Progressive Thinking

This week Senator Kathleen Vinehout writes about the advocacy of hundreds of Wisconsin citizens in support of Family Care and the IRIS programs. Gov. Walker’s budget proposes significant changes to these programs and the adverse impacts of the changes were shared in personal stories from people all over the state.

MADISON - I remember when I first met a man I’ll call ‘Ron’. He came to my office with his caregiver. He couldn’t speak but used a speech synthesizer and an iPad to introduce himself. He was joined by several friends – all in wheelchairs – who told me their inspiring stories of independence.

Ron passionately detailed how his caregiver assisted him with everyday activities we take for granted. He wanted me to work for funding so he could pay his caregiver a living wage. Wages for care workers are very low and have been for years.

Fast-forward a few years. Ron and his friends joined hundreds of citizens in the Capitol to advocate for critical long-term care programs. Many of the visitors had never been the Capitol and never met with a legislator. These citizen lobbyists were advocating for programs that provide them or their family member with health and independence.

The governor’s budget proposal would likely turn Wisconsin’s Family Care system over to a large for-profit insurance company in a no-bid contract. Wisconsin’s IRIS program would be eliminated. Opponents are concerned the insurance company would deny services and eliminate caregivers.

Parents, family members, caregivers, neighbors and participants in the Family Care and IRIS programs called on legislators to stop the governor’s proposed changes. These people gave a strong voice to the often voiceless participants in the long-term care portion of the state’s Medicaid program.

Family Care is organized around regional non-profit Medical Care Organizations (MCOs) that oversee services for over 40,000 frail elderly, developmentally and physically disabled. In 2011 the Legislative Audit Bureau reported that nearly 60% of Family Care participants were able to stay in their own homes. IRIS is a fee-for-service option that establishes a small budget participants can self-direct to certain services and caregivers. Another 11,000 people use this option. Without these services most people would be forced to reside in expensive institutions.

Instead many individuals live more independently in Group Homes. An owner of a Black River Falls group home recently contacted me. She was forced to close one home because of previous budget cuts. She now worries about the other home she and her dairy farm family operates.

“I am scared for our disabled and mentally ill people, and I don't want to see the MCO's go away. They provide such wonderful care for these people! The teams I work with are amazing people, and they sincerely care about these clients, it's not just a job. Several of the team members have given me their cell phone numbers in case of issues outside of business hours, they do not get paid for this. Please help keep these MCO's intact: the people need them.”

Family situations are all unique. The self-directed IRIS program allows flexibility in services based on those unique circumstances. I was contacted by an Eau Claire County couple who maintain their independence with the help of IRIS. The husband is a Gulf War vet; his wife of 16 years has severe disabilities because of a brain tumor.

“If IRIS loses funding, Karen and I will be separated, her to a nursing home and me out of a job and homeless. Can you help us please?”

Tammy McKelvie recently shared with me how IRIS changed her son Noah’s life and “gave him a voice.” IRIS allowed her son to live independently despite the fact he needs constant care.

“Noah may never reach the level of independence most people strive for but at least let him have choices over the parts of his life he can control. Let him be the architect to design blueprints to create a life of meaning."

“As human beings, none of us are totally independent. In some ways we are all interdependent upon each other and that is how it should be because we all live in society together."

Indeed. As Hubert Humphrey so eloquently said, “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

Five years after the passage of the Affordable Care Act the law is guaranteeing Wisconsinites more freedom to control their own health decisions. But benefits are at risk due to inaction on Supreme Court threat. Reform more important in Wisconsin due to higher insurance costs.

STATEWIDE - Five years after the passage of the Affordable Care Act the law is guaranteeing, more than any time in American history, the freedom of Wisconsinites to control their own health decisions. Before the Affordable Care Act passed, Americans faced shocking health insurance discrimination based on age, preexisting medical conditions, gender, and other factors. Today over 207,000 Wisconsinites have quality health coverage that can never be taken away by insurance companies.

There are substantial tax subsidies to make health coverage affordable which have an especially important benefit in a high cost state like Wisconsin. Because Wisconsin health insurance premiums are higher than surrounding states, Wisconsin health consumers gain substantially more. Local numbers and comparison charts are below.

