Politics of Public Health Part 3-BadgerCare Expansion with Lt Gov Sarah Rodriguez

Transcript

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The following is brought to you by the committee to protect healthcare.

Chris: 0:04

In the emergency department, we see real time consequences of people not having access to health care. Expansion of Medicaid in Wisconsin would mean less cases to the emergency department. It would prevent closures of hospitals in our communities, and most importantly, save lives. The majority of states in the country have expanded Medicaid with bipartisan support, yet legislators in Wisconsin are blocking expansion of Medicaid. They're blocking the opportunity for our patients to have a healthier life. Tell your legislator to save lives and pass Medicaid expansion. Now the 40th state to expand Medicaid under the Affordable Care Act. The bipartisan expansion, signed last month, comes after a decade of Republican resistance As John Yang reports, it will be life changing for some uninsured North Carolinians tucked away in a shopping center on Winston Salem's southwest side, non profit United Health Centers is a lifeline for patients. Across three locations it serves 6, 000 patients. Most are Black, Hispanic, or Latino. The nearly 80 percent of patients who don't have insurance pay on a sliding scale. In one place, patients can see a doctor, get prescriptions filled, and receive dental care. They can even enroll in Medicaid, the federal and state health insurance program for those with low incomes. Access to health care has been a challenge for low income residents of North Carolina, one of 11 states that hadn't expanded Medicaid under the Affordable Care Act. When it's implemented, the program will be open to families and individuals whose incomes are lower than 100, 000. 138 percent of the federal poverty line. about 20, 000 for an individual. Before expansion, most adults without children or a disability weren't eligible at all, no matter how low their income. Some Wisconsin doctors are calling on the Republican controlled legislature to expand BadgerCare in its special session tomorrow. Last week, Governor Evers called a special session to expand Medicaid. The bill would use nearly a billion dollars in federal stimulus money tied to expanding Medicaid on projects across the state. The governor says over 90, 000 Wisconsinites will gain coverage. Badger care expansion will mean fewer people have to go without health insurance affordable medication and care that improves their lives, Many Wisconsin residents cannot afford private insurance. Wisconsin Republicans say they will immediately gavel out of the I'm Assembly Speaker Robin Voss. Recently, Republicans on the Joint Committee on Finance removed Governor Eber's budget request to expand welfare in Wisconsin. There is no reason to expand Medicaid here BadgerCare covers people earning up to 100 percent of the federal poverty level. The bottom line is that everyone who wants insurance in our state already has access this is just another example of the disincentives that the governor is putting into getting people back to work, much like the enhanced unemployment benefits keeping people on the sidelines I'm Wisconsin's Lieutenant Governor Sarah Rodriguez, but long before I took office, I was a registered nurse. I served in the Peace Corps at the height of HIV AIDS and in Baltimore emergency rooms at the height of the heroin and gun violence epidemics. During the COVID pandemic, Wisconsin Republicans. Failed to protect our health. That's why I ran for office and flipped a red district blue. Because once a nurse, always a nurse. Welcome to pulse check, Wisconsin. Good morning. Good evening. Good afternoon. Whatever it may be for you. This is a Dr. Ford from pulse check, Wisconsin. And I want to thank you for. For joining us for our third and final part of our series on the politics. Of public health. We have a very. Special. Conclusion to the series here today. What we want to do is we want to emphasize some of the key topics. That are going to be top of ticket for a lot of folks here in the state of Wisconsin. And to be honest, a lot of the issues that we have. In the country. Focus around education focuses. Around the economy and it focuses around your healthcare. I've had the opportunity over the last couple of months to travel the country to Washington DC. And. Both here, state side as well. And talk to people about things. That are at the top of their priorities. And healthcare comes up over and over and over again. A lot of that has. To do with provisions of the affordable care act that recently have. pass and that are set to pass in 2025. And we have that to thank to the inflation reduction act. That recently was celebrated at Washington DC for a two year anniversary. This is going to be. A game-changer for a lot of people. Who. Previously had a hard time affording their medications or. Frankly could not afford their medications. I had the opportunity recently to go to the white house and. I listened to a couple of the stories from folks who were affected the most by.= The inflation reduction act. I spoke to folks. Folks who could retire or could. I could afford. Time to be with their families. Because they no longer had to work simply for their medications here's state side. The state of Wisconsin. An issue that is top of ticket for. Us here is our Medicaid expansion or Badger care expansion There was a recent discussion that. I was able to view. View back in January at the beginning of this year. That. Cover the matter of Badger care expansion to some of the benefits that. We would experience here instead of Wisconsin. Wisconsin. Of course being a part of the handful of states in the union that have. I have not expanded Medicaid. This lecture was. Really good at highlighting, not only the benefits of Badger care expansion, but also. How a bill becomes a law in the state of Wisconsin. So I'll link that. To our website. So everyone who is interested can take a look at it, but. But I'm also wanting to go directly to the source and to get. This person's perspective, who was the presenter? Because I felt she did. A really good job at breaking it down and distilling what we needed. To know, as both healthcare providers, as well as citizens throughout the state of Wisconsin. Consen and the tangible effects that expansion of Badger care would have on. On us all. As such, I am grateful to have on with us today Lieutenant governor Sarah Rodriguez. Sarah Rodriguez is our 46 Lieutenant governor in the state of Wisconsin. She is an ER nurse, a former healthcare executive who worked in various leadership. Leadership roles over the last 20 years. Prior to her becoming Lieutenant governor. She was an assembly member out of Waukesha. County. And during her time as. A state representative. She worked on the committees on health insurance energy and. Utilities science and technology and broadband. She brings to the role of Lieutenant governor. Leadership. From the healthcare perspective, as well as lived experience in. And what we're seeing in the emergency departments day in and day out, and some of the strains. Means that our patients are feeling. Not only in their pocket books, but. But in access to healthcare in general. And again, We are so proud to have her here and I hope you enjoy her interview. There were a lot. Of key topics that she discussed here and plans and going forward. So would that be inset?

