Wisconsin health experts say ACA and health tax credits are here to stay

Regardless of which party wins the next presidential election, the Affordable Care Act will remain in place, tax credits for purchasing insurance will likely continue, and more hospitals could close if Medicare reimbursement rates remain unchanged.

Those were the conclusions drawn from a panel of medical experts and state lawmakers organized by Wisconsin Health News.

The Republican Party’s 2024 policy platform, released Monday, makes no mention of the 2010 health care law.

“I think it’s notable that the ACA wasn’t mentioned, given that Republicans have spent years talking about repealing and replacing it, assuming that continues into the future,” said Eric Borgerding, CEO of the Wisconsin Hospital Association.

Brad Walters, director of federal government relations for Marshfield Clinic Health System, said prescription drug prices will be a focus no matter which party wins the White House.

“But where that happens between the two potential administrations will be very different,” Walters said.

John Nygren, executive director of the Wisconsin Health Insurance Association, agreed that both parties are likely to focus on drug prices.

If President Joe Biden is re-elected, “the $35 cap on insulin could potentially be applied to other medications as well,” Nygren said.

The enhanced tax credit for purchasing insurance in the ACA marketplaces, enacted in 2021 and extended in 2022, is set to expire on December 31, 2025.

“Most politicians don’t want to be labeled as raising health care costs or premiums for individuals,” said Nygren, a former Republican member of the Wisconsin General Assembly.

Regarding tax credits, he said, “They will be adjusted. They will not be eliminated. The tax credits will continue to exist.”

Sen. LaTonya Jackson, D-Milwaukee, said she’s concerned about more hospital closures in the state.

“Here in Wisconsin, we recently had two hospitals close, one in Eau Claire and one in Chippewa Falls. And when those hospitals close, patients have to go somewhere,” Jackson said.

“That means hospitals that have Medicaid coverage rates of over 50 percent, and in some areas as high as 70 percent, that are closing down, are going to shift that burden to other hospitals, other clinics,” she continued.

Borgerding said part of the reason for the hospital closures is payer mix — the ratio of people with Medicare and Medicaid to those with private insurance.

“Do we change the payer mix by getting more people on Medicaid, or do we improve the impact of the payer mix by improving payments for patients that many other providers simply don’t see? That’s what’s putting so much pressure on hospitals right now,” he said.

Bolgerding said lawmakers may need to turn to private-equity-backed medical centers, which are luring privately insured patients away from struggling hospitals.

Some hospitals are reimbursing up to 74% of the costs of treating three-quarters of patients.

“This has a very perverse, distorting effect on the so-called free market in health care,” he said.