programs that provide health care coverage to children are even more important.

Unfortunately, researchers found states that did not expand MA coverage under the federal Affordable Care Act (ACA) had fewer eligible children and parents participating in Medicaid.

Wisconsin’s governor chose not to expand MA under the ACA.

States that opted to expand MA successfully increased their level of health care coverage for eligible populations. Those states were effective at outreach, easy enrollment and easy renewal processes.

Researchers however cautioned that cuts to the funding available for outreach and elimination of the “individual mandate” (the requirement that everyone have health insurance) is predicted to lower health coverage for children in the future.

Health news from states that did expand MA coverage brings us a clearer picture of the benefits Wisconsin could reap under a change in our state policy.

Diabetes is one of Wisconsin’s top “avoidable” disease burdens. Diabetes can lead to many other health problems including eye and heart disease. Diabetic patients can control their blood sugar through lifesaving medications. But patients without health insurance frequently cannot afford costly medications.

Getting folks to fill their prescriptions and use their medicine as prescribed, can prevent other health problems, provide long-term benefits for the patient’s health and lower overall cost.

New research comparing MA expansion states with non-expansion states (like Wisconsin) show a significant increase in patients filling prescriptions for diabetic medication among the expansion states when compared to the non-expansion states. Researchers found older – below age 65 – patients experienced the largest increase in prescription fills.

The study looked at patterns in over ninety-six million prescription fills. Authors suggested that state savings can grow over time as people age but stay healthier. These savings could help justify the state’s investment in MA expansion.

Researchers also looked into better understanding the effect of MA expansion on coverage for those suffering from addiction. Researchers in Oregon suggested MA expansion was associated with a decrease in depressive symptoms and an increase in self-reported mental and physical health.

Getting the full complement of treatment options to MA patients suffering from substance abuse is a challenge for many states. Limits on MA – the nation’s largest payer for addiction treatment – has been a problem for many years.

Restricting access to services for addiction makes no sense, especially with the often small window when patients realize how sick they are and are willing to comply with treatment. For MA expansion states, the Affordable Care Act “ushered in landmark reforms to Medicaid coverage for addiction treatment,” wrote researchers in the recent edition of Health Affairs.

Wisconsin has the option of expanding MA coverage under the ACA. The current administration rejected MA expansion even though data from the nonpartisan Legislative Fiscal Bureau showed over a billion dollar six-year savings to the state budget (fiscal years 2013-14 through FY 18-19).

If leaders chose MA expansion in the current budget, the state would save two hundred and eighty-six million as federal money replaced precious state “general fund” dollars. I proposed using this savings to make a long-needed investment in community-based mental health and addiction recovery services.

Uninsured patients cost all of us, as hospitals shift the costs of those unable to pay their bills onto other patients. Programs like MA help all of us by providing lifesaving coverage.

Sen. Kathleen Vinehout writes about how stagnant shared revenue payments cause problems for local units of government as they try to address increasing costs.

ALMA, WI - “I just hope the county doesn’t cut the budget,” a local judge told me. We were discussing how effectiveness of his alternative treatment court program and how much he needed money to keep the program operating.

Across the State, local governments – counties, cities, village and towns – are preparing budgets for their 2019 operations. A major source of their income is shared revenue from the state.

“Shared revenue” has been a fixture in Wisconsin since 1911. The state sends money to local units of government at the end of July and again in mid-November. These payments help offset the property taxes folks pay to operate local government.

The system of sharing of revenue began as a way to return a portion of the new state income tax to local governments in order to offset the property tax exemptions that were enacted at that time. The state sent the money back to locals based on how much residents of each city, village, town or county paid into the state.

At first, ninety percent of the income taxes collected were sent back to the local governments from which they came. Called “return to origin,” the payments were higher to wealthier areas as those residents paid more in income taxes on their higher incomes.

During the 1970s, the system was changed to match local need. Lawmakers created a complex formula that included population, property values and local revenue efforts. Communities that had a utility, which didn’t pay property taxes, received additional payments. The policy objective was to provide a minimum amount of money from the state even if a community had many costs and low property values.

