Obamacare repeal must protect those who gained insurance, key state Republican says

Jan. 13--A repeal of the Affordable Care Act must preserve insurance for nearly 200,000 people in Wisconsin who gained coverage since the health law fully kicked in three years ago, the chairman of the state Assembly's health committee said Thursday.

"We've made some great strides," said state Rep. Joe Sanfelippo, R-New Berlin. "Anything going forward has to make sure we protect that."

Sanfelippo criticized the health law overall, calling it "not a well thought-out program," and said he welcomed changes under consideration to Medicaid, the state-federal health program for the poor.

His comments, at a forum sponsored by Wisconsin Health News, came as Congress and President-elect Donald Trump are moving quickly to overturn the health law, also known as Obamacare.

Republican leaders say they want to get rid of the law's insurance exchanges and subsidies, through which many of the nearly 200,000 people gained coverage in Wisconsin, and provide insurance through high-deductible plans, health savings accounts, tax credits based on age and the sale of policies across state lines.

But keeping those who gained coverage from becoming uninsured again won't be easy, said Eric Borgerding, CEO of the Wisconsin Hospital Association.

"I think this entire thing is a massive quandary," Borgerding said. "It is a love-hate relationship with this law. Those that hate it are realizing how difficult it is to divorce from it."

Mike Wallace, CEO of Fort HealthCare, said having more people insured through the law has cut uncompensated care at his hospital in half, but the cost of care still exceeds payments from insurers.

"It's unsustainable," Wallace said.

Coreen Dicus-Johnson, CEO of Network Health Plan, in Menasha, said insurers need to file paperwork to be on the exchange next year by May, when the future of the exchange may still be up in the air. "Uncertainty is obviously the enemy of stability, and I think that's exactly where we're at."

Sanfelippo said the health law's provision allowing people under age 26 to stay on their parents' health plan is "shooting yourself in the foot" because it has kept many young, healthy people out of the exchanges. That has increased premiums for others and led some insurers to pull out, experts say.

Also, Sanfelippo said, people can wait to buy insurance until they have big medical expenses, then drop out after the care is covered, though they likely would face a penalty. "You have this whole in-and-out game," he said.

A proposal supported by Trump and other Republicans to convert Medicaid funding to block grants would allow Wisconsin and other states to experiment with the program more without having to get federal approval, Sanfelippo said.

Wisconsin might emphasize primary care, reduce the number of billing codes or encourage home visit programs, he said. Recipients also could be charged more for coverage, others have said.

"Hopefully that barrier (of getting federal approval) is out of the way now, and it puts us much more in charge," Sanfelippo said.

Gov. Scott Walker didn't accept federal funds through the health law to fully expand Medicaid. Instead, he opened up Medicaid to childless adults with incomes under the poverty level and shifted parents above the poverty level off of the program, saying they could buy insurance on the Obamacare exchange.

Because of Walker's approach, what happens to the exchange and its subsidies matters more in Wisconsin than in most places, said Donna Friedsam, health policy programs director at UW-Madison's Population Health Institute.

It "made our state perhaps more dependent on the ability of (the) Obamacare (exchange) to cover those lower-income people than other states that left those people in the Medicaid expansions," she said.

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