- I'm Frederica Freyberg.
Tonight on "Here and Now," a "First Look" at the Republican
American Health Care Act, what it means in Wisconsin.
After that, a "Closer Look" at what potential federal cuts to
great lakes restoration efforts may cause.
Then, in our "WisContext" segment, the water battle
ongoing in Waukesha.
It's "Here and Now" for March 10.
- Funding for "Here and Now" is provided, in part,
by Friends of W isconsin Public Television.
- It repeals Obamacare's taxes.
It repeals Obamacare's spending.
It repeals Obamacare's mandates.
It creates a vibrant market where insurance companies
compete for your business, where you have lower costs,
more choices and greater control over your health care.
- House Speaker Paul Ryan.
A "First Look" tonight at the GOP repeal and replace plan
for Obamacare.
Here's a statement on the bill from the other side of the aisle
from Wisconsin U.S. Senator Democrat Tammy Baldwin.
She says quote President Trump promised insurance for
everybody, but Trumpcare breaks that promise by putting millions
of people she says at risk of losing health care coverage and
forcing millions to pay more for less care.
Here are the major provisions of the American Health Care Act:
it gets rid of mandates to have insurance, replacing those with
a 30% surcharge on policies if plans have lapsed.
It replaces income-based subsidies with tax credits
mostly based on age.
For example, those aged 20 to 29 would get a $2,000 credit.
Those 60 and older would receive $4,000 to help cover insurance
costs.
It maintains allowing dependents to stay on parents' insurance
plans until age 26, bans coverage denial
based on preexisting conditions and bans caps on coverage.
On Medicaid, it gives states a per capita amount based on how
much they spent in 2016.
Now, the GOP plan also repeals a tax on high-income earners that
helped pay for Obamacare.
So who are the winners and losers and how does the new plan
treat Wisconsin?
We turn to expert Donna Friedsam, policy director at the
Population Health Institute at UW-Madison.
Thanks very much for being here.
- Good to be with you.
- So as to that first question, who are the winners and losers
in this?
- Well, I should start out by saying that we don't have the
definitive evidence right now because we're awaiting the
congressional budget office to score the bill.
That's a standard procedure with legislation.
Generally, when we have legislation in Congress, the
Congressional Budget Office, which is a nonpartisan agency,
will go through a bill and do its scoring procedure and we'll
learn from them what the bill will cost and how it will have
various impacts.
This is a little unusual in the fast track that we're on right
now, that the house is going ahead and voting on the bill
without having the CBO score.
So we can only go, given that we don't have a CBO score, we're
expecting it to come out around March 13, right now we can only
go on the various estimates out there from a range of different
analysts that are affiliated with different groups or think
tanks and the like.
So I'm just going to preface my comments with that.
From reading across the various spectrum, partisan spectrum
and from different academic analysts and the like,
it looks like the way the tax credits are structured
and the various other provisions of the bill
will have different impacts on different people.
So that certainly young people will benefit from this
relative to older people.
People in urban areas where the premiums might be lower than
rural areas might benefit.
And people with higher income will benefit
relative to lower income.
If you want to talk about winners and losers,
that's a way of framing it.
Younger people, people with higher incomes and people in
areas where premiums are lower, usually urban areas, are going
to so-call win and people who are older or sicker and people
who are in rural areas and with lower incomes will so-call lose.
- So with that said, how do you think it treats Wisconsin?
- So Wisconsin is going to be no different than other states
in that regard.
Wisconsin happens to have quite a large number of people
relative to many other states enrolled in the Affordable Care
Act or Obamacare.
So we have about 230,000 people enrolled right now
in Affordable Care Act plans.
And that's throughout the state.
So in -- our rural counties actually have larger percentages
of their population enrolled in Obamacare policies
than do our urban counties.
So we have a fairly significant investment in our state in the
Affordable Care Act as it stands today.
About -- of the 230,000 people that are enrolled in Obamacare,
about 84% of them are currently able to enroll in Obamacare
plans because of the availability of the premium
subsidies, which are tax credits.
So those people, the 190,000 people who currently get those
tax credits in our state, are going to be at some risk with
the change in tax credit structure.
