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Some consider the state Senate’s proposed Healthy Wisconsin health insurance plan a necessary solution to health insurance access and affordability problems. Others, though, consider it to be “Michael Moore’s medical dream state,” referring to the filmmaker who recently released a highly charged documentary on the health care system called “Sicko.”

In an attempt to get views on the proposal, the Wisconsin Alliance for Retired Americans sponsored an informational forum to discuss the plan at the West Salem library Monday afternoon.

The Alliance is advocating passage of the Senate legislation creating an insurance plan to cover everyone working or residing in Wisconsin called “Healthy Wisconsin: Your Choice, Your Plan.”

Bobbie Gribble of West Salem attended the session Monday and spoke about her family’s problems with the high cost of health insurance.

“We’ve got a $10,000 annual deductible and an $800 monthly premium,” said Gribble, a stay-at-home mom with a 4 1/2-year-old boy. “I think (the proposal) is very interesting, and we do need something and soon. It needs to happen.”

Anyone residing or working in Wisconsin would be eligible for the plan unless already eligible for Medicare, Medicaid/ Badger Care, federal worker benefits or Tricare (military plan). For those moving into the state, 12 months of residency must be proven unless the person is gainfully employed. Those younger than 19 and pregnant women moving to the state would be exempt from the residency requirement.

Proposed coverage would be as comprehensive as the plan covering state legislators and would include preventive dental care for children, mental health benefits, chemical dependency coverage, vision exams, prescription drugs and regular medical care including office visits.

Plan design elements as proposed include annual deductibles of $300 per adult or $600 per family. Co-payments would be $20 per visit unless for preventive care or 25 percent of a specialist’s fee if not referred by a network physician.

The maximum out-of-pocket expense, including the annual deductible, would be $2,000 per adult or $3,000 per family. Prescription drug coverage co-pays would be $5 for generics, after deductible, $15 after deductible for brand formulary drugs and $40 after deductible for brand non-formulary drugs.

The Senate proposal is financed by a tax of 2 percent to 4 percent of FICA wages on employees who are not on Medicaid or Badger Care and a 9 percent to 12 percent payroll tax on employers. Sole proprietors would pay 10 percent of Social Security wages.

Those with income but no employment wages would pay 10 percent of adjusted gross income up to Social Security wage limit.

For the basic package outlined above, there would be no additional cost beyond the payroll contributions. There will be other plans offered with more benefits that citizens can choose by paying all or part of the costs of the higher-coverage plan. The premium would depend upon the number of competing plans.

Steve Doyle, La Crosse County Board chairman, had requested a financial analysis of the effect on La Crosse County of the proposed plan. A preliminary estimate indicates there would be a net county savings of just over $4 million, according to county Finance Director Gary Ingvalson.

An estimate of the cost of the plan is $15.2 billion in new payroll taxes. But proponents say the plan will save billions of dollars.

State Sen. Kathleen Vinehout, D-Alma, said in a published fact sheet, “The Healthy Wisconsin Plan is estimated to save state and local governments $1.36 billion. Local governments are required under the bill to refund at least half of this savings to their property tax payers.”

Municipalities could use the other half for general-purpose funds. The plan is being touted as saving $751 million in the first year and $13.8 billion in the next 10 years.

Proponents say the savings will come from reduced emergency room visits and helped by preventive medical practices by those currently uninsured.

According to Families USA, “With fewer uninsured people, less money will be needed to provide care for the uninsured. This, in turn will reduce the costs that are passed on to those with health insurance.”

Others say savings would also come from reduced administration costs and bureaucracy.

The Alliance is promoting the proposal because “it would improve the quality of life for Wisconsin residents, there will be efficiencies in health care administration and health care costs will go down,” said Leon Burzynski, president of the Alliance and a speaker at the forum.

The proposal, which passed the Senate by an 18-15 vote on June 26, was proposed by state Sen. Judith B. Robson, D-Janesville. Healthy Wisconsin also is backed by the Wisconsin AFL-CIO, Families USA, the Citizen Action of Wisconsin and the Coalition of Wisconsin Aging Groups.

The Wisconsin Taxpayers Alliance objects to the plan because of how it will be governed. The proposal calls for a new department in state government, a Healthy Wisconsin Board, that would annually determine the amount of payroll tax to assess on employees and employers.

The Taxpayers Alliance objects because this 16-member board, which will not be elected, will have more taxing authority than the state Legislature in terms of dollars. According to the most recent edition of the Taxpayers Alliance publication Focus, “the board’s $15.2 billion in payroll taxes would surpass the taxes imposed by elected officials at the state ($13.92 billion), school ($3.59 billion), municipal ($2.35 billion) and county ($1.966 billion) levels.”

According to the Heartland Institute, in its September 2007 issue, spokesperson for Senate Minority Leader Scott Fitzgerald, Mike Prentiss said, “It’s bad policy that has been poorly executed and sprung on the people of Wisconsin at the last minute and we think it will be disastrous for the economy and for jobs in Wisconsin, and also for health care coverage and the health care system.” Fitzgerald (R-Juneau) voted against the bill.

Critics say legislators had less than 24 hours to review and absorb the bill before it was voted upon.

At the West Salem forum, Tom Williams of Holmen asked how the plan could be legal and not in conflict with ERISA, a law that exempts self-insured plans from state mandated benefits. According to Burzynski, the plan will not be challenged against ERISA because of the way it is administered. “The lawyers have checked it all out and they say it will work,” Burzynski said.

Williams was concerned that the Healthy Wisconsin plan does not do anything to reduce medical costs. “This doesn’t address the real issues of health care utilization and health care costs.”

An editorial in the Wall Street Journal (July 24, 2007) said, “Proponents use the familiar argument for national health care that this will save money through efficiency gains by eliminating the administrative costs of private insurance. And unions and some big businesses with rich union health plans are only too happy to dump these liabilities onto the government. But those costs won’t vanish; they’ll merely shift to taxpayers and businesses. … So where will savings come from? …Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore’s medical dream state.”

The Wall Street Journal editorial went on to say “the plan is also openly hostile to market incentives that contain costs.”

When asked how the state will attract new businesses to the state that are not now providing any health insurance coverage, Burzynski said that if they don’t provide coverage to their employees, “maybe Wisconsin is better off without them.”

For those who are providing coverage, Burzynski said he wouldn’t be surprised if they flock to Wisconsin. “Employers are paying a whole lot more than this 9 percent to 12 percent of wages now.”

Dave Stark, an Onalaska resident who works for the Highway Department of La Crosse County said he was for the plan.

A Bangor resident at the forum, who would not provide his name, said he did not like the plan and wanted legislators to conduct town hall meetings and listening sessions to hear the people’s issues with the current health care system and listen to opinions about this proposal.

It might be too late for that this year. The Healthy Wisconsin plan is being hotly debated in the conference committee hammering out the new budget. There is still no estimate for when the budget process will be complete.