WHA’s Eric Borgerding wants Wisconsin’s health care improvements recognized

Eric Borgerding, CEO and president of the Wisconsin Hospital Association, says any replacement for the Affordable Care Act coming down the pipe must fairly reflect Wisconsin’s health care improvements.

“Here we are again on the brink of upheaval in health care,” Borgerding told WisBusiness.com. “When that happens remains to be seen. What is certain is uncertainty.”

He says the health care conversation in 2017 will be dominated by what happens to the ACA — what goes away, what is replaced, how it is replaced, and when this will all occur. Since it passed in 2010, health care has been “realigning and redirecting resources” to deal with the shifting landscape, he says.

“Our members want first and foremost to know what is coming, to know what will change, so they can adapt and they can be positioned,” Borgerding said.

As it stands, those members are anxious about what will happen next, he says. But he added, “Our members, hospitals and systems are adept at delivering high-quality health care whatever the environment.”

This anxiety comes at a time when the uninsured rate “has dropped dropped significantly, by 37 or 38 percent.”

“A lot more people have insurance now,” he said. “Whatever replaces the ACA must sustain those coverage gains. The last thing anyone, Democrat or Republican, wants to see is people losing their coverage.”

Looking ahead to potential changes to Medicaid funding, Borgerding sees two possibilities for spending limits: block grants and per capita limits.

Block grants are fixed amounts of money provided to states that can possibly go up because of inflationary factors, Borgerding says. He sees this as the only modifying factor to the amount of money in the block grants.

Per capita spending limits would peg Medicaid spending to the number of Medicaid enrollees. While Borgerding says both methods provide challenges, he thinks the block grant approach is flawed.

“Spending caps have to be responsive of things that are out of the state’s control,” he said. “We think the per capita approach makes more sense.”

He also thinks the current method for providing base funding for states is deeply problematic and fails to reflect real changes made in Wisconsin to provide health care to more people.

Wisconsin was one of the states that rejected the Obamacare Medicaid expansion. The federal government said all states expanding Medicaid coverage to at least 133 percent of the federal poverty limit would get funding to support the added individuals.

That resulted in states like Wisconsin paying more to support surrounding states’ Medicaid expansion for doing “what Congress wants to do now,” according to Borgerding.

“The irony here is interesting and almost disturbing,” he said. “We believe that is unfair, inequitable and wrong. We clearly expanded Medicaid below 100 percent of the federal poverty level, and Wisconsin is paying $280 million that other states don’t have to pay for.”

He called Wisconsin a “donor state,” saying any changes to Medicaid must acknowledge this inequity.

“That’s a big issue which I think is clearly emerging as a key hold-up and significant point of contentious debate of how to repeal and replace that aspect of Obamacare,” Borgerding said.

Any replacement that does come about should avoid backtracking on insurance coverage at all costs, Borgerding said, adding that at least in Wisconsin, he is hopeful about politicians making these issues a main priority in the upcoming legislative session.

“This is a great example of an issue that brings state and federal policy makers to the same table,” Borgerding said. “There is so much at stake, wrapped up in the state of Obamacare, that our state officials have to be weighing in, and have to be participating.”

He added he is “pleased to see state legislators are understanding, and weighing in on this federal issue.”

–By Alex Moe