- Because, as we described in the introduction, the tax credit
structure, and, again, looking at older people and younger
people, let's say for somebody over 60, income $75,000 or less,
it's a $4,000 tax credit.
How does that compare to what someone in Wisconsin in that
demographic would be getting if they were enrolled in an
Obamacare plan?
- So keep in mind that the bill in the House currently, the
subsidies are not linked to income.
They're linked to age.
- Right.
- But it's capped at $75,000 for an individual
and $150,000 for a family.
So the $4,000 credit would be available to a person over age
60 and $2,000 credit for a younger person around age 20.
So $2,000, $3,000, $4,000.
That's much less in subsidy than what's currently available
under the Affordable Care Act.
So while a $2,000 credit might be fairly significant for a
young, healthy person to be able to buy a fairly thin health
insurance coverage because that's all they need, so maybe
it will cover most of their cost, but $4,000 for a
60-year-old low-income person is not going to come near what they
would need to purchase their policy.
It may not even cover a third or a quarter of what they would
need to purchase a health insurance policy.
- And then meanwhile kind of tacked onto that this GOP plan
would allow insurers to charge older people five times more
than they charge younger customers and that's more also
than the Affordable Care Act.
- Right.
The Affordable Care Act has what we call rate bans
that allow insurers to vary the rate three to one.
So a person that's the same in every other way except age, they
can charge three times more.
And this bill changes it to five times more.
Now, that's not necessarily a bad idea if you provide proper
subsidies for lower-income people to afford that.
But the challenge here is that these subsidies are linked to
age but not to income.
So you could have a 60-year-old who's making $75,000 a year
getting the same $4,000 that a 60-year-old that makes $10,000 a
year.
And so it's very unlikely that that low-income older person is
going to be able to afford that coverage.
- As long as we're talking about young and old and kind of
the insurance pool, I know that the GOP talks all the time about
how Obamacare is in a definite death spiral.
Is that true?
- Most -- I would say that most objective observers would say
that it's not the case that Obamacare is in a death spiral.
Certainly there were and are challenges with regard to trying
to get more younger and healthier people into the
insurance pool and there are fixes that can and should be
made to either the existing law or a change in the law to get
more younger, healthy people in.
But a death spiral would be if we were observing a decline in
enrollment, which we are not.
We saw more people in Wisconsin enroll this year than we did
last year.
And it would say that there's an increase in premiums that we
were unable to identify reasons why
and unable to fix those reasons.
And that is not the case. - All right.
I want to ask about another prong of this and there are many
more I want to ask about, but it is this issue of high-risk pools
envisioned in this plan.
- Right.
- Would you expect those to work?
- So we did have a high-risk pool in Wisconsin before
Obamacare.
I do want to say I use Obamacare and the ACA interchangeably.
And it was called HIRSP and it was a very successful plan by
most accounts for what it did do.
It served people who could not get insurance elsewhere and who
had various conditions.
The issue with HIRSP was that at the height of its enrollment, it
enrolled about 21,000 people and it was still fairly expensive
for people to enroll and there was a six-month waiting period
for people with preexisting conditions.
People still found it fairly expensive even with some
available subsidies by the state to purchase that insurance.
So think about at the time that HIRSP existed and reached its
peak enrollment at 21,000, we still had over half a million
people in our state who were uninsured.
And those people just couldn't find available or affordable
options for themselves for various reasons.
So it was not a solution at the time.
People do talk about various ways to make high-risk pools
more tenable, but it would by most analyses require a lot more
money to make it work for the population than what is
contemplated in the current bill.
- Let's talk about, speaking of a lot of money,
let's talk about Medicaid.
The new plan would give states a per capita amount
based on 2016 spending.
Does that hurt Wisconsin, which didn't take the expansion?
- So it's a rather complicated answer.
There are provisions in the bill to allow an extra amount of
money to states that did not participate in the Affordable
Care Act's expansion and to allow them to do various things
to bring them toward some kind of equity with states that did
take the Affordable Care Act expansion.
So it's not a direct hurt, as some people might characterize
it.
