Evers Issues Medicaid Expansion, Pre-existing Conditions EOs

In some of the first executive actions of his term, Gov. Evers this week signed two executive orders directing state agencies to implement plans for expanding Medicaid and prohibiting pre-existing conditions exclusions in health insurance.

Executive Order 3 directs the Department of Health Services (DHS) to develop a plan for expanding Medicaid eligibility. EO 3 also directs DHS to prioritize increasing healthcare coverage, improving access, investing in prevention and wellness, developing the healthcare workforce, fostering innovation, and reducing disparities.

Executive Order 4 directs DHS, the Office of the Commissioner of Insurance, and the Department of Trade, Agriculture & Consumer Protection to implement action plans and provide recommendations to Gov. Evers on how to protect consumers with pre-existing conditions and to generally enhance health insurance coverage in Wisconsin. EO 4 asks the departments to “protect against…short-term plans that do not comply with Affordable Care Act requirements.” President Trump has touted short-term plans as an inexpensive option for consumers needing insurance for short periods of time who are coming off their parents insurance, are in between jobs, missed open enrollment and do not have a qualifying event for special enrollment, are awaiting Medicare eligibility, are in their waiting period before ACA coverage begins, or are needing a temporary alternative to COBRA.

EO 4 mentions that protections for pre-existing conditions under the ACA are uncertain due to the pending lawsuit filed by former Republican Attorney General Brad Schimel. Evers said this week he is planning to send a letter to current Democrat Attorney General Josh Kaul ordering the Department of Justice to change Wisconsin’s stance on the lawsuit. However, the extraordinary session legislation signed by former Gov. Scott Walker in December requires the Republican legislature to approve the attorney general’s decision to discontinue a case on behalf of the state.

A federal district court recently ruled that the ACA’s individual mandate is unconstitutional and, because the individual mandate is “essential” to the ACA, the remaining provisions of the law are also invalid. The district court did not place an immediate injunction on enforcement of the law, so there will be no immediate impact to 2019 coverage under the ACA. It is expected that the case will be appealed eventually to the U.S. Supreme Court.

Meanwhile, with the validity of the ACA up in the air in federal courts, the Wisconsin legislature could take action again on state-level pre-existing conditions legislation. Sen. Andre Jacque (R-DePere) and Rep. Kevin Petersen (R-Waupaca) have re-introduced the bill as AB 1, and the Assembly Committee on Health has scheduled a hearing on it on Tuesday, Jan. 15. Assembly Republicans said in a letter to Evers this week that they want it to be the first bill passed this session. The legislation would place a state-level prohibition on pre-existing conditions exclusions, if the ACA is repealed or is otherwise unenforceable. The bill would, though, extend these prohibitions to short-terms plan which President Trump, by executive order, exempted from these prohibitions.