Brian Dake

Senate Republicans on Thursday released a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does.

The Senate measure would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per capita basis. The Senate measure would also seek to phase out the program’s expansion – although at a more gradual rate than the House version.

Yet the Senate bill is expected to go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

In a move that will please the health-care industry, the draft also proposes repealing all the ACA taxes except for its ‘‘Cadillac tax’’ on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies – which help cover consumers’ deductibles and copays – in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

Health insurer Anthem Blue Cross and Blue Shield says it will largely stop selling insurance plans in Wisconsin on the marketplaces set up through the Affordable Care Act next year, citing a volatile market for insurance plans that comply with the law.

Anthem will be the second large national insurance company to stop selling health plans on the state’s marketplaces. UnitedHealthcare pulled out last year.

About 14,000 people are covered by the Anthem health plans sold on Wisconsin’s marketplaces. That works out to less than 6% of the 242,863 people who were enrolled in health plans sold on the marketplaces as of Jan. 31. Anthem said its decision does not affect its health plans for employers, its Medicare Advantage plans or Medicaid plans.

It also will continue to renew its so-called transitional plans that were sold before March 2010 and December 2013. Those plans, which are not available to new customers, cover about 4,500 people in Wisconsin.

Anthem previously pulled out of the marketplaces for Milwaukee, Racine and Kenosha counties. But Molina Healthcare, Common Ground Healthcare Cooperative, Children’s Community Health Plan and Network Health sold plans in Milwaukee County this year.

Other health insurers selling marketplace plans in the state include Dean Health Plan, Unity Health Insurance, Security Health, Gundersen Health Plan and Aspirus Arise Health Plan of Wisconsin.

All of the insurers, though, have struggled.

“The Wisconsin individual market remains volatile, making planning and pricing for ACA-compliant health plans increasingly difficult,” Anthem said Wednesday in a statement.

Among the factors Anthem cited were a shrinking and deteriorating market and uncertainty at the federal level.

The Supreme Court will once again wade into the world of partisan gerrymandering – that is, the practice of purposely drawing district lines to favor one party and put another at a disadvantage. The justices announced today that they will review Wisconsin’s appeal of the decision by a three-judge district court striking down, as the product of partisan gerrymandering, the redistricting map that the Republican-controlled legislature created after the 2010 census.

The lower court also ordered the state to create a new redistricting plan by the fall, but a deeply divided Supreme Court today put that order on hold. The Supreme Court’s ruling in the case, which is likely to come next year, will almost certainly be a major one that could affect redistricting efforts for decades to come.

When the Supreme Court last tried to take on the issue of partisan gerrymandering in 2004, the result was deeply unsatisfying for almost everyone involved. In a challenge to Pennsylvania’s redistricting plan, four justices – Justice Antonin Scalia, joined by then-Chief Justice William Rehnquist and Justices Sandra Day O’Connor and Clarence Thomas – agreed that courts should never review partisan-gerrymandering claims, because it is too hard to come with a manageable test to determine when the role of politics in redistricting is too influential. Four other justices – Justices John Paul Stevens, Ruth Bader Ginsburg, David Souter and Stephen Breyer – believed that courts should be able to review partisan-gerrymandering claims. The key vote in the case came (as it so often does) from Justice Anthony Kennedy, who agreed that the Supreme Court should stay out of the Pennsylvania case but left open the door for courts to have a role in reviewing partisan-gerrymandering cases in the future if a workable standard could be found.

Thirteen years later, it appears that the justices are ready to try again. In its brief seeking review of the district court’s decision, Wisconsin complains about various aspects of the lower court’s ruling. It argues, for example, that the plaintiffs cannot challenge the map in its entirety, but instead need to go district by district, and that the plan cannot be a partisan gerrymander if it is also consistent with traditional redistricting principles. But the state is also playing for all the marbles. It observes that “wasteful and fruitless litigation” over partisan gerrymandering has continued over the past 13 years, and it maintains that because this “additional experience has failed to yield a ‘limited and precise’ standard” for evaluating partisan-gerrymandering claims, the Supreme Court should rule that such claims “are nonjusticiable.”

Wisconsin filed its request for review in March, but in May it also asked the justices to put the lower court’s order requiring new maps on hold until they can resolve the state’s appeal. In an order issued shortly after the justices left the bench this morning, the Supreme Court agreed to do so. Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan indicated that they would have denied the state’s request. But the fact that the state could muster the five votes needed for the stay bodes poorly for the challengers, because one factor that the justices had to consider in making their decision was whether the state is likely to succeed on the merits of its claim.

