If Walker becomes president?

Do the actions of a state governor foreshadow the approach he would take and the policies he would advocate if elected to this country’s highest office? If so, then those in long-term care may want to pay attention to what’s going on in the Badger State.

Wisconsin Governor Scott Walker, potential 2016 Republican presidential candidateWisconsin Gov. Scott Walker, left, who is expected to throw his hat in the ring for the 2016 presidential race, has proposed a 2015‒2017 budget (PDF) for his state that includes language one group is calling “arguably the most significant public policy change in the history of Wisconsin’s long term care service system.” That organization, caught off guard by the proposal, does not mean its assessment as a compliment.

In an open letter (PDF) to “interested parties,” the Wisconsin Family Care Association (WFCA) details how $2 billion in spending, affecting more than 50,000 of the state’s elderly and disabled residents who are living independently, would be overhauled under the proposed budget. Long-term services and supports (LTSS) and medical care, currently provided separately, would be combined in an effort to coordinate care and services as well as save costs. The changes, however, are unnecessary and threaten the state’s “long history of innovation and program excellence” in this area, WFCA maintains.

“Wisconsin’s Family Care program is a recognized national leader in the delivery of managed long-term care services that focuses on independence, supporting meaningful community-based lives, and cost-effectiveness,” the letter states. “The program has increased access, reduced waiting lists, improved quality, enhanced choice, and reduced per member costs significantly since its inception.”

The Family Care program, according to the Milwaukee Journal Sentinel, is administered by eight organizations that use funds from the state to contract for services (such as personal care, housekeeping and medical care, according to the Wisconsin Department of Health Services) provided by for-profit companies and nonprofit organizations. Under the new arrangement proposed by Walker, the state would contract with insurance companies to manage care and LTSS for Medicare and Medicaid beneficiaries. The budget proposal, if approved, could result in the closing by mid-2017 of four managed care organizations serving more than 17,000 Family Care members, according to WFCA, although the proposed budget calls for a 36-month transition to the new arrangement and states that the 2017 starting date could be delayed.

The Journal Sentinel editorial board maintains that although changes to the existing system may be warranted, the fact that the proposal came “as a complete surprise to virtually all the stakeholders—from the state agency that oversees the care to the agencies and programs that provide it to the residents who benefit from it” means that further discussion is needed. “The changes to the long-term care system seem to be another slapped-together proposal to bolster Walker’s claim that he’s an agent of bold change,” the newspaper wrote in a March 19 editorial, recommending that the state legislature consider the subject outside of budget talks.

Presidential chances

Walker has not declared his candidacy for president but is expected to do so. Although it’s too early to say how he would fare in the general election—or even the primaries—his prospects look good at this point, if polls are any indication.

Public Policy Polling (PPP) research reported April 21 found Hillary Clinton leading all Republicans in New Hampshire by anywhere from nine to 15 points, but the closest Republican hopefuls were Rand Paul and Walker. PPP research reported April 15 found Walker “in a tier by himself,” with 24 percent of poll-participating New Hampshire voters saying he was their top choice for the state’s Republican primary. “Walker is easily the best liked of the potential GOP contenders in New Hampshire,” PPP stated, noting his favorable rating with 57 percent of the state’s voters and the finding that only 13 percent had a negative view.

A Gallup poll conducted in early March found that Americans view Walker more positively than negatively, although he has lower-than-average familiarity among voters compared with other contenders and potential contenders in the race for president.

The fate of the LTSS provisions in the Wisconsin budget is uncertain, and if Walker declares his candidacy for president, it remains to be seen whether—and how—his long-term care-related actions will affect votes. My eyes, for two, will be watching.

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Topics: Advocacy , Medicare/Medicaid