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I wanted. Just you

Chris: 8:34

Lieutenant governor Sarah Rodriguez. Well. I did an intro for you at the very beginning for our listeners, but I want to thank you. We're very grateful to have you here, Lieutenant Governor. Um, can you just give us a little bit of a background of yourself, and then we'll get into some of the topic that we discussed today. Right. Perfect. So I am the Lieutenant Governor of Wisconsin, and I have been in this role for a year and a half. almost two years now. Pri in the assembly for two y a district that included Milwaukee County. Um, but worked in health care. I and have been doing publi Uh, so it's been a really interesting transition to work on public health in the community as well as now working in public policy. Even early on, I was a Peace Corps volunteer. I worked on HIV AIDS, reproductive health. This has been something that's been an interest of mine for my entire life. Yeah. And we, we truly appreciate everything that you do. I can speak for myself and my colleagues. That it's good to have someone who has been in the trenches with us to know what the problems are at the ground level and how to address it. And then you actually took the step forward in order to make that policy and help affect that change. Yeah, and I would say we need more clinicians in policy level positions because there are so many things that may have unintended consequences when people are making legislation or policies. And if you are not entrenched within the healthcare system, you're not always aware of what those issues might be. And so making sure we have physicians and other clinicians within within policy making positions is really, really important. And there's just not enough. Okay. Yeah, that's the truth, right? Mm-Hmm. And so, you know, one of the things that we open this, you know, podcast with is the most recent ad that we're doing, we're campaigning as a pac, you know, committee to protect healthcare in order to expand badger care. And so for a lot of people, we did a kind of a intro because this is the first time they're learning. There's a difference between BadgerCare, you know, Medicaid, you know, Medicare, things of that nature. One of the things that we wanted to talk to you about, because I saw a lecture that you gave at University of Wisconsin back in January and you kind of broke it down and I felt like it was good for healthcare providers and it would be good for our listeners as well. But could you explain a little bit about what BadgerCare expansion would mean and who would qualify? So within Wisconsin BadgerCare expansion would We cover working people, usually single people, at about 135 to 138 percent of poverty, depending on if there's what percentage Wisconsin decides to implement. And right now in Wisconsin, we cover folks up to 100 percent of poverty. So we did expand a little bit in terms of that expansion, but not to the Affordable Care Act's requirement. And what that means for Wisconsin is that we do not get federal matching funds. And so we would be able to save on your taxpayer dollars, my taxpayer dollars, about 1. 6 to about 2 billion dollars over the biennium that would just go to our bottom line. That we could invest in healthcare, we could invest in communities. And that doesn't even include some of, you know, the incentives that the federal government has to be able to ask states to expand BadgerCare or Medicaid. That would be almost another 2 billion dollars that we would be able to have. So it is, it's fiscally responsible to expand Medicaid here in Wisconsin, but it's also the right thing to do because we have folks that want to be able to take care of their diabetes, want to be able to take care of their high blood pressure, maybe even want to add a couple more hours that they're working. And they can't do that because they'll lose their coverage. And, and, you know, like I said, you walked the walk, ER nurse. And so I truly appreciate having another ER provider in the, in the office, but you know, what. What is the importance from what you've seen just as a practicing nurse, what would be the importance of patients that you say interacted with day to day in the emergency department? What would be those benefits? So you and I both know that sometimes people come in to the emergency department for primary care. Because they don't have any other option. They're not covered by any other type of insurance. They're not covered by anything that's going to help them. And so they come to the emergency department way sicker than they should be, and for primary care. So if we were able to expand Medicaid, if we were able to have those folks who would be able to see a primary care provider outside of the emergency department, we could catch those things. earlier, before they needed to be admitted, before it became a crisis, and we want to make sure that the emergency departments are truly treating emergencies. And I say this all the time, we will treat you when you come, but we are not a substitute for primary care. And we don't do it as well as those primary care offices do. You need follow up, you need somebody to monitor and help you with your medications. ERs are not, are not set up to do that. And so if we were able to expand. Medicaid here in Wisconsin. That would be a way that people could get that primary care outside of the emergency department and catch those illnesses a whole lot earlier before it becomes a crisis. Yeah. And exactly that. So I'm, as you can see, I'm getting ready to go in and a little bit to a shift. So, but I will guarantee you, I will see a cohort of patients that are just that, right. It's those exacerbations of those preventable conditions that have gone to extremists because Folks don't want to see me in the emergency department. They want to go to the primary doctor, but they don't have access to the medication that I have access to those appointments. One of the things that we talk about, that's one of the misconceptions is that when lobbying at the state level, at the federal level, folks think that this is an issue of just one cohort of the population, right? So this is just an issue that we're seeing in the overrun urban emergency departments. But there was a really good book that came out. It was called the politics of resentment that was done by Dr. Kramer, who's at. At University of Wisconsin that talked about how a lot of these issues are joined in both rural communities as well in Wisconsin. How