|
|
Wisconsin Health Security Act summary
2007 Senate Bill 51
The Wisconsin Health Security Act is a comprehensive plan to provide quality
health care to all Wisconsin residents--rich and poor, young and old, regardless
of health condition, medical history or employment status. By replacing more
than 700 different health insurers with a single publicly financed plan,
it would eliminate waste, runaway costs, and red tape. It would be administered
at the state and local level, accountable to the residents of Wisconsin.
|
| Administration: |
| A publicly funded program administered by the Department of Health Planning
and Finance (DHFP) under the guidance of the Wisconsin Health Policy Board. |
| Coverage: |
| Covers all Wisconsin residents regardless of preexisting health condition
(see page 9, line 6 of the legislation), age, sex, race, sexual orientation,
geographic location, employment or economic status. |
| Benefits: |
Necessary medical services for maintaining health or for diagnosis or
treatment or rehabilitation following an injury, disability or disease.
Covered services (see page 11 of the legislation) include:
-
Hospital and clinic services; office visits and house calls;
-
Services of physicians, dentists, social workers, and other licensed
professionals;
-
Prescription drugs
-
Health promotion and illness or injury prevention including immunizations
-
Equipment, appliances and supplies such as pacemakers, prostheses, eyeglasses,
and hearing aids;
-
Long term care, including home, hospice, and nursing home care;
-
Mental health services, and alcohol and other drug rehabilitation services
|
| Freedom of Choice: |
| Freedom for patients to choose health providers. Patient
charges prohibited (see page 11, line 1, and page 17, line 5 of the legislation). |
| Provider Reimbursement: |
| The Department would negotiate payment rates with providers,
taking into consideration regional, rural, and urban differences (see page
16, line 13 of the legislation). Most hospitals and clinics would remain
privately owned and operated. Physicians could continue to practice on a
fee-for-service basis, or receive salaries from group practices, hospitals
or clinics.Annual hospital budgets set by DHPF. Capital budgets and purchase
of major equipment (see page 16, line 18 of the legislation) approved separately
from operating budget, based on health service delivery needs. Long term
care facility budgets set by DHPF. Out of state providers to be paid reasonable
rates for providing emergency or urgent care to Wisconsin residents traveling
outside of the state (see page 10, line 23 of the legislation). |
| Cost Sharing: |
| No direct billing by providers |
| Cost Controls: |
| Publicly administered system eliminates unnecessary administrative expenses
of multiple insurance plans, physician overcharges, provider and insurance
industry advertising costs and profits. Sets single statewide price for each
medicinal substance, after negotiations to obtain lowest possible cost (see
page 20, lines 19-24 of the legislation). Operates on a global statewide
budget from which all providers are paid. |
| Quality and Oversight: |
| Sets up monitoring and oversight mechanisms in six defined
regions of the state (see pages 4-6 of the legislation). Regional investigations
of quality, access to medical services, and consumer complaints. |
| Financing: |
| Establishes Health Trust Fund (see page 19, line 11 of the legislation)
in Department of Health Planning and Finance. All revenues earmarked for
health care to be deposited into Fund, from which all providers are reimbursed. |
| Revenue Sources: |
| Public funds already spent for health care (Federal and
state shares of Medicaid and Medicare, General Assistance Medical, Healthy
Start, HIRSP, etc.); fair share taxes on employers and individuals (see page
17 of the legislation); savings from reduction of paperwork, streamlined
administration, and cost controls. |
| Insurance Industry Role: |
| Health insurance coverage permitted for services not covered
by Wisconsin Health Security Act. |
 |
 |
|