The bigger concern, I think, is that the per capita caps would
pin the amount that the federal government is going to pay the
state to 2016 outlays and whatever we're paying now per
individual, according to five different groups: children,
parents, elderly, et cetera.
And it would say whatever we're paying now plus the rate -- the
CPI and 1%, that's what the federal government is going to
contribute going into the future regardless of what the expenses
turn out to be for these different populations.
And I think most, many analysts would suggest that the rate of
cost for these populations is very likely going to exceed that
rate of inflation, number one.
And for Wisconsin right now, we actually are at the low end of
what we pay per capita for several of these populations
relative to other states.
So we're going to start out at a baseline getting a lower per
capita payment than many of these other states and in that
regard we may end up being relatively disadvantaged.
- Let's take a listen to another sound bite from Speaker
Paul Ryan who was talking specifically about how states
can manage their Medicaid.
- Our problems in Wisconsin are a whole lot different than the
problems they have in New York or in Nevada or in Utah or
California.
So we propose more efficient spending, bring the spending on
Medicaid to something that is sustainable so it doesn't go
bankrupt and have a safety net for the most vulnerable.
Give local control to our states and our governors so they can
craft and customize Medicaid to work for their populations.
- When he says bring the Medicaid to something that is
sustainable, does that sound like a cut?
- Well, I mean, people use the word differently, but certainly
it may be sustainable for the federal government.
It will certainly provide some control and large cuts in the
amount of federal spending toward the Medicaid program.
The states are going to be left having to manage with a lot less
federal money in their pockets.
For the current Medicaid program and going forward, they will
have a declining amount of federal share and will have to
figure out how to work with much less federal contribution.
The only way to handle that, there's three ways.
They can reduce the eligibility, so the way that people can get
enrolled in the program.
They can reduce the benefits in the program.
Or they can reduce payments to providers.
But they're going to have to figure out as the rate of costs
in the Medicaid program increase more than the federal
contribution, states are going to be left having to handle that
within their own budgets, unless they're willing of course to
allocate more money to the Medicaid program.
- Now overall does this new plan in your estimation result
in fewer people being insured, as Tammy Baldwin would say?
- From what we know today -- and again we're waiting for the
Congressional Budget Office to weigh in so I don't have
definitive estimates, but the various estimates that are out
there suggest that anywhere from 10 to 20 million people will
lose insurance under the current plan.
And if you listen to the House leadership talking about the
plan, they're not trying to suggest that that isn't the
case.
They're saying we're not trying to measure the plan by the
amount of people covered under insurance.
We're measuring the plan by a number of different factors.
And so I think that we need to decide are we interested in
maintaining the level of insurance coverage per se or are
we interested in some other policy goals?
- All right.
We need to leave it there.
Thank you very much for your expertise on this.
- Thank you.
- A "Closer Look" now at a federal proposal to drastically
cut annual funding to the Great Lakes Restoration Initiative,
from $300 million to $10 million.
The initiative began in 2010 to speed up efforts to protect and
restore the Great Lakes, described as the largest system
of fresh surface water in the world.
The initiative works to clean up particular areas of concern,
prevents and controls invasive species, reduce algae blooms and
restores habitat.
Last year alone, Wisconsin saw nearly $300 million in funding
from the Initiative.
In tonight's "Closer Look," potential impact of cuts to
Great Lakes restoration.
Joel Brammeier is the president of Alliance for the Great Lakes.
He joins us from Chicago and thanks very much for doing so.
- Thanks for having me.
- Well, first, what is your reaction
to the proposed funding cuts?
- Well, the cuts would be devastating to the Great Lakes.
The Great Lakes Restoration Initiative has really brought
the region back from the brink, in terms of supporting clean-ups
of some of these contaminated sites, protecting the Great
Lakes from things like Asian carp which made headlines
several years ago.
And so the program has been wildly successful.
It's funded more than 2,000 projects across the Great Lakes
region and we're really looking forward to continue and we think
it can because it has a lot of bipartisan support in Congress.
- The Great Lakes Restoration Initiative is funding to kind of
accelerate clean-up.
Could it be regarded as a booster fund in addition to
other efforts that are already ongoing?