As significant as these advances are, Governor Scott Walker’s refusal to prepare for the potential adverse decision in the U.S. Supreme Court decision of King v. Burwell threatens to take health coverage away from over 183,000 Wisconsinites who receive tax subsidies and have nowhere else to go. Many of these consumers have pre-existing conditions and faced shocking discrimination from insurance companies before the passage of health reform. Others were forced on the marketplace by Governor Walker’s ill-conceived decision to reject hundreds of millions of federal dollars for BadgerCare provided by the Affordable Care Act.

“The advance in freedom provided by health reform is at risk in Wisconsin due to Governor Walker’s actions,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “It is political malpractice for Governor Walker not to prepare for a predictable disaster which could strip affordable health coverage from over 183,000 Wisconsinites. By failing to prepare a Wisconsin health insurance marketplace in the event the Supreme Court makes a damaging decision, Walker is putting at risk the lives and fundamental freedoms of people in every corner of Wisconsin.”

Table 1: Affordable Care Act’s Tax Credits Very Effective At Making Private Insurance More Affordable

(Click here to see data for more Metropolitan areas)

Data collected from Healthcare.gov and MNSure.org for 40 year old single applicant, non-smoking. Tax credits estimated for 40 year old single applicant making 200% of the federal poverty line, or $23,541 a year

Table 2: Affordable Care Act’s Outlawing of Pre-existing Condition Discrimination Protects Thousands

(Click here to see data for more Wisconsin localities)

Estimates from Families USA analysis of consumers in Wisconsin of non-institutionalized, non-Medicare-eligible population

Table 3: Citizens Around Wisconsin Have Signed Up for Health Coverage

(Click here to see data for more Wisconsin counties)

Source - County enrollment distribution based on Dept of Health Services June 2014 enrollment report adjusted for most recent February Healthcare.gov state enrollment numbers. Total tax credits are based on local enrollment and HHS reported average Wisconsin tax credit, annualized.

Poll shows massive public support for Wisconsin to take the enhanced federal funding for BadgerCare rejected in the Governor’s budget and for Governor Walker and the Legislature to prepare for the possibility that the U.S. Supreme Court could yank health insurance subsidies from over 183,000 Wisconsinites.

STATEWIDE - This morning Citizen Action of Wisconsin joined Public Policy Polling and members of the Legislature’s powerful Joint Finance Committee to release new poll results on key health care issues.

Audio of the release can be accessed here.

The polling shows massive public support for Wisconsin to take the enhanced federal funding for BadgerCare rejected in the Governor’s budget. It also shows overwhelming support for Governor Walker and the Legislature to prepare for the possibility that the U.S. Supreme Court could yank health insurance subsidies from over 183,000 Wisconsinites. Both are closely related budget issues. The polling results can be accessed here.

On taking the BadgerCare dollars currently being left on the table by Governor Walker, the public supports taking the money by an overwhelming 31 point margin (58% to 27%).

On the question of taking precautions against a U.S. Supreme Court decision that could endanger health insurance subsidies for over 183,00 Wisconsinites, the public by a 20 point margin (53% to 33%) thinks it is the Governor’s responsibility to take action to prevent anyone from losing their health care. This is a budget issue, because Governor Walker pushed 57,000 people off BadgerCare, and denied access to 81,000 people who would have been eligible, placing them on the federal marketplaces where they are vulnerable to an adverse U.S. Supreme Court decision.

The media call this morning was joined by three members of the Joint Finance Committee, Senator Jon Erpenbach, Representative Gordon Hintz, and Representative Chris Taylor.

“This is not the time to point fingers, we need leaders to step up,” said Representative Hintz.

On BadgerCare, Representative Chris Taylor said: “It’s a no-brainer. Why wouldn't we take this money to cover more people for less money.”

“For the life of me, I can’t understand why we have not done this,” added Senator Erpenbach. “It is up to Governor Walker to fix the problem, It’s the right thing to do.”

