MENOMONIE -- Before he arrived for a listening session at the Menomonie Public Library Wednesday afternoon, U.S. Rep. Ron Kind (D-La Crosse) was in Durand where he met with a small business owner.
“He knew something was wrong, but because he didn’t have healthcare coverage, he didn’t go in to have it checked out,” Kind said. “He waited and he waited. Then the pain got to be too much.”
Seeking medical attention, the man learned he had an inflammation in his nervous system.
“After a week in the hospital, he was discharged with a $36,000 bill that he can’t pay, and now he’s on the verge of bankruptcy,” Kind told the gathering of about 10 people. “And yet they told him, if he had just come in when he first knew that something wasn’t quite right, they could have put him on a week of oral antibiotics for 150 bucks that would have cleared it right up.”
It’s an all-too familiar story, Kind said. “I’m not here to convince anyone that the Affordable Care Act is a perfect bill; it’s not. But it’s what we have right now in place and we’ve got to learn what’s working and what isn’t working and make changes and adjustments along the way.”
Kind said Minnesota decided to set up its own state-based healthcare exchange.
“They have a pretty seamless website that’s set up, a lot of access, people signing up over there because they decided to do it on their own,” Kind said, noting that he encouraged Republican Gov. Scott Walker to do the same.
“Instead, he decided to reduce the roles of BadgerCare and put them into the exchange — about 100,000 people who weren’t intended to be in the exchange to begin with,” Kind said.
Equally disturbing, he added, is the governor’s refusal to challenge the insurance rates that are being established.
“Now states have the ability to go in and ask the tough questions of why rates are being established where they are,” Kind explained. “Governor (Mark) Dayton in Minnesota has decided to do it — and the premiums they’re getting back are substantially below what Wisconsin premiums are.”
Alluding to speculations that Walker may have aspirations that would take him to Washington, D.C. in 2016, Kind said, “I think it’s because we have a governor now who’s doing everything he can to undermine health care reform for whatever reason.”
Quality of care
According to Kind, any discussion about getting the federal budget under control centers around getting healthcare costs under control. He wants to change the payment system so that it’s based on value and outcome rather than volume.
“This fee-for-service system is bankrupting us,” Kind said. “Payments are made as to how many tests, how many procedures, how many things are done. That’s a crazy way to pay for anything. ... We’re paying for a lot of unnecessary tests and procedures that aren’t improving patient care.”
Fred Menz of Menomonie told Kind, “We need to look at what are we getting out of healthcare and how are we affecting the healthcare system.”
Kind agreed that it’s important to set good quality measurement and protocols of care for providers to follow. He reported that an average of $7,000 is spent on Medicare recipient in Wisconsin; in Miami, it’s $15,000.
“We’ve got healthcare providers in this area that have developed models of care that do work very well,” Kind said. “If we could take that system live, I don’t think we would have the healthcare crisis that we do today in this country.”
Menz said he has interviewed people with disabilities throughout the country and asked them if they worked. “Their primary answer was, ‘We can’t afford to take the risk to lose the health coverage we have.’ ... That tells me that this is one of the most significant issues to be facing this field.”
Kind said with the ACA’s health insurance exchanges, the insurance is attached to the individual — not his or her place of employment.
One attendee, Margaret Johnson, asked about those people who have received word that their insurance is being cancelled as a result of the Affordable Care Act.
Checking with private plans in the area, Kind said, “They’re telling us they’re not cancelling the insurance. They’re signing them up with new plans that are compliant with ACA and this national media story isn’t all that applicable for here in Wisconsin.”
Less than 5 percent of the population faces potential cancellation, Kind said. “And I know most of them are going to get a much better deal in the healthcare exchange — good price and much better benefits than what they were paying before.”
Johnson said her 25-year-old grandson — currently in school and working part-time — is looking for insurance.
Kind said more than 50 percent recipients in the exchange won’t be paying anything for their insurance plans because they will qualify for premium tax credits.
“If you’re a young individual, just starting out and probably not making a whole lot of money, you’re probably going to get a real good deal,” Kind said.
Johnson pointed out that those without income, including prisoners just coming out of jail, are eligible for Medicaid.
“And who pays for that?” she asked. “We do.”
What may look like free care, Kind said, really isn’t.
“We’re going to pay one way or another,” Kind concluded. “Either we’re going to pay for uncompensated care right now — and those costs get shifted onto people with healthcare coverage — or we try to get them into a healthcare system early so they don’t have a $36,000 bill and instead pay a $150 like that small business owner down in Durand.”