would expanding BadgerCare impact those rural communities that you've seen or that you would see potentially? Well, if you look at many of our rural communities, the vast majority of folks do have Medicaid when they're coming through their hospital system. And if they do not have that expanded Medicaid, they're not getting reimbursed for the services that they're providing. And some of that comes out of charity care, some of that comes out of their bottom line. Uh, but if we were able to expand Medicaid, many of these rural hospitals would have an additional lifeline in terms of reimbursement that they are going to be able to stay in their communities. It is a crisis in rural healthcare right now. We have had hospitals closing all across Wisconsin and all across the nation. And one of the ways that we would be able to help with some of those rural hospitals and rural areas is to be able to expand Medicaid so they can get the reimbursement for the services that they're providing. Yeah. So just a general benefit for most low income families throughout the state of Wisconsin, this is what we're seeing. And this is some of the things that we talk about too. Like, you know, this goes hand in hand with lead poisoning, things like that. There are more similarities that we have, you know, as a community, as a state, uh, than, than divisions. And so it's really good that we highlight that. I agree. And to be clear, Wisconsin is only one of nine states that has not expanded. Medicaid or BadgerCare here in Wisconsin. So we have had red states, purple states, blue states, all expanding Medicaid or BadgerCare. And they've had really great results. And one of the statistics that I like to have, and it may have been in that presentation that I put out there, is that it doesn't affect healthcare. It also affects whether or not you're stable in your house. Right. And so evictions went down, um, when they expanded Medicaid. And they were able to look at that. People were able to add more hours to their day for working. Their, their wages went up. So these are real tangible economic effects when we take care of people's health. It has enormous implications all across the state for our economic value, for, for what we're, we're bringing here. And so, this is another way that I think we should be able to make that argument, that we should be taking care of people's health care so that they can better contribute to the economy, better contribute to their families, be more stable. And keep them out of the hospital where we know it's very expensive to treat them once they get to that spot. Right. And we had a former health commissioner, Jeanette Koalik that came on and she was famous for having the old moniker of, you know, housing is health, right? So if you have people that don't have the ability to have a roof over their head, ability to feed themselves, healthcare is going to come secondary to those things. If you want to feed your kids, if you want to keep a house stable. And so we're saying that this is going to take that, take that drain away from people that they can put those funds to think and work more days, et cetera. Right, right. It's absolutely true. The other thing that I wanted to mention is Wisconsin is now only one of two states that has not expanded BadgerCare or Medicaid for 12 months postpartum. Only one of two. Now that is shameful for me because you and I both know that You know, just having coverage for that very short period of time after somebody has a baby, it's just not enough. You see all sorts of complications in that year after someone has a child. And so we wanted to make sure that we are able to cover those 12 months. And Wisconsin's only one of two states that has not done that. And, and, you know, if we want to take care of families, if we want to take care of moms and babies, this is, this is a no brainer to me. We should be able to cover them for 12 months after they have a child. Absolutely. Like you said, that's the most dangerous portion of the postpartum state when you have women who are, you know, especially first time moms, you know, they don't have that PCP follow up. And I believe now it's only about 60 days after, after you deliver that you have that or somewhere around that range. 90 days, I believe. 90 days. 90 days. Yeah. Yeah. And that's it. And that is just, That's barely anything, right? I mean, I have two kids. They're 15 and 17. I mean, that's, that's the time you spend at home with them for the most part, if you can. And then you're back to, you're back to work. But, um, we know that there are complications after that. And so making sure that people have that coverage is, is very, very important. So I, I'm actually excited because we're going to have a very new legislature coming up this January and their hopes brings eternal, that they're going to look at this data. They're going to look at these economic impacts. And be able to not only pass the 12 month postpartum expansion, but also the overall expansion of, uh, BadgerCare here in Wisconsin. One of the things that is concerning a lot of people that I talked to about this, because after we did, you know, this, this, this commercial about, you know, the importance of expanding, a lot of people are concerned about how are they going to afford this, right? Like, is this going to be another tax on them? How can we as a state pay for this? Are there any funds that are coming from anywhere else? Could you explain kind of that federal kickback that we get as well as that incentive that we would get? So what happens is, is when we expand, there's a 90 percent match from the federal government. And so that's what I'm talking about when we expand. If we expanded from about 87 percent to 100 percent of poverty, uh, we would, we are not getting our 90 percent match there. So that's around 1. 