“It is clear that the Wisconsin public by huge margins supports major revisions to the state budget on health care issues,” said Robert Kraig, Executive Director of Citizen Action of Wisconsin. “The public wants Wisconsin to take all the money that is on the table to strengthen BadgerCare, and believes it is Governor Walker’s responsibility to take action to safeguard the health coverage of the over 183,000 Wisconsinites at risk from a potentially dangerous U.S. Supreme Court decision.”

About the poll: Public Policy Polling surveyed 1,071 registered Wisconsin voters from March 6th to 8th. The margin of error for the survey is +/- 3.0%. 80% of interviews for the poll were conducted over the phone with 20% interviewed over the internet to reach respondents who don’t have landline telephones. Full poll results can be accessed  HERE

Web Link to Release

As Farmers come in as part of Ag Day at the Capitol, they focus on parts of the state budget that hurt rural communities. That includes rural schools, conservation, on-farm research, the Natural Resources board, the spring Conservation Congress, funding for the U.W. Extension, 4H, and farm safety. Many wonder why the governor is doing away with needed services.

MADISON - “It’s very important that we are here today,” the farmer from Independence told me. “In fact, it’s more important that we be here than anywhere else.” Here was in my Capitol office. Local farmers were visiting as part of Ag Day at the Capitol.

The weather that day was dry and warm. It was perfect for getting early spring chores done. Instead, these farmers drove hundreds of miles to meet with their legislators.

They were on a mission to change parts of the state budget that hurt rural communities. The first thing on their mind – in every group that visited – was rural schools.

“What are you going to do about rural schools?” the Buffalo County man asked me. “Our local school has two referenda on the ballot in April – one to fix the furnace and other delayed improvements; another to continue to keep the school open”.

“See this binder?” I showed him a large binder full of pages with red and green Post-It notes. “This is the Cliff Note version of the budget: It’s over 500 pages.”

“Everything in red I’m trying to get rid of. Everything in green is money I’m trying to get for education, the UW and other cuts,” I explained. Red notes far outnumbered green ones. Changes to agriculture and conservation were among the notes I flagged in red.

We talked through the farmers’ problems: managing tillage, conservation, chemical applications and nutrient management – i.e. when to spread manure. Many of the management questions farmers had to answer were assisted by on-farm research.

The flagship system of on-farm research is Discovery Farms. At twenty farms across the state, scientists monitor details like water and nutrient flow, erosion and soil structure, to help farmers develop best practices.

Thousands of farmers and ag support folks visit Discovery Farms to learn first-hand from U.W. Extension staff, scientists and the farmers themselves. The research brings a steady stream of knowledge to help preserve land and protect water for all of us.

Farmers also strongly opposed taking away the power of the citizen Natural Resources and Ag Department boards. “We just got a farmer on the Natural Resources board,” one farmer said. “This takes away our voice,” said another.

We talked about spring Conservation Congress meetings. Folks gather by the hundreds in school gyms around the state. Anglers and hunters use wisdom they’ve gathered over decades to make recommendations related to conservation. For example: should the pan fish limit at the local lake be changed?

The vote goes to the state Conservation Congress board, made up of members elected by their neighbors, and on to the Natural Resources board. Policy is made from the votes of those affected by the decisions. But the governor’s proposal would eliminate the input of the Conservation Congress by taking away the power of the citizen Natural Resources Board.

Many farmers also served on town boards. More than once I heard about the governor’s proposal to take away towns’ ability to hire property assessors. “This just doesn’t make sense,” one farmer told me. “The counties don’t want to take over the assessors, the state hasn’t given money to do this. And we lose our powers.”

We talked through other farmer concerns including funding for U.W. Extension, 4H, and farm safety. The conversation came back to schools and education. “Our schools pay for the independent charter schools in Milwaukee. I don’t think that’s fair,” said one farmer. “My children already spend an hour and a quarter on the bus,” said another.

“You know I was just appointed to the environmental education board,” said a third. “I really don’t understand why the governor is doing away with environmental education. These programs help school kids learn about Wisconsin’s natural resources.

As he got up to leave one of the farmers gestured to my budget binder still sitting on the table. “I like the way you did that,” he said, referring to the red and green tabs.

“It’s a big budget with a lot of bad in it,” I nodded. “You’ve got to eat an elephant one bite at a time.”

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.