Changes over the years ‘tweaked’ the formula. Automatic increases were eliminated, and even though the formula was still law it wasn’t followed. During the 2008-2010 recession shared revenue was cut by three and one-half percent.

In Governor Walker’s first budget, funding was cut by over nine percent. Since 2012, annual shared revenue aid to local government has remained unchanged.

In addition to not increasing shared revenue payments, the state asked more of local government in the form of mandates. Many of these mandates were unfunded, leaving local governments with more to do without additional resources.

State law limits local governments’ ability to raise revenue from property taxes by imposing levy caps. The combination of levy caps and decreased shared revenue from the state leaves local officials asking ‘What do we cut?’

On this one-way street where the state makes the rules, limits what local government can spend, and doesn’t share increasing revenue, local folks are stuck paying more of the cost and have few options to get extra money.

Many local governments have spent their reserves and are forced to consider borrowing money to cover needed improvements or unexpected costs, like repairing flood damage.

As discretionary programs are eliminated, more of local government budgets are taken up by public safety. Police and fire protection costs are increasing. But neither the levy cap nor the state shared revenue payments cover the increase.

Local officials are forced to choose whether to cut: public safety, repairing the roads, and/or community mental health and drug addiction programs.

Local officials are looking at increasing deficits in coming years. Next year state budget writers must address the shortfall or residents may face dire cuts in local programs.

In a memo I requested from the nonpartisan Legislative Fiscal Bureau, shared revenue would need to increase by about 30% just to keep up with inflation since 2004. That would require an investment of $415 million in the next state budget.

That sum compares to the estimated $464 million payment promised by the Governor to Foxconn for building a factory in Racine.

As local governments cut their programs this fall, we will be reminded that we can’t spend the same dollar twice. What goes to Foxconn won’t be available for shared revenue.

Local governments faced with decreased shared revenue and Wisconsin Medicaid payments are hard pressed to combat addiction with community-based treatment alternatives instead of incarceration. Sen. Kathleen Vinehout describes the challenges and offers solutions.

ALMA, WI - “Let me tell you a story,” the county supervisor said.

A man I’ll call Frank was picked up for drunk driving. Frank faced a felony charge. Frank was sent by our local judge to a county-based program funded with a grant. Over the years, the county supervisor helped the county get funding from the Treatment Alternatives and Diversion (TAD) program.

“The drug counsellor asked the man why he drank a quart of vodka a day,” the supervisor told me. The man said, “My teeth hurt.”

Counsellors worked to get Frank BadgerCare, and medical care. They got him to a dentist, who pulled all his teeth. Frank spent two months on antibiotics. He’s now sober and able to do some fishing – something he loves and hadn’t done in years. The supervisor thanked me for my help, saying the TAD program saved money and saved lives.

In county court rooms, judges have alternatives to sending those suffering from mental health and addiction issues to prison. But not all judges and counties are able to use this life changing program. In the current budget, the state funds only a tenth of what is needed to expand TAD statewide. In the alternative I wrote to the Governor’s budget, I showed how to pay for fully expanding the program with the same state dollars by rearranging priorities.

Folks like Frank need treatment, not prison. Our state mental health system is not adequate. As a consequence, law enforcement and prison costs are increasing, as lives are wasted.

For example, the new Secretary of Corrections recently told the Audit Committee seventy percent of Wisconsin inmates suffer from addiction and over eighty percent of women in prison have mental health conditions.

Minnesota has a very different approach to mental health and addiction recovery. Minnesota is called by some the Land of Ten Thousand Treatment Centers. Years ago, the state invested in a community-based mental health and addiction recovery system. Now, with a similar crime rate and similar population, our neighbor to the west has less than half its residents in prison compared to Wisconsin.

The key to helping those with addiction and mental health challenges are community-based resources. For two decades, the state cut or level funded local governments in the “shared revenue” counties and cities received. In addition to facing decreased funding, state officials piled on more requirements with less help.