6 to about 2 billion dollars over the biennium. And then what happens is, is that they have the incentives for, for folks to be able to expand for a period of time, and that's around 2 billion dollars to be able to do that. So there's all sorts of things we can do with those dollars. We could put money into prevention. We could increase reimbursement rates, which we know are a struggle out in, in certain communities and certain procedures, have very low reimbursement rates for BadgerCare. These are the kind of things that we could use these dollars for. And so, as of today, and it's, it's been over 10 years that this has been in place think about the dollars that we have missed over those 10 years. It's an enormous amount of money that we have been using. Our taxpayers are going. Our tax dollars are going to the federal government. It's going someplace else. It's not coming back to Wisconsin. And so, that's the kind of thing that we want to be able to use here. Have, have state tax dollars stay here in Wisconsin. Get that 90 percent match. So that we can be able to invest in our, in our communities. But there's just, there's so much we can, we can do with that. And one of the worries that I do hear for why we haven't expanded is that you know, the Affordable Care Act may go away, but it's been over 10 years and you've got, you know, red states, purple states, blue states that have implemented it and they've seen fantastic results. That's going to be really challenging to reverse, and we've had a Republican president. And it didn't get reversed the last time. So I I'm confident that we have created a system that's working well for states and that we're going to be able to have that 90 percent match going into the future. Yeah. And like you said, no, we've seen it work. Right. It works in the majority of our country. Right. And so like recently, North Carolina, they did, you know, the, the, the studies based on when, after they, they expanded their Medicaid and what they saw was, patients that went down to the single digits that now have, primary care doctors that didn't before, right. Mental health facilities were able to open up, which is huge, especially in the day and age that we live in now. And the paucity of mental health resources that we have throughout the country, right? Like that's something that we desperately need for, drug abuse programs, things of that nature. So these are things that are going to be tangible, not only for Wisconsin Aced out, but down the line for generations. Yeah, no, I absolutely agree. And so, I mean, that is one of the things, and we know it's popular in Wisconsin. When we survey people, over 60 percent of individuals want us to bring those dollars home. They want us to expand BadgerCare here in Wisconsin. Um, and so, it has been very frustrating for me, as Lieutenant Governor, but also when I was in the Assembly, to not even be able to get a hearing on it. Not even be able to have the conversation about it, because let's have that conversation. Let's talk about the benefits of this, let's address some of the concerns, but at least let's have that back and forth to be able to talk about how we can expand BadgerCare here in Wisconsin that meets the needs of the community, because the community members Um, and we should be responsive to what our constituents need and want. And that was a good segue. Cause I was going to say, you want it. I want it. Majority of Wisconsinites want it. Let's do it. Right. So what are the main political and legislative to expanding BadgerCare in Wisconsin? So we have had a Republican led legislature for many years now, over 10 years, and they have been unwilling to put this to a vote. They've been unwilling to even bring it to committee. So people don't know how the process works in Wisconsin. So when I was in the assembly, I was, One of the authors of the, the Medicaid or BadgerCare expansion within the state of Wisconsin. And so we had co authors on there. We had people who are signing up saying, yes, they support this. And then what happens is it needs to go to a committee, usually something like the health committee, which is what I was on. But the leader of the assembly or the leader of the Senate are the ones who decide where those, where that legislation goes. And then the heads of the committees, which are, if you are in. Republican control, then they, it's a Republican head of the committee, decides whether or not to bring it to the committee. And it has never been brought to a committee. Um, and so it's never been on the docket. It's never been discussed. It's never been happening. And then in that committee session, you talk about things, maybe there's an amendment and this happens. So not even that has ever happened with with Medicaid expansion or BadgerCare expansion. And then, let's say, by a miracle, it gets through the committee, the committee votes on it, and it goes to the floor. Then, the head, again, of the Assembly and the Senate decides whether to bring that legislation to a vote. So there's another barrier in terms of being able to actually vote on that within the entire legislative body. Again, it's never been brought to the floor. We've tried a couple of times to substitute the legislation on other bills, but it, it, it never has been able to, to come for a vote. So that's very, very frustrating. And then what happens is, is that, okay, let's say it does come to the assembly or the Senate, Then that piece of legislation has to be matched between the Senate and the Assembly before it goes to the governor to sign. So we haven't even gotten through step one, right? But maybe step one, step one is writing the legislation. So we've got to step one, but we've never been able to get it past that. And so what I'm really excited about is, if your listeners don't know, is that we were able to pass fair maps legislation this last legislative cycle. Yes, so exciting. We are a purple state. We are, right? We are about evenly split between Republicans and Democrats in terms of what we do for statewide. So the governor and I won with about three percentage points of, of, you know, just over, little over three percentage points. However, right now, before this new legislative session starts, right now we have a super majority of Republicans in the Senate and almost a super majority of Republicans in the Assembly. Like you ask any normal person who can do math, That doesn't make sense, right? It doesn't make sense. It should be split about 50 50, and every once in a while it's Democratic control, and every once in a while it's Republican control. But that's not what it looks like today. But now that we have these new maps we are going to have a whole lot more purple districts. Purple districts like the one I represented, and I live in Waukesha County. There will be an incentive to work across the aisle to be able to get this type of legislation. That community members want these legislators are now going to have to be more responsive to their constituents than they've had to be in the past. And so I hope springs eternal that we're going to be able to get this across the finish line. The governor is included in every single budget he's had to