HOW - State Employees
Generally, Wisconsin provides its employees with benefits, including healthcare insurance. Healthcare of Wisconsin [HOW] would be a legislative action for a pilot project and a better way to provide state employees with healthcare because it 1) deals directly with healthcare providers and 2) eliminates insurance companies and pharmacy benefit managers. HOW returns control of healthcare to patients and their providers. State employees keep the providers they love and lose the insurance companies they don't.
HOW is neither a governmental single payer “Medicare for All” plan nor a self-insurance plan. HOW is an expansion of the direct primary care model to include the healthcare currently provided to state employees. Instead of paying premiums to healthcare insurance companies, Wisconsin keeps the money and buys healthcare not insurance.
HOW achieves the lowest costs for taxpayers, saving them millions of tax dollars.
HOW – It Works!
With one exception, HOW uses current state agencies and existing state policies to provide healthcare to state employees. Healthcare providers continue to:
· manage themselves,
· set their prices for goods and services,
· prepare their billing statements,
· set procedures for payments, referrals, prior authorizations, patients’ appeals, services utilization, and other operations.
The one exception is the statutory joint venture of all healthcare providers licensed in Wisconsin, with a governing body chosen by them. The governing body has the authority to resolve disagreements concerning payments, referrals, prior authorizations, patients’ appeals, services utilization, and other operations. Wisconsin, on behalf of its employees, negotiates a contract with the governing body to provide state employees with healthcare goods and services. This healthcare-requirements contract includes guardrails against fraud, claims anomalies, and overutilization.
HOW - Compliance
HOW is fully complaint with the Affordable Care Act and the State-Action Antitrust Immunity Doctrine “As explained in Parker v. Brown, 317 U.S. 341 (1943), under the state-action doctrine, state and municipal authorities are immune from federal antitrust lawsuits for actions taken pursuant to a clearly expressed state policy that, when legislated, had foreseeable anticompetitive effects.
When a state approves and regulates certain conduct, even if it is anticompetitive under FTC or DOJ standards, the federal government must respect the decision of the state. Therefore, if a state sanctions anticompetitive conduct, the state is immune from investigation and possible prosecution by the FTC.
This doctrine can apply to provide immunity to non-state actors as well if a two-pronged requirement is met:
https://www.law.cornell.edu/wex/state_action_antitrust_immunity
HOW – Trust Fund
Instead of paying premiums to insurance companies, the state of Wisconsin pays the money into a trust fund [FUND], managed by the State of Wisconsin Investment Board, together with any requisite initial capitalization and reserves. State employees also pay their premium portions into the FUND. In addition, state employe
HOW – Trust Fund
Instead of paying premiums to insurance companies, the state of Wisconsin pays the money into a trust fund [FUND], managed by the State of Wisconsin Investment Board, together with any requisite initial capitalization and reserves. State employees also pay their premium portions into the FUND. In addition, state employees pay reasonable co-pays and deductibles. The FUND covers the costs of goods and services provided to state employees by healthcare providers. The FUND purchases insurance for cost overruns and foreseeable but unexpected events like pandemics.
HOW - State Agencies
HOW has its costs too, including additional personnel to existing Wisconsin agencies. By adding a limited number of employees, HOW eliminates an entire industry from the healthcare system equation resulting in savings to taxpayers, increased benefits to state employees, and increased profits for healthcare providers in
HOW - State Agencies
HOW has its costs too, including additional personnel to existing Wisconsin agencies. By adding a limited number of employees, HOW eliminates an entire industry from the healthcare system equation resulting in savings to taxpayers, increased benefits to state employees, and increased profits for healthcare providers in Wisconsin.
HOW has nothing to do with personal gain. I am not selling anything; I am not buying anything.