Affordable Care Act attacks also snag state issues, legislators say

Feb. 07--Wisconsin lawmakers say public health measures at the state level are mired in uncertainty and confusion because of the assault on the federal Affordable Care Act by President Donald Trump and the congressional Republicans.

"I've heard folks say the sickest and those who get there first will get health care, and others won't," Democratic State Sen. Jennifer Shilling said during the La Crosse County Health Department's periodic legislative forum Monday.

Lawmakers or their representatives addressed the crowd of about 150 people -- the majority of whom were nursing and health students from Western Technical College, the University of Wisconsin-La Crosse and Viterbo University in La Crosse -- during the forum in Western's Lunda Center. Also attending were several county health workers, professors and instructors, and members of the general public.

Shilling referred to the proposal of U.S. House Speaker Paul Ryan, R-Wis., to funnel Medicaid payments to states through block grants instead of reimbursement to health care facilities based on patient services.

Repealing and replacing Obamacare, as Trump and the GOP have vowed to do, and switching Medicaid to block grants would be major setbacks for health care in Wisconsin, said Shilling, a La Crosse Democrat.

John Medinger, speaking as the regional representative for Democratic U.S. Sen. Tammy Baldwin, D-Wis., said dismantling the ACA could have a devastating impact on rural hospitals and residents.

"If people don't have insurance, they won't go to their rural hospitals for care," the former La Crosse mayor said. "If you lose your hospital in a rural area, you've lost your anchor."

Tony Kurtz, regional director for U.S. Sen. Ron Johnson, when asked about the Oshkosh Republican's position on the issue, said Johnson objects to the ACA's costs and "the government telling you what to do."

One of the main Republican objections to President Barack Obama's signature legislation is its mandate that people buy insurance or face annual penalties, one of the vehicles that helps pay for elements of the law.

However, Kurtz said, Johnson will work to ensure a suitable replacement. The senator is among many who back the law's requirement for insurance coverage of pre-existing conditions and allowing young adults to remain on their parents' policies through the age of 26, he said.

In light of the furor in Washington and across the country, Kurtz said, "Give this some time. There is a lot of back and forth. Give it three, four months. I think the folks of Wisconsin will be pleased."

Medinger countered with a comment about funding, saying, "How can you keep the good parts if you don't keep the things that pay for it?

"If you don't mandate that people have insurance, how will you pay for it?" Medinger asked.

Medinger questioned the potential inclinations of some of Trump's Cabinet picks related to health issues, such as "for Health and Human Services, he has Tom Price, a guy who doesn't like Medicare, and Tom Pruitt for the EPA, a guy who doesn't like climate change."

In contrast, Medinger cited local health officials' attitudes to eschew turf wars and work together to help connect people to the resources they need.

That runs contrary to what many politicians do, he said, adding, "If these programs were coordinated by health professionals, you would get the job done."

Loren Kannenberg, speaking as regional rep for U.S. Rep. Ron Kind, noted that Kind has been one of the staunchest supporters of the ACA. While agreeing that some parts of the law need tweaking, Kind remains committed to "ensuring that it will provide adequate health care," Kannenberg said.

State issues the legislators addressed included:

Shilling stressed the need to preserve SeniorCare, a "wildly popular program" that she said holds down seniors' prescription drug costs through negotiation with drug companies. "It's better than Medicare Part D," she said. Part D involves prescription drugs.

Shilling pressed for continued support of the state's Farm2School programs, possibly through tax credits and grants, so that "healthy eating for young people will become the norm."

She also advocated continued funding for Planned Parenthood, after new laws resulted in the closure of five clinics in the state, and improved access to dental care in rural areas.

Rep. Steve Doyle, D-Onalaska, expressed hope for so-called "right-to-try" legislation for terminally ill patients. Such laws allow people who are dying, when no other medicines are available, to try experimental drugs that may not have approval yet.

Rep. Jill Billings, D-La Crosse, told of her work on the Governor's Task Force on Opioid Abuse, saying, "We are in an opioid crisis."

Drug overdoses have more than tripled, from 194 to 622, and drugged driving is becoming an increasingly troublesome problem, Billings said.

A proposed recovery high school would enable youths addicted to drugs to go to school at the same time they participate in recovery programs, she said.

Billings expressed hope that prescription drug monitoring will prevent doctor shopping because of its registry for physicians to check whether a patient already has a script for a drug.

"We can't arrest our way out of jail," Billings said, welcoming increasingly bipartisan support for treatment and diversion programs.

"Hallelujah!" she said. "Democrats have been promoting that for 15 years, and our Republican colleagues have come to see the light."

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