do it and it gets stripped out every time. Um, but that's why I think it's so important that we not only vote for the top of the ticket, but we vote all the way down, making sure that those individuals who are representing you match your values in terms of what you want to see, ask them, are they willing to expand BadgerCare if that's one of the top issues that you have. Yeah, and you know, I will be doing this is a part of a three part special for the politics of public health. I will be doing a MAPS one coming up. I think it's just the two years that I spent doing it with the People's MAPS Commission. Let's just give it a little break here. But, but, but no, it's so true, right? You know, we talked about during all of our hearings in each congressional district, how having that competitiveness, having that responsiveness, that power of the voters in order for to make that decision for their elected on vice versa. And so, you know, we're seeing now for the first time, potentially that, you know, the voters will have a say. And this is something that is top of the ticket for a lot of people, you know, reproductive rights, which is our second part of this series is one of it as well, you know, there are a lot of issues that folks who are on the ticket will now, no longer have a safe seat, no matter what, their constituents say, and we need to continue to push that and say to Wisconsin. No, I absolutely agree. And we have to make sure that we continue to have these, these fair maps that we continue to have something that represents the community. Because there's a whole lot of other things that people want to be able to see if you ask them about public education. They want to make sure we're fully funding public education. You know, if we ask them about clean water, clean air. They want to see that we're cleaning up the PFAS in the water. This is, you know, a high percentage of folks want us to do these types of things. And so, if we're able to, and you talked about reproductive rights, again, over 60 percent of individuals within the state of Wisconsin want us to codify something like Roe in, you know, in the state. And so, we should be responsive to that. We should make sure that we are listening to our constituents and that we do what they, what, what they want us to do. Yeah. I'm going to play devil's advocate here. And I'm going to have you put yourself in the shoes of, the folks that are really against, the expansion of badger care folks in the legislative majority, what, what do you think is their position? Like, why is this something that outside of political realm that they're, they're, they're vehemently opposed to? So, and I will say what I have heard on the floor, okay? So when I was in the assembly, what I would hear on the floor in terms of the opposition. There's two, two different rationales that I have heard. One is fiscal. And the other is philosophical. So the fiscal argument against BadgerCare expansion is what I had mentioned before. They're worried that it's going to be overturned. They're worried that that 90 percent match is no longer going to be available to states. And now we're on the hook for the full bill. So again, my argument to that is that it's been over 10 years. And it has not happened. And so this is something that we have baked into healthcare here in, you know, here in the United States. So I, I'm not as concerned about that in terms of not having that, that match moving forward. The second is philosophical. What is the role of government? It's the role of government to provide a safety net for individuals who are vulnerable. In my opinion, it is. It is. It's the role of government to be able to provide that safety net in terms of healthcare if they're not able to afford it on their own. And I want to remind your listeners, these are people who are working. They just don't make enough money to be able to afford the health care and their health insurance. So expensive for them. Um, and so the philosophical issue is, is that this is a form of welfare, which is what I've heard in the past, and that we do not want to expand welfare in Wisconsin. But as you and I both know, so many people end up on BadgerCare, um, within part of their lives. And I'll tell you a story about that. So my father, he, um, He is a veteran. He served during Vietnam, um, worked every day of his life worked the Friday before he got diagnosed with Alzheimer's on that Monday in his 60s. So, and you and I both know that dementia or, or those types of issues is just a suck on family's finances, particularly when he was diagnosed so early. And so he was on BadgerCare at the end of his life. And it was a blessing to our family to know that he was covered, that it wasn't going to be financially ruinous for us to be able to take care of him at the end of his life. And so I say to that, is that what you're calling welfare? Or, is it taking care of the most vulnerable members of our community who have made that social contract, who have done what they've needed to do, and yet have fallen on some harder times. So, this is, this is something that I, I talk about a lot, and I, and I tell people that he was on, a proud man, was on BadgerCare at the end of his life, because that's what he needed to be able to have him being taken care of. Yeah, and like you said, so many Wisconsinites have that same story. We just recently had the opportunity to go to the White House where they did the celebration of the Inflation Reduction Act. And you know, I got to sit down with, you know, the head of the CDC and, the head of CMS, et cetera. And we heard some of these stories from, from folks all around the country who, now are able to see their grandkids, right? Because they can afford their medications and they can afford a bus ticket or a plane ticket. They could afford to retire, right? Because, they can now afford their medications because their insulin was kept, right? And so, all these, all these programs, Medicare, Medicaid, BadgerCare here in the state of Wisconsin, as being seen as this form of, of, of welfare is just It's it's fodder, And so I guarantee you someone that you know and someone that you love will be affected by the expansion of these programs and I can tell you as a provider and I'm sure the Lieutenant Governor can tell you as well, we see patients or we saw patients every day that that were affected by these and could have had changed and could not have presented to the emergency department in this term that they did based on if they had