No matter how the Supreme Court ultimately rules, its decision will be significant. If the justices were to hold that courts cannot review partisan-gerrymandering claims, their ruling could insulate redistricting maps from challenges, allowing the political party in power to extend its control for decades: The dominant party will be able to draw districts to maximize its chances of maintaining control of the state legislature, which will in turn allow it to draw the new map after the next census. On the other hand, a ruling that courts can evaluate partisan-gerrymandering claims could open the door to a flood of litigation challenging existing and future maps. Of course, this assumes that the Supreme Court rules on the merits of the case at all: Today’s announcement also indicated that the justices would put off a decision on whether the court has jurisdiction to review the case until they hear the merits of the case. Postponing the determination of whether the court has jurisdiction could prove to be just a formality, or it could provide a way for the justices to sidestep a ruling on the merits if the case proves too hard – only time will tell.

The case will likely be argued in November or December, with a decision to follow next year – perhaps only a few months before the 2018 elections, and less than two years before the 2020 census.

The state budget committee voted unanimously Thursday to reject Gov. Scott Walker’s proposal to move about 250,000 state workers to a self-insurance system.

Under the proposed change, the state would pay employee medical bills directly through a third-party administrator instead of paying premiums to an insurance provider.

Lawmakers had previously signaled they planned to reject the move, arguing it’s too risky. Leaders of the finance committee reiterated that point Thursday.

“Our competitive marketplace is really a model for the nation, and we think with what’s happening nationally this is the wrong time for us to make major shifts in the marketplace,” said Sen. Alberta Darling, R-River Hills, co-chair of the budget committee.

The governor had linked $60 million in estimated savings to the proposed move to self-insurance. The budget committee identified $63.9 million in other savings.

Those changes include $22.7 million in negotiation savings, $25.8 million from the state insurance board’s reserve fund, and $15.4 million from increased usage of health plan tiers and plan design changes. They say they’ll achieve those by making changes to employee benefit plans and using money from the state insurance board’s reserve fund.

Committee co-chair Rep. John Nygren, R-Marinette, said those plan design changes will not result in state employees seeing premiums, co-pays or other expenses rise more than 10 percent in each of the 2018 and 2019 calendar years.

Joint Finance Committee Co-Chairman John Nygren (R-Marinette) told Newswatch 12 last week he sees three potential options to fix a billion-dollar shortfall: raising registration fees, raising the gas tax, or using toll roads.

Nygren says lawmakers have pushed off this issue for the last two budgets, so now’s the time to take action.

“I do think tolling, which is a true user fee–you can use other roads if you choose not to use the interstate system–could be an option,” Nygren said.

Toll roads wouldn’t be an immediate fix, because Wisconsin would need federal approval. Nygren thinks the system would be easy enough to install.

“It’s the direction we’re going and, as I said, it’s a true user fee,” Nygren said. “I know it’s not the old world of tolling with all the booths. You can do it nowadays with a transponder in your car.”

Gov. Scott Walker told reporters last week he’s not pushing for toll roads, telling the Associated Press that if he agreed to tolls, he would want the gas tax to drop. Meanwhile, Joint Finance Co-Chair Sen. Alberta Darling (R-River Hills) said Republicans aren’t unified in backing the toll idea.

“I don’t know that I ever met anybody who agrees with me on every single issue, right?” Nygren said. “I don’t care if they’re a constituent or they’re another elected official. We’re elected to bring different perspectives to the table.”

The Joint Finance Committee plans to meet Thursday, when Nygren hopes to focus more on transportation funding.

The Wisconsin Department of Health Services (DHS) has submitted an application to the Centers for Medicare and Medicaid Services (CMS)  requesting an amendment to certain provisions of the Section 1115 Demonstration Waiver, known as the BadgerCare Reform Demonstration Waiver. The policy amendments, many of which are included in 2015 Wisconsin Act 55, are aimed at bolstering Governor Scott Walker’s efforts to help people move from government dependence to true independence.

“Wisconsin Works for Everyone is about helping people transition from public assistance into Wisconsin’s workforce, where they can build a solid financial foundation for themselves and their families,” Governor Walker said. “Unemployment is low, and the percentage of people working in Wisconsin is among the best in the nation. This application is a step in the right direction, and we’re continuing to build on Wisconsin’s legacy as a leader in welfare reform.”

The core changes in the waiver amendment application affect the childless adult population and include the following:

• Establishes monthly premiums and copayments for emergency department visits.
• Implements a work requirement that members work or participate in job skills training at least 80 hours every month.
• Limits benefits to 48 months, unless a member meets a work requirement.
• Rewards healthy behaviors by establishing lower premiums for members who make healthy choices.
• Requires members to be screened for drugs and if necessary, submit to a drug test. Those who test positive will be offered treatment so they can get healthy. Healthy workers help Wisconsin employers fill jobs that require passing a drug test.
• Expands access to treatment by creating a new residential substance use disorder treatment benefit to allow coverage of medically necessary residential substance use disorder treatment services for up to 90 days for all BadgerCare Plus and Medicaid members.

Once CMS receives the complete application, a 30-day federal public notice process begins along with a 45-day minimum federal decision-making period. During this time, DHS will work with CMS to finalize the details of the waiver. Once the changes to the waiver are approved by CMS, the effective date of the changes will be at least one year after approval to inform and work with members, providers, and partners, and to make system enhancements and implement the changes.