When the state adds more requirements but no more money, locals describe the combined effect of less money and spending caps as “the vise squeezing counties.”

“Relationships work when they share purpose and responsibility,” a local county health official recently wrote. “The State-County partnership delivering health and human services to Wisconsin residents falls short on many fronts.”

For example, he said, mental health services are coordinated through a system called Comprehensive Community Services. Like the help Frank received, many mental health and addiction recovery services are paid for through Medicaid (MA).

“MA revenues are billed services vulnerable to disallowances [non-payment],” the local official said. “When this occurs, the county provider is responsible for paying funds back.” With mental health care “the State has taken back hundreds of thousands of dollars but refused to provide guidance to counties … the State provides little technical assistance.”

We can and must do better. Wisconsin must treat local governments like the full partners they are in delivering needed mental health services. We must invest in expanding services as the state works with locals to find the best path forward.

To address the struggle families face across our state, Wisconsin must take the Medicaid expansion money from the feds, cover 79,000 additional people with healthcare and use the freed-up state dollars - almost $300 million estimated for this budget – to make a down payment on a community-based mental health and addiction recovery system.

Locals should be at the table when decisions are made. Flexibility is important. One-size does not fit all. Incentivizing local creativity would improve service delivery.

People are suffering. But there is hope. Comprehensive treatment can be available – just like in Minnesota. Wisconsin can become the Land of Fifteen-Thousand Treatment Centers. Now is the time to act to solve the problems of mental health and addiction. This saves lives and saves money.

Governor now finds it convenient to pretend to care about health care costs, but 7 years of sabotage of the ACA reveals that he has been more than willing to play politics with the lives of Wisconsinites.

STATEWIDE - Governor Scott Walker is touting the approval by the Trump Administration of his complicated health insurance scheme that does not even begin to make up for the cost of ongoing efforts to sabotage the Affordable Care Act (ACA).

Walker’s complicated scheme called “reinsurance” funnels $200 million in direct public subsidies to insurance companies in the hope that they would lower premiums for some consumers. The proposal does not require that health insurance companies pass on any savings to consumers, and even if they did it would only impact a small percentage of Wisconsinites.

Reinsurance will not help anyone who gets insurance at work or small businesses or most people who buy insurance on their own. Although Governor Walker claims it is focused on people who buy insurance on their own, it will not impact 83% of the Wisconsinites who buy health coverage through the ACA marketplace and receive tax subsidies. Reinsurance will not effect deductibles or copays. It will only modestly help the 17% of enrollees who make too much money to be eligible to federal tax credits

Walker’s press release touts a 3.5% reduction in premiums for some Wisconsinites who buy insurance on the ACA marketplace, a much lower number then what was claimed when the proposal was introduced.  But according to the Urban Institute just two of Donald Trump’s acts of sabotage, refusal to enforce the individual mandate and the extension of short term “lemon” health plans will increase premiums by 18.2%.

There are a number of far more effective policy changes that would make health coverage much more affordable if we deployed the full power of state government.

1. Opening BadgerCare to everyone in Wisconsin as a public option would reduce premiums and deductibles by an average of 38%. It would also help people who buy insurance on their own and small businesses, most of whom cannot afford to provide coverage to their employees.

2. Reversing Walker’s decision to turn down the Medicaid expansion money in the ACA could reduce premiums by about 7%.

3. Reversing the Walker Administration's decision in May to continue to allow the sale of substandard “lemon” plans in Wisconsin could reduce premiums by as much as 10%.

In addition, although Walker has decided to tout what he is doing to stabilize the ACA, he approved the filing of a lawsuit by the Wisconsin Attorney General that would strike down the law, taking health care away to nearly 200,000 Wisconsinites.

“Scott Walker now finds it politically convenient in an election year to pretend to care about health care costs, but 7 years of sabotage of the ACA reveals that he has been more than willing to play politics with the lives of Wisconsinites who do not have good coverage at work,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “More corporate subsidies are not the answer. It is a simple truth that only “we the people,” through the agency of our own democratic government, can guarantee health care to everyone in Wisconsin.”