this funding available, right? And I think you might be a little younger than me. But I, I remember pre ACA, right, of when taking care of individuals who weren't able to get that type of coverage on the individual market. And I can remember this woman vividly who came in with chest pain because she was unable to afford her antihypertensive medication because she had recently been laid off. It was part of the recession. It was pre ACA. She had been laid off. She worked as an admin assistant for years and she was 62 years old. So Josh just had to make it just short of Medicare, and so she was, she was just short of Medicare, 62 years old, very difficult to find another job on that. They offered her Cobra, right? Which is when you leave, they offer you insurance, but you have to pay the full price of that. This is a woman who wasn't making that much money and to try to pay 1, 000, 1, 500 a month To be able to, to get something that was very little coverage, she wasn't able to do it. And so here we had, she had to be admitted to the hospital because of that. Now here we've got somebody who now we are, she can't afford that hospital bill either. So where is, where is that, we are paying for it either now on the front end and we're paying less. Or we're going to pay for it on the back end as, as our communities, because people can't get the care that they need. And so that was a very expensive admission. She was in there first for quite some time because she had all sorts of other things wrong with her because she didn't have the medication that she needed. And so our community is going to be paying for that because we didn't cover her on the front end and to be able to keep that continuity of care going. Yeah. And you know, I, I, I, I also had to go on COBRA for a very short amount of time right after residency, sorry, before residency, right after medical school. And it was two or 3, 000. Like, I don't know who can afford that. Right. And especially the coverage, it has gaps, et cetera, et cetera. So this is something that is not tangible for a lot of the patients that we see, especially those, you know, the majority of which do not want to come to the emergency department. They don't want to be there. Right. And I think that's the other misnomer that a lot of people think, right? Like, Oh, they're just a drain to the society. They're going to the emergency department for their primary care. They don't want to. I have yet to meet anybody that wants to do that. I have yet to meet anybody that wants to do it either. I mean, they would much rather have their needs taken care of in in a more proactive way. And so we have an opportunity here in Wisconsin to be able to live our values. And do we take care of people who are vulnerable? Do we take care of people who need the healthcare to be able to continue working? To be able to take care of their families? Or do we not? And I'm, this is why I'm looking forward to a new legislature in January, and, and it's, there's a, it's almost a, there are so many people who have left and are coming in new, it's, it's almost a full new legislature, that I'm really hopeful that we're going to be able to get this across the finish line, and all of these other types of, of healthcare needs. that we have in Wisconsin to be able to really have that type of conversation about how we want to be able to take care of people. Yeah. So we talk about the legislator. The other aspect are insurance companies, right? Large insurance companies and other stakeholders that play a role in, the debate over radical expansion. What role do you think that they play in the grand scheme of things? And how does that affect people day to day trying to get access to health? Well, you have folks who are on the individual market in other states. So those larger health insurance companies are in other states on the individual market offering plans through the ACA. So, depending on, I'm not going to speak for the insurance companies but depending on the insurance company, they may be supportive of, of having this go through if they have products that they would like to be able to offer on the, on the market. So it, it could be a mixed, a mixed bag for that, it, depending on where those insurance companies are. What market that they're in but we haven't had a big pushback from a lot of the larger insurance companies on on expansion. So some of them are quite supportive. Some of them are neutral and and I imagine some of them are are against the legislation. But it's it's not you know, kind of what we're seeing today. So I I do think that that it truly is pro a problem we can solve, right? We're gonna have mm-hmm, almost$4 billion to be able to solve the concerns that people have about expansion within the state of Wisconsin. And I've talked to a multitude of, of, of, you know, healthcare systems. I've talked to a multitude of long-term care companies. All of these other things. We just had a healthcare workforce task force. Mm-Hmm. This was a recommendation that came out of the task force. To say we should be expanding badger care and that included just a wide range of folks all across the state providers themselves dental health care systems long term care home care all sorts of Folks they see the value in being able to expand and bring those dollars home Because they know then we can invest in the workforce They know that we can invest in mental health like you're talking about we can raise reimbursement rates to help people Particularly some of those rural hospitals out. That's the kind of stuff that you're going to be able to see across Wisconsin. Yeah, and we had Governor Evers on in season one and and that was right around the time that you know The healthcare task force came out and I sung your praises at that time I said, you know, I can't think of anybody else that I would want in charge of that but I'm glad that you brought that up and I'm glad that you're you know, you guys are discussing that because Yeah, just to harken back to season one, you know, this is a multidisciplinary task force that is addressing or looking to address some of the issues that we're seeing in Wisconsin regarding health care, health care policy, the nursing shorters, et cetera, et cetera. And we have lieutenant governor. Thank for that. Yeah, well, it was it was actually I really enjoyed it. I really enjoyed helping run that task force, getting people's opinions, and I, my charge to everybody there is I wanted to make sure that whatever we suggested was