Do the dollars make sense?

Recent health care referendum expected to land on legislator's doorsteps in coming months

Story by John R. Ingrisano

“Shall the next state Legislature enact health care reform legislation by December 31, 2009, that guarantees every Wisconsin resident affordable health care coverage as good as what is provided to state legislators?”

Question posed to voters on various referenda held Nov. 4, 2008, in the cities of Appleton, Green Bay, Menasha and Oshkosh, as well as 18 other cities or counties across Wisconsin.

The advisory referendum passed in every community with flying colors. Voters in the city of Menasha approved the referendum with 85 percent indicating “yes,” the highest endorsement of anywhere in the state. Other local approval rates were: Oshkosh, with 78 percent saying “yes;” and Appleton and Green Bay, both with a 73 percent approval.
The largest single voting block came from the entirety of Dane County – home to the Madison metropolitan area – where 73 percent, or more than 176,000 voters, approved the advisory referendum.

FROM THE SELF-EMPLOYED CONSULTANT WORKING out of the back bedroom to multi-national corporations, we all pretty much agree that health care costs are killing us. The real question is whether Wisconsin’s efforts at healthcare reform will cure what ails us … or finish us off for good?

Wisconsin, never a state to shy away from cutting-edge ideas, has been a leader in healthcare reform. In addition to SeniorCare and BadgerCare Plus – which provides coverage for uninsured children – we are the only state in the country that allows small businesses to join together in health care cooperatives, explained Randy Connour, executive director of Healthy Lifestyles, a Green Bay-based cooperative that covers all of northeast Wisconsin. Offering strength in numbers, cooperatives like Healthy Lifestyles provide a baseline high-deductible insurance plan, along with rate caps for businesses that implement specific wellness policies.

“We manage both the insurance side and the prevention side,” added Connour. 

Still, there have been some fierce battles in the attempt to bring balance back into the health insurance cost equation. Bills that addressed limited reforms like SeniorCare and BadgerCare Plus passed through the state legislature with strong bi-partisan support. Healthy Wisconsin, on the other hand – introduced about a year ago to encompass sweeping, comprehensive healthcare changes, but with a multi-billion-dollar price tag – flat-lined in the capitol.

The healthcare reform debate at the state level is far from dead. Business owners and individuals alike are frustrated by increasing costs. That may explain why a 32-word advisory referendum sponsored by Citizen Action of Wisconsin was approved by an average of 73 percent of voters in the 22 municipalities and counties where it appeared on the ballots across the state on Nov. 4.

Battle lines are drawn
THE REFERENDUM CAME WITH VERY LITTLE campaigning or media coverage in the weeks leading up to November, and as a result, caught many voters by surprise on election day. Citizen Action of Wisconsin helped to circulate petitions this past summer in order to garner the signatures necessary to place the measure on the ballot in 22 communities.

“The goal of the referendum was to set the agenda during the elections to get a commitment to act” from the legislature, explained Robert Kraig, program director for Citizen Action of Wisconsin, a public interest advocacy group. With 80,000 people signing petitions to put the referendum on ballots and more than 300,000 marking “yes” in the voting booths, Kraig said this is a strong indication that state residents want reform and want it in 2009.

“We think the referendum plays a role in clarifying this as a top priority for voters,” Kraig said.

Few argue about the need for reform, even among legislators and business leaders.

“We need to reform our healthcare system to make it more affordable to all citizens,” said Rep. Dean Kaufert (R-Neenah), representative for the 55th Assembly District which includes the cities of Neenah and Menasha. “Wisconsin has taken steps forward through SeniorCare and BadgerCare, but more needs to be done.”

Still, there’s a lot of disagreement about how to approach the problem of affordable, quality healthcare. Thomas J. Boldt, CEO of The Boldt Company in Appleton, urges a go-slow approach.

“I don’t think the referendum was particularly helpful,” Boldt said, adding, “healthcare reform is on the top of the list in Washington. I would be cautious if I were a legislator to not get too far out in front, but wait to see what initiatives come from Washington.”

Others simply see the referenda as unnecessary. R.J. Pirlot, director of legislative relations for Wisconsin Manufacturers & Commerce, argued the issue continues to be at the center of the radar in Madison.

“The Legislature, both Democrats and Republicans, and Governor Doyle are keenly interested in ensuring that Wisconsinites have access to affordable coverage,” Pirlot said. “So, with or without these referenda, I would anticipate strong legislative attention.”

