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WisBusiness: National health care debate lacking, key players say

Democrats, Republicans, providers, insurers. Few key Wisconsin players seem entirely happy with the national health care debate so far.

That was one of the themes emerging from the Nov. 17 WisPolitics.com/WisBusiness.com health care discussion in Madison.

All the panelists, speaking before Senate Democratic leader Harry Reid unveiled his caucus' health care overhaul, had criticisms of the process or the House-passed bill or both.

Among the worries: inadequate protections for "leading edge" states like Wisconsin that have worked hard to bring coverage to the uninsured, better reimbursement rates for Medicare and Medicaid providers, lack of cost controls, and concerns the debate is bypassing concerns of the patients.

Speaking about the House bill, Gov. Jim Doyle's Health Secretary Karen Timberlake said "we hope it will" get better though she backed the overall goal of insuring more Americans. "Let's talk about leading edge states, and let's make sure we're not left behind," added Timberlake, pointing to how lagging states appear poised to get large infusions of federal money to catch up.

Larry Schreiber, president of Anthem Blue Cross/Blue Shield in Wisconsin, said the House-passed bill wasn't good for Wisconsin and would drive up insurance costs for most user groups, except for older, less healthy people. The bill "does really almost nothing to address cost and quality issues," he said.

Schreiber said doing a better job of connecting uninsured people to existing program can bring in more than 25 percent of the uninsured, and said the House bill, if enacted, would bring in only about half of the current 46 million uninsured Americans in the next eight years.

Asked Schreiber: "Do we really need to do a very risky overhaul of the entire system that in the end will cost ...over a trillion dollars to take care of half of the uninsured today?"

Dr. Nick Turkal, a family physician who leads Aurora Health Care, predicted passage of some kind of measure early next year and said "the devil will be in the details." But he said the debate has been about insurance, not health. "We really need a focus on the patient, and what happens from a quality and cost perspective from their viewpoint," he said.

And Sen. Alberta Darling, R-River Hills, said the House bill would be nothing short of an "absolute tragedy" for Wisconsin jobs.

"It's insurance reform, it's not health care reform," Darling said of the House bill passed last weekend. She predicted the bill would do nothing to stem cost-shifting onto private insurance holders while implementing new taxes on small businesses.

"We're ranked 2nd in the country for having the smallest number of uninsured," said Darling, who sits on the Legislature's Joint Finance Committee. "Why would we want to be thrown into this whole pool as we shift everything around and increase costs?"

But Timberlake took issue with the "myth... that all is well in Wisconsin if you have private insurance."

"The numbers certainly belie that," Timberlake said, noting continuously increasing costs and increasing levels of underinsured Wisconsinites. "This is not a sustainable path."

Schreiber said Anthem supported comprehensive health care reform "if it's done right." but said his company's analysis shows premiums rising sharply under the House bill for average Americans, particularly younger workers.

"We're doing very little in Washington to address the issue of underlying cost and quality," Schreiber said.

Turkal agreed, saying that "some of what has gotten lost ... is what happens to the individual patient."

He said that the state must be careful not to fall behind its current coverage capabilities under any new system, and cautioned that a dramatic expansion in Medicaid wouldn't benefit Wisconsin unless payment rates are reformed.

"Everything that is talked about in trying to tamp down the cost of health care is not going to be successful if we don't start getting reimbursed based on value provided to the community," Turkal said.

Timberlake acknowledged that the Doyle administration would prefer an alternative to the House bill's Medicaid provision. She said the House bill rewards states like Louisiana, which has not stretched its Medicaid resources as far as Wisconsin; she pitched a Senate plan that would maintain the current Medicaid levels until a health insurance exchange becomes active in 2013.

Darling said the Medicaid system needs to be overhauled altogether.

"The Medicaid costs have become a bigger and bigger part of our budget," Darling said. "That means that we have been driving up taxes in Wisconsin; we've been taking away money from other areas that we need like education."

"We need to reform Medicaid in our state. We've been a leader, but we need to do much better."

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