doable. And not only did we have interventions that are going to cost us some dollars if we want to be able to incentivize people. folks to go into health care, uh, but we also have the BadgerCare expansion, which is, it's revenue generating. And so we're going to be able to have some dollars coming in the door, too, to be able to help pay for some of these types of investments that we have. Um, and, and so that's what I really, really liked about that task force is to be able to have some real tangible solutions of how we get people into the health care, um, And how do we keep them there? Because I, you know, you were, you were, um, you know, during COVID you were, you were there as an emergency room physician. You saw the burnout of what happened during that time. I talked to a lot of my old colleagues and nurses left in droves after that, because of how exhausting it was. And so making sure that they, And I love this statistic. So they do all they do these, um, surveys of specifically of nurses, but I imagine it would be the same for other healthcare providers. Um, they ask them what they want, like what they want to be able to have satisfaction in their job. Like what are the dissatisfiers? The number one thing for nurses is to feel safe on the job. And when I say safe, it means they want to be able to safely take care of their patients. They don't want to be overwhelmed. They don't want to be understaffed. Um, you would think pay would be number one because I think what you're paying for is a little more too. But it's not. It's not. It is being able to safely take care of patients. Because you don't necessarily go into this profession to be a billionaire, right? You go into this profession because you want to take care of people. And so that is something that if we are able to have the entire workforce Um, and, and recruit people for the entire team. Everybody is going to have a better experience on the job, and we're going to be able to retain clinicians in Wisconsin. Absolutely. And the price of, you know, knowing that you're stretched or the price of knowing that you're not providing the best care that you can in the setting that you have too many patients or you feel like you don't have the resources that drains a career, right? And you can do it for a finite amount of time. And you know, we're all in healthcare and we're all type a personalities, right? And so we're going to do what we got to do in order to get our patients. Right. But. That wears down on you, and unfortunately it's insidious and you don't know it until it's too late, right? Well, and I've said this all the time, I can vividly remember the panic in the pit of my stomach when I had one more patient wheeled in. And I wasn't sure I was going to be able to take care of them the way that I wanted to be able to take care of them. And that didn't happen all the time when I was working, but I can't imagine, and I wasn't working clinically during COVID, I can't imagine what that was like for, you know, a year on end to have just one more patient coming in. And having that panic in the pit of your stomach saying, How am I going to do this? How am I going to stretch myself thin enough to be able to give care the way that these patients deserve? And so I put my hats off to you on what you have done during that time. I know how difficult that was. And all the clinicians that have worked during that time. Thank you so much. So our listeners here are, you know, always asking, what can they do, right? What, how can they support the expansion of BadgerCare? There's some smaller elections that are coming up. I don't know if you heard about them, but But outside of those efforts, how can, how can folks help out to, you know, these efforts to expand BadgerCare? So I, you know, yes, there are elections coming up and yes, you have to make sure that you're voting for people who represent your values. You have to make sure of that. But secondly, reaching out to your legislatures is a really important thing to do. Um, make, so that they know, even if you think they're supportive. So I would read everything that came in to me. I, and we would keep tallies on that. We would say, okay, like who's coming in and saying that they're supportive of this piece of legislation and who's saying that they're not. And so even if you think your legislator is supportive, Reach out, email, call, do something. The other thing that I recommend is to do, like what you're doing, is work with your professional organization or another organization that's doing some lobbying. Um, or not lobbying, or I don't know if lobbying is that, advocacy. There we go. Lobbying is a very specific word. I don't want to use that. For advocacy, To say, you know, because it's easier for me to come into my office It's it's challenging for me to meet with every single person, but I can meet with the medical association I can meet with a group of people who have some policy priorities That that is easier for me as lieutenant governor to be able to do that. So it's going to be easier for the legislators as well. So trying to coordinate with whatever, um, professional organization you have to be able to do that advocacy I think is really important too. So keep on the lookout for that. To be able to say, hey, how can I be helpful here? Can I bring stories? Because at the end of the day, um, legislators are people. And you and I, you said we're type A, so we really like data, right? We do. So, we love data. And I love making decisions based on data, right? We are in the minority, my friend. So, most people make decisions on how they feel. And the way to show what the impact of BadgerCare expansion would be is to tell a story. So I told you the story about my dad, right? That's, that is a personal story from me about how BadgerCare or Medicaid affected my family. You as all your clinicians have stories like that, whether they're personal or personal. or they're from their patients about what this would do for your patients, what this would do for your community. And telling those stories, I think is really important. Yeah. And I feel like a lot of people, you know, and it's, it's with good attention, right? A lot of people, they get bared down with a lot of, you know, The negativity that they hear, you know, the news, et cetera, et cetera. But you would be surprised, these events, Doctor's Day, right? You know, just reaching out to some of your representatives, these folks are extremely tangible, right? Especially at the state level, right? So