Kathleen Vinehout: State Exchange Best Option for Lowering Health Costs

From my email inbox comes this column from Democratic State Sen. Kathleen Vinehout regarding Republican Gov. Scott Walker’s unwillingness to set up a state health insurance exchange as is mandated by Obamacare.

“Over the years I have seen the devastation of company denials on families [and] witnessed the financial devastation on families that cannot get health insurance,” wrote a local insurance broker. “I urge you to continue your fight to get Wisconsin involved in these exchanges.”

The woman who wrote me echoed the words of many brokers who want to see a state-run rather than a federally-run health exchange in Wisconsin.
Governor Walker announced he would have the federal government create an exchange. This action set off a chorus of complaints among traditionally conservative leaning organizations.

The Governor’s justification was the state would be on the hook for the cost of an exchange. But the Affordable Care Act specifically requires the exchange be self-supporting. Therefore, state support would be contrary to the law. The bill I wrote to create a Wisconsin based exchange details how to accomplish a self-supporting exchange.

With no other argument against the exchange, I challenge my Republican colleagues to take up the mantle of conservative leaning groups and join me in creating a bi-partisan bill that will withstand the Governor’s veto.

Why a Wisconsin exchange?

We must control health costs for small businesses and people who buy health insurance on their own. We must continue Wisconsin’s tradition of providing high quality health care. This can be best achieved through a state based exchange.

Wisconsin is a leader in collecting information on the cost and quality of health care and creating collaboration among providers and insurers to maintain quality and lower cost. Wisconsin already has the resources to meet the goals of low cost and high quality.

Using information on cost and quality to influence purchasing decisions is the heart of the exchange. The Wisconsin Health Information Organization collects information on cost and quality. They maintain one of the most comprehensive sources of health insurance claims data in the country.

The Wisconsin Collaborative for Healthcare Quality is an organization that brings providers and insurers together to discuss ways to lower cost and preserve high quality. This multi-stakeholder consortium has a 10 year history of carrying out initiatives to improve quality and drive down cost.

To ignore the work of these two groups is folly. Together they can create the way to accomplish our seemingly antithetical goals of lower cost and high quality. This is why I placed both organizations on the governing board of the exchange in the bill I introduced in the past two sessions.

If Wisconsin is so advanced in collecting information why don’t we see lower health insurance costs for small businesses?

It’s because buyers – the business community and the individual buying insurance on their own – haven’t been in the equation.

The information collected and wisdom gained from collaboration of insurers and providers haven’t been used to influence insurance purchase decisions of small businesses.

We can create an exchange that shares information on cost and quality in a clear, easy to understand fashion. The one-stop shop for health insurance can make outcome and cost information on specific diseases and procedures available with the click of a mouse.

The information itself won’t drive down costs. The action of buyers will force providers and insurance companies to lower costs. Having information on cost and quality easily available will also allow leaders to monitor providers’ progress.

All providers and insurers don’t want this to happen. Unleashing the free market forces will raise questions about individual actors. Some will have to justify high salaries and poor outcomes.

Smart leaders will emerge who work collaboratively with providers and insurers to lower costs and maintain quality. Smart providers will be rewarded with a larger market share.

There are dangers to a state organized exchange. Unveiling information already collected will raise questions about the validity of quality measures. But let’s have this discussion. The exchange must adapt and flexibility is best achieved when Wisconsin holds the reins.

Taking a ‘hands-off’ federalized approach is bad policy; somewhat like going back to the barn to find another horse when your best one is saddled up and ready to run. You just need to get on it.

The run may take you to uncharted territory and you may have to change course. But run we must.

So, to my colleagues – if the Governor won’t lead – it’s our turn. Let’s work together and get it done.