Pirlot also questions whether the referenda – even with 73 percent approval – is a mandate.

“The referenda didn’t articulate how much this would cost or how it would be paid for; nor did the referenda articulate what ‘affordable’ means. Voters voted, but for what? Frankly, I’m surprised one out of four voters voted against Santa Claus.”
“Our research has found,” added Pirlot, “that as the public learns more of the details about government take-over proposals like Healthy Wisconsin, support evaporates.”

Most everyone agrees that details are lacking, which makes discussion difficult.

“The referendum did not ask ‘How’ to provide affordable health care and it did not ask ‘Who’ should pay for the affordable health care,” said Penny Bernard Schaber, a Democrat recently elected to the 57th Assembly District seat which includes most of Appleton. “I think the simplicity of the question was intentional.”

Citizen Action of Wisconsin’s Kraig agrees with Bernard Schaber’s statement.

These referenda are meant to be a “mandate on some broad principles, not on a specific 2,000-page plan,” Kraig said. “A lot of the details do need to be worked out.”

Money drives the debate
NONETHELESS, THE DEBATE QUICKLY TURNS BACK to Healthy Wisconsin, a comprehensive bill that some see as the blueprint for reform. 

“Healthy Wisconsin would meet the criteria as a starting point,” said Kraig. “It was a good start.”

“One goal is to have small businesses pay in. Currently, only 40 percent of Wisconsin businesses offer health care benefits. How do we bring them in and pay their fair share and not be hurt?”

The Healthy Wisconsin Plan was discussed by both houses of the state legislature during the 2007-08 session, but was defeated by the senate. According to The Lewin Group, a health care policy research and management-consulting firm, the cost of the proposal was estimated to be $15.2 billion the first year. 

The level of coverage provided under the Healthy Wisconsin proposal was designed to replace most forms of employer-based health care coverage, explained Sam Austin and Eric Peck, both fiscal analysts with the Wisconsin Legislative Fiscal Bureau. In addition, by generating other savings, Austin and Peck said the Lewin Group estimated that total health care expenditures in Wisconsin would have declined by about $751 million in 2007 as a result of the proposal.

Others believe the cost shifting involved in the proposal will harm everyone. Kaufert didn’t approve of Healthy Wisconsin the first time around.

“The government-run Healthy Wisconsin proposal would be devastating to small businesses, and would lead to thousands of job losses,” Rep. Kaufert said. “It would be paid for by a new 14.5 percent payroll tax increase for a combined federal-state payroll tax of 30 percent. It could lead to as many as 45,000 jobs lost in Wisconsin per year.”

There is some agreement
CITIZEN ACTION OF WISCONSIN’S KRAIG SAID he’s mostly interested in generating a healthy dialogue.

“It’s very hard to defend the status quo. The cost of doing nothing is unsustainable,” Kraig said. “The more business owners who get involved in the discussion, the better. That represents everyone’s economic interests. To the extent that business owners are involved and not just oppose reform, will make it much more possible to get a positive result.”
Representative-elect Bernard Schaber agrees.

“In my mind, the results (of the referenda) are an indication of the importance that affordable healthcare has for many people,” she said. The real question, of course, is deciding what to do. “The responsibility for paying for healthcare cannot be borne only by business or only by government or only by individuals and their families. The responsibility…should be shared.”

There’s nearly universal agreement that we need to review both the healthcare system itself, and how residents view their own responsibilities to staying healthy. Explains Bernard Schaber, who is a physical therapist by profession and health care provider for 28 years, “I would like to see a system that promotes prevention of illness, maintenance of health and adequate coverage of catastrophic illness or accidents….I would like to see Wisconsin as a leader in this process because in the long run, I believe money will be saved by all and we will have a much healthier community in which to work and live.”

In this respect, 2009 is shaping up as a critical time for discussion about healthcare reform and how to do it.

“There is not a silver bullet solution to fix our health care system,” said Rep. Kaufert. “We need to reduce the huge administrative costs associated with health care and require health care transparency. We also need medical malpractice reform, preventive care initiatives,” and more.

It should be a truly interesting year for health care.

John Ingrisano is a Wisconsin-based marketing strategist, business journalist and author of The Back to Basics Book of Selling: A Guide to A Successful Sales Career. He can be contacted at john@TheFreestyleEntrepreneur.com.