like, if you're reaching out, if you're attending these events, they are always looking for those stories, You'll be surprised how many folks that I know. They ended up on the legislative floor, to tell these stories, because this is what we need to hear. So this is the time to speak up. This is the time to provide that context because, you're advocating not only for yourself, for your patients, you're advocating for your communities. And that could be the change. That could be the one story that turns this whole thing upside down. Right. And I absolutely agree. And I always like to say, you know, legislators are people too. Right? We are people. And so there might be something within that legislator's background that will hit. One of those stories might remind them of something in their own personal life. And then you can sway an opinion that way. So that's what I think is really important. Now, always have the data in your back pocket. You're always. Always. Always. Having those stories is so important. And, um, knowing that your clinicians are on the front line, seeing this day in and day out is really, really important. So let's say to go, but we're going to close out here. Cause I want to make sure that we leave you time. Uh, I know you're busy, any closing thoughts that you have for our listeners. So I would say that your vote is your voice. And making sure that you know if you're registered, check it online, you can. You can also register the day of voting. So make sure that you know that. And look, look to see, do the research on the candidates that are out there and see where they stand on some of these things. Make a call. See what happens there. And then make sure that you're connecting with those advocacy groups that again reflect your values so that you can bring your voice to some of these arguments. It's really, really important. And last thing, consider running for office. Yes. Absolutely. And we need more. We need more. All right. Lieutenant Gary, I appreciate you so much. We are grateful for you making the time and thank you for all the data. I'll post a couple of videos that you've done already to go a little bit more into how a bill becomes a law, especially in the state of Wisconsin, and we'll be in touch. Thank you so much. Thank you so much for having me. I appreciate it. Absolutely. BadgerCare plus is the. Largest Medicaid program in the state of Wisconsin. And it's estimated. To provide healthcare insurance to more than 900,000. Low-income residents in the city of Wisconsin. More than half of. I'm being children. Expansion of Badger care would. I would add as many as 90,000 people to the program that are not. Currently at it. And as Lieutenant governor, Sarah Rodriguez. Has mentioned it would unlock additional federal funding. That. It is currently being held up at the federal level. We are wasting tax. Dollars we're leaving money on the table. It's estimated. At$1.7 billion. In savings would. Be garnered from expansion of Badger care. In the state of Wisconsin. And being an emergency medicine doctor on. The ground level of health care. This would be invaluable. Double for our patients. We not only have strains in the emergency department. In terms of the cares that we can provide folks, especially. When they have been without primary care for so long and without those Medicaid. Occasions that they typically would otherwise take if they had access to them or. Or had access to primary care in general. But we're also in a. Mental health shortage as well. We don't have. A number of facilities in. The state. In order to provide mental health for all the patients that. I need it when they come to the emergency department. At the worst. Time. Of their crisis. We'll see. The use of these funds for things like Drug treatment programs as well for folks. Who are affected by. The disease process. That is substance abuse addiction. You'll hear a lot in the upcoming. Upcoming days as I record this I think we're 10 days out now from the national election. So you're going. To see. A ton of ads on TV pointing a finger. One way or the other. Uh, in terms of who is at fault. For things like the fitness crisis who's at fault for. Crime, et cetera, et cetera. In the state of Wisconsin and throughout. The country. However, what I would challenge everyone. Who's listening to this recording to do. Is to do your own research. The point of. This podcast is to provide. And you that information and to provide you information straight from the sources. From experts such as Lieutenant governor, Rodriguez. And other. Experts that we've had on over the last several months. In order to. Help you make your own healthcare decisions and help you make your own decisions. When you are trying to choose. Who is going to represent. You. At a state and at a federal level. A lot of the work that I've done over the years has been to promote. Your ability to do that. To make it so that. Your vote counts and that you are choosing your representatives and not the other way. Around, as we mentioned during the interview. I would challenge everyone who has listened to this. Not only to vote your heart vote, which, you know, Would help your communities, your opinion matters regardless. Make. Sure that you are exercising your civic ability to the best of your abilities. Again, we are 10 days out from. The national elections. But as we said before, They're local elections are going to be the ones that are going to affect you the most. Most. And some districts, we have assembly district. Elections coming up. We have Senate district elections coming up as well. And I cannot emphasize more. The need for you to vote in. In this election, I cannot emphasize how this election is going to. Have longstanding. repercussions. On your health and your wellness of your communities. So, if you haven't created a plan to vote early, voting has started. And the state of Wisconsin October 22nd. Be sure. That you do. So be sure that you take the information that you've gained from this. Series. And do some further research on the candidates that are. On the top it is imperative that you're not only. Make sure that you're registered to vote. But make sure that you are getting your family members to vote, make sure you're getting your friends to vote. Because, regardless of again, how you vote. Doing. Doing so. Is going to affect your health in the long run. The time. To listen to this series. Think. Lieutenant governor Sarah Rodriguez for joining us today. We will start back up