RACINE — One issue where candidates on both sides of the political aisle seem to be able to find common ground these days is on mental health — the need to reduce stigma surround mental illness and to ensure people needing treatment can access it.
Where they disagree is how to make treatment accessible and who should pay for it.
At a National Alliance on Mental Illness candidate forum Monday at the Downtown Racine YMCA, candidates for state Assembly districts 62, 63, 66 and state Senate District 21 agreed that more needed to be done regarding mental health services in the state.
But the discussion that brought out the strongest disagreements was over mental health coverage requirements for insurance plans.
‘Short-term’ or ‘junk’ insurance?
In August, the Trump administration issued a rule allowing the sale of insurance plans that do not comply with the Affordable Care Act requirements. The 2010 ACA law allowed the sale of short-term insurance plans meant as a stop-gap between long-term plans. The Trump administration’s rule allows those plans to be extended as long as three years.
The plans are cheaper than long-term plans but do not offer the same level of coverage as plans that comply with the ACA; prescription drugs, pre-existing conditions, pregnancy and mental health coverage is not required.
These gaps in insurance have prompted Democrats to nickname the plans “junk insurance.”
At Monday’s candidate forum, the two Republicans in attendance defended the administration’s move, characterizing it as providing more options.
“I am not a believer in mandating by governments certain levels of coverage certain things that must be covered,” said Robert Wittke, Racine Unified School Board president and the Republican nominee for the 62nd Assembly District. “People struggle with the cost of health care now and as you mandate more coverage across the board it drives up the rates that are there.”
Wittke said “safety nets” should be in place for people who need mental health services but aren’t covered under their insurance, such as at schools where they could be available for young people.
Republican Robin Vos, Assembly speaker and 63rd District incumbent, sees the rule as a positive, allowing people to choose the coverage that fits their needs, whether its a more affordable plan or a plan at the “Cadillac” level of coverage.
“If you’re a 60-year-old couple with no children, you’re still going to buy pregnancy coverage — that’s the law (under the ACA),” said Vos. “What the Trump administration did was give a waiver to allow people to choose what kind of insurance fits their family the best.”
State Rep. Greta Neubauer, D-Racine, who represents the 66th Assembly District and is running unopposed in November, said these insurance plans don’t really offer a choice.
“We know who suffers when insurance is not expansive,” said Neubauer. “It’s usually not people who are making choices to not have access to that insurance — it’s people who literally cannot afford to take care of their family, afford their medication, afford the kinds of coaching or services that they need, therapy, psychiatry appointments, etc.”
Former state Sen. John Lehman, a Democrat who is running against Wittke for the 62nd District seat, spoke after Wittke and Vos and characterized the message given by the Republicans as “we’re not all in this together.”
“That doesn’t help society as a whole and it doesn’t help most people with mental illness,” said Lehman. “We need an attitude change, quite frankly, from my Republican friends that we’re all in this together.”
Medicaid expansion decision questioned
Democrat Lori Hawkins from Bristol, who is running against incumbent Van Wanggaard for the 21st Senate District seat, pointed out that mental health care is more expensive than other types of care in part because of the lack of providers. Wanggaard, R-Racine, did not attend Monday’s forum.
Even with the Mental Health Parity and Addictions Equality Act that was signed into law in 2008, many people with insurance report having difficulty finding in-network providers.
Hawkins also said that many mental health providers don’t accept BadgerCare, the state’s medical assistance program, in part because of the state’s decision not to accept Medicaid expansion funds under the ACA.
Wisconsin has one of the lowest Medicaid reimbursement rates in the region. Neubauer said that had the state accepted those funds, approximately $190 million a year, the state could have paid higher Medicare/Medicaid reimbursement rates which would have drawn more mental health providers to the state.
“We do have the resources, we’re just not prioritizing them towards these kinds of issues,” said Neubauer.
Democrat Joel Jacobsen of Burlington, who is running against Vos for the 63rd District seat, said: “I’m just going to reiterate the federal Medicaid dollars — it all starts there. Then you are going to start opening up other things in mental health care.”
Jacobsen also added that expanding mental health care can affect Wisconsin’s incarceration rate. “That is one of the things that I think is key to our moving Wisconsin forward,” Jacobsen said.