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Wisconsin Senator Erpenbach is the current Chair of the Health and Human Services Committee and a member of NCSL's Health Committee. He was first elected to the Senate in 1998 and is now serving his third term. He shared his views with on how states could win and lose from national health care reform. The interview was originally published in State Legislatures Online Magazine.
Q: What do states have most to gain from national health reform efforts?
A: In his last state of the union address, President Bush encouraged states to become laboratories of reform. Because there seems to be a degree of resistance to implement reforms on the national level, states like Wisconsin, Maine, Massachusetts and California, took it upon themselves to initiate changes, large-scale reforms, at the state level. If changes were in fact to happen at the national level, states that have started this somewhat lonely process would be bolstered simply by the fact that they are no longer trying to go it alone against a powerful industry lobby. The voices of that lobby would be considerably quieter for policy makers and legislators if they knew reform was inevitable.
Q: What do you fear most about these platforms?
A: I only fear that national reforms will not go as far as they need to, or they will be done piecemeal. In Wisconsin, our health care reform plan addresses the three key components of health care reform: cost, access and quality. Here, access is not the key issue. Health care costs are rising out of affordability for many Wisconsinites. We have some of the highest quality health care services in the nation available to us, we simply can’t afford it. Therefore, a comprehensive plan that addressed those rising costs was necessary here. Other states may have issues with a high number of uninsured, or a lack of high-quality health care. For national reforms to be successful, they must address all three components of reform.
Q: Some candidates propose giving a lot of flexibility to Medicaid, without a lot of new money, would that be helpful?
A: Many times, in order to access federal monetary assistance, states must be granted waivers, and there may be periods of budgetary uncertainty while waiting for answers from CMS. In order for states to make reforms on their own, the federal government could make the waiver process easier. That said, states are facing medical assistance deficits, much of it as a result of more and more people forced to go on Medicaid because they can no longer afford insurance in the private market. Without additional money, it is likely states wouldn’t be able to afford the additional caseloads.
Q: Some candidates propose reforming the tax code, so that employers would lose the tax deductibility of health insurance. Would that help states, giving that it might bring more money into state coffers? Or do you think that would ultimately increase the number of uninsured as employers drop coverage? What kinds of tax code reforms would you support?
A: I believe that ultimately companies would choose to drop coverage and there would be an increase in the number of uninsured individuals. I would support changing the tax code to eliminate the allowable deductions for health savings accounts. I would also support reforms that more closely scrutinize the non-profit status of hospitals and their subsequent tax breaks because of their non-profit status.
Q: What’s your view on increasing, or decreasing, regulations for the insurance industry?
A: I would support increased regulations on the insurance industry. We need to take a look at their profits, and their denial rates.
Q: What could national politicians learn from state reform efforts?
A: National politicians should take a look at what Healthy Wisconsin did with the pooling concept. 5.5 million people pooling together is a lot of buying power. I also think that they should not be afraid to be bold, not be afraid to enact comprehensive reform. It’s time to stop tinkering around the edges of reform and do something to help.
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