Jacque looks to enshrine some ACA protections into state law
Last week, the Assembly passed a bill that would put federal protections guaranteeing access to health insurance for those with pre-existing conditions into state law.
A federal court ruled the Affordable Care Act and its protections unconstitutional in December after Wisconsin and other states sued. That ruling is being appealed.
“Whatever the future of healthcare policy looks like, this is something that we’re hoping to enshrine very strongly in terms of protections in state law,” bill author Sen. André Jacque, R-De Pere, said in an interview Wednesday with Wisconsin Health News.
Jacque spoke about the proposal as well as other measures he’s pushing this legislative session.
Edited excerpts are below.
WHN: Why are you pursuing this?
AJ: I thought it was important to be able to continue the discussion that we’ve had on the issue before we got too far down the road. It is something where there has been ongoing litigation, and then there’s just still the uncertainty with a lot of things at the federal level. Of course, we recently had the shutdown. We just wanted to look at something where there was a bipartisan consensus and has been for some time, which is protecting individuals with pre-existing conditions so they’re going to be able to have access to coverage, that they’re not going to be discriminated against on the basis of a health condition that they’ve already been dealing with. I reached out to one of my former Assembly colleagues, Rep. Kevin Petersen, R-Waupaca, who I know had worked on the issue previously. I’m very pleased with the bipartisan support that we’ve received thus far. I do think that it’s an opportunity to start off the session on the right note and take a deep breath and look for a bunch of different areas in healthcare where there can be kind of a bipartisan consensus reached.
WHN: The proposal was amended to bar insurers from capping annual and lifetime costs. Do you support that?
AJ: That was actually something I was looking to introduce as standalone legislation. Obviously as it stands, that’s something that has been incorporated in the Assembly version, and I’m comfortable with that. We’re still going to have caucus discussions later on this week. So by the time this will be appearing, we’ll have already gotten a sense of where things are headed. But I’m certainly very optimistic just based on the feedback that I’ve received from talking to my Senate colleagues.
WHN: Gov. Tony Evers wants the bill to include the ACA’s essential health benefits, including coverage of prescription drugs and maternity care. Do you support that?
AJ: Well I certainly looked at that as well. I think there’s just a whole lot of discussion that deserves to be had with a number of these different issues. And sometimes mingling them together…there’s a reason why these have been standalone issues previously. There’s a reason the legislation, at least on pre-existing conditions, why I wanted to keep it specific to the three core components of what pre-existing conditions are supposed to be – basically the guaranteed issue, the pre-existing exclusions and the community rating. Certainly, there are other things that I think merit discussion. But we also have to take a look at what the state’s role can be in terms of innovating in the absence of Obamacare as well. I think what we’re able to do in terms of pre-existing conditions and lifetime caps is giving the assurances to the most vulnerable population. There are going to be opportunities for a lot of other discussions. And I think it’s going to be easier to do that the more we have some cooperation across the aisle in looking at ways that we can work together in good faith without trying to point fingers. I certainly have confidence that this is a bill that Gov. Evers is going to sign at the end of the day.
WHN: There are concerns that the bill won’t work without the premium subsidies available under the Affordable Care Act. What’s your response?
AJ: There’s a lot of things that would be different about the healthcare landscape in the absence of Obamacare. Certainly, the state level is going to be much more empowered. And there has always been a safety net that’s been there at the state level. Pre-existing conditions are something the state has tried to address prior to Obamacare as well. So I think in a way, passing this legislation is again to assure folks that there’s going to be that safety net regardless of what the scare tactics might be. There’s always going to be state and federal investments in the health of our people and making sure that we are providing for the most vulnerable populations. I have every expectation, regardless of whatever those investments are going to be from the state or federal level and what they might look like in terms of different plan designs or what’s possible, that what we’re trying to pass right now is going to be a good foundational starting point that we can absolutely make work within whatever that framework will be. And certainly, it’s going to offer that assurance to people that they’re not just going to have the rug pulled out from underneath them. This is showing that people at the state level can work together.
WHN: Are there other ACA provisions that you are interested in?
AJ: We’re exploring some of the issues with essential health benefits. That certainly was already in discussion as a separate piece of legislation along with the annual and lifetime caps. But I’ve probably got about 80 bills that are in different stages of the drafting process. So far, I’ve got probably about nine of them that have circulated so far. So I don’t want to tip my hand as to what else we might be looking at in terms of innovation. I know that my colleagues have a lot of great ideas in terms of healthcare yet this session. So I think we’ll have some more conversations on that in caucus. Certainly, I’ve been very interested in having discussions with my colleagues on either side of the aisle. That’s actually one of the things where I was a little surprised that Gov. Evers wanted to talk to Assembly Speaker Robin Vos, R-Rochester, and Senate Majority Leader Scott Fitzgerald, R-Juneau, rather than inviting Rep. Petersen and I into that conversation. But ultimately we all ended up having the same discussions. It’s just I’m always a fan of getting more people into the room together sooner to be able to ease that communication.
WHN: You’re supporting a bill that would make changes to step therapy. Why are you in favor of that?
AJ: I was very proud to be the lead co-author behind Sen. Alberta Darling, R-River Hills, on the Senate side. I’ve heard from just a number of constituents and friends, people that have been on step therapy protocols where they call it fail-first or essentially it’s not getting the best medication that hopefully is going to be the most suitable for the patient that a physician is prescribing. Sometimes there are reasonable steps where you can see whether there are other options that are going to have the desired effect. And many times, you are kind of going through what can be a lengthy process when some people don’t necessarily have time on their side in trying to find a treatment that’s going to work for them when really early intervention is critical for better health outcomes.
WHN: You’re on the Senate health committee. What are some of your priorities or other legislation that you’re looking at?
AJ: I enjoyed serving on the health committee on the Assembly side. Now having that opportunity again in the Senate is something that I’m very appreciative of. One of the things that we were able to do last session that is now kind of a best practice that’s being taken to a number of other states nationwide is Dillon’s Law, which deals with epinephrine and being able to help with anaphylaxis, an allergic reaction, that you have the option for life-saving treatment…(I’m) looking at potentially teaming with Rep. Daniel Riemer, D-Milwaukee, on some legislation for CPR training within schools. School-based training on administering epinephrine is also something that I’m interested in encouraging because we’ve already seen it occur on a broad basis and there’s grant programs out there for defibrillators or for stocks of epinephrine auto-injectors. There is perhaps some clean up legislation as well related to Dillon’s Law just to make sure that the full range of generics are going to be available to potential first responders or trained lay people.
Certainly, there’s a health component to a lot of pieces of legislation. Whether I’m talking about a post-traumatic stress injury for first responders, or you’re talking about suicide prevention and teen mental health, when you’re talking about responding to heroin or opioids or other addiction-related issues within the criminal justice system. There’s certainly connections to a lot of the other committees I’m serving on and other pieces of legislation I’m working on even if they won’t necessarily be handled by [the health] committee. One of the things that I’m very excited about is what’s going forward with the Medicaid Purchase Program for individuals with disabilities and being able to support really the participation in the workforce for a number of disabled individuals that are now going to be able to support themselves and their families and take on additional work opportunities. I’ve been part of some of those stakeholder discussions at the Department of Health Services. I think there’s the opportunity for a lot of very positive things to get done this session.
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