- Well, states and cities are also spending millions of
dollars every year to restore the Great Lakes.
And what the Great Lakes Restoration Initiative has done
has really brought all of that effort together as a partnership
from the federal level all the way down to the local level.
And so you're actually now seeing billions of dollars of
restoration money being invested across levels of government and
the private sector.
The GLRI, as it's known, has had this sort of
collaboration-inducing effect in addition to the raw dollars.
We stand to lose a lot of that collaboration if this program
goes away.
- I know in Wisconsin the Initiative has worked to address
the Sheboygan River and lower Fox River, designated as areas
of concern because of industrial contamination and pollution.
How does the funding address that kind of clean-up?
- Part of the Great Lakes Restoration Initiative is
designated to support cities around the region like Sheboygan
and like the lower Fox River area that experienced that
legacy of contamination.
In a very real way, the Midwest built the world.
We provided the steel, the cars, the paper.
There's a legacy of contamination that goes with
that.
So dozens of cities around the Great Lakes have a very heavy
contamination burden.
The GLRI is sparking clean-ups across the region.
Four of the most contaminated areas in the United States have
been cleaned up as a result of the GLRI and other partnerships.
And there's a couple dozen more on the list still waiting.
- So what are some kind of specific examples of work that
has happened because of the funding of which you speak?
- Well, you brought one up already right there in
Wisconsin.
The Sheboygan clean-up has received substantial funding
from the GLRI, from a number of federal agencies, and combined
with local investment is making a huge difference in the
comeback of Sheboygan's Lake Michigan resources.
A little south of there you've got Milwaukee, what's called an
area of concern that's in the process of being cleaned up.
In Illinois, just a little bit south Waukegan.
There's example after example of a city on the coast of the Great
Lakes that doesn't actually get all the benefits of being on the
Great Lakes because they've got this legacy of contamination.
We also have, of course, the effort to protect the Great
Lakes from species like Asian carp, which is being directly
funded in Illinois to the tunes of tens of millions of dollars
each year.
Part of that is coming out of the GLRI.
- So if this funding gets reduced to the extent that is
proposed, is it your expectation that these projects would just
stop in their tracks?
- That federal spark is almost critical to the future of these
clean-ups.
You've got to have that federal engagement to drive those
clean-ups forward or the projects face a very real risk
of grinding to a halt.
To give you an example, in the 20 years prior to the creation
of the GLRI, there were designations on the books, there
were plans that had been written, there were community
forums, but there was no dollars actually going to make these
clean-ups happen.
And the GLRI fast forwarded all that.
Now we're on the pace to actually get those projects
done.
-How would you describe the current health of the Great Lakes?
- I think we're at some very real risk.
Places like Toledo, Ohio that can't access clean drinking
water sometimes because the water is so contaminated from
toxic algae.
You've got locations like the bay of Green Bay, where clean
water concerns are doing damage to the region's image, not to
mention the fact that people are having a hard time accessing
safe drinking water northeast of Green Bay.
And there's examples like that all over the Great Lakes.
We're facing some very real risks right now.
It's not as though the clean-up is done
and we can just walk away.
- How likely do you think it is that these funding cuts
will actually become reality?
- Well, if there is a silver lining here, it's that there has
been a massive effort over the last ten years to build up the
bipartisan support for restoring the Great Lakes.
And so you've seen, for example, this spring there was a letter
sent in Congress that nearly 50 members of Congress, Republicans
and Democrats from the Great Lakes region, signed on to
supporting full funding for this initiative.
It was authorized officially by Congress at the end of last
year.
I think there's a great prospect to actually get this program
back where it needs to be, regardless of what the White
House puts forward.
- We'll be watching.
Joel Brammeier out of Chicago, thanks a lot for joining us.
- Thank you.
- It's been less than a year since Waukesha gained approval
to divert Lake Michigan water for its own use.
A diversion granted as an exception to the Great Lakes
Compact as the city argued it needed the water because its
wells are contaminated by radium.
But next week there's a hearing on a challenge to the decision
approving the water diversion.
We sat down with Scott Gordon, journalist for WisContext, for
more on the status of the Waukesha water deal and started
by asking why a group representing cities surrounding
the Great Lakes in the U.S.
and Canada is bringing a challenge to it.
- So their big overarching concern is to make sure that the
Great Lakes Compact is being enforced the way they think it
should be.
So that whole issue of precedent is a big one.
But they've also are kind of looking at this from an
environmental standpoint, you know, what kind of affects
Waukesha will have in drawing the water and discharging
wastewater back into the Great Lakes through the Root River.
And they also are still contending that Waukesha still
has alternative water sources.
- You're reporting on what happens to the water that
Waukesha pulls out of Lake Michigan, treats and returns to
the lake via the Root River under the agreement and
specifically the river itself.
What have you found about the Root River?
- The Root River has some environmental problems,
especially with the level of phosphorus in the water.
The Department of Natural Resources considers it impaired
for its level of phosphorus.
Other issues include the fact that sometimes the flow of the
river is very low and it's struggled to maintain some of
its fish population and stuff, which has effects
on other things like recreation and tourism,
which are important to Racine.
- Meanwhile, Waukesha says that the water it treats will go back
into the Root River cleaner than the Root River was originally.
- It's an interesting argument they are making because Waukesha
is basically saying that its sewage plant that it's going to
be discharging this water from, they actually call their sewage
plant the clean water plant.
That's the actual name of it so clearly they take pride
in how they're treating it.
But they're saying that they're going to be able to discharge
water that meets pretty high standards, that it will have
lower concentrations of phosphorus than what's already
in the river.
Kind of an interesting argument they're making - well we're
actually improving the quality of the river by diluting it even
if we're adding more phosphorus into the overall picture.
- So what have you learned about what happens once that
water that's running through the Root River that has been,
you know, discharged from the clean water plant in Waukesha,
what happens when it reaches the lake?
- One city like Waukesha by itself is probably not going to
have a huge environmental impact on the Great Lakes, just because
it's such a large body of water when you put it altogether.
The Great Lakes overall are in fairly decent shape in a lot of
senses when it comes to phosphorus.
It's gotten a lot better since the '60s and '70s, probably
better than a lot of people would expect just given the
amount of large cities around the Great Lakes and the amount
of shipping and other activities that go on.
Lake Erie obviously is an exception.
It has had huge problems with phosphorus.
But I think the concern is less about what Waukesha by itself
could do to the system and more about what would be the
cumulative effect of more communities coming and doing
this.
- None of this is happening anytime soon, though, right?
What's the status of this project itself?
- So Waukesha still has to build some infrastructure to be
able to actually do this.
The water itself is coming in from Oak Creek, so they'll be
taking the water from Lake Michigan and then Waukesha has
to build a pipeline that takes the water from Oak Creek to
Waukesha.
Then they have to build another pipeline that takes wastewater
from their treatment plant to an outflow site on the Root River,
which is going to be in Franklin, Wisconsin.
And of course they still have to finalize plans and get permits
to construct all of that.
And they're saying at this point that won't start happening until
2019 and, you know, the whole drawing and wastewater issue
won't actually start happening until probably 2023.
So it's a while out, but right now Waukesha is really confident
that the agreement will be upheld and they're basically
kind of already behaving as if
it's full speed ahead with this thing.
- All right, Scott Gordon, thanks very much.
- Thanks very much, Fred.
- That was journalist Scott Gordon.
Look for his reporting at WisContext.org, a collaboration
of Wisconsin Public Radio and TV and UW-Extension.
Now a "Closer Look" at other Wisconsin news at the state
capitol.
The Assembly passed two bills on Tuesday that could help the
severely ill.
One legalizes CBD oil, a cannabis exact, which has proven
useful in treating seizure-causing conditions like
epilepsy.
The other commonly known as the "right to try" bill allows
people suffering from terminal illnesses to try drugs not yet
approved by the FDA.
Organizations like the Wisconsin Medical Society have been
critical of the bill, saying it could slow down the formal FDA
approval process.
And that is our program for tonight.
I'm Frederica Freyberg.
Have a great weekend.
- Funding for "Here and Now" is provided, in part, by Friends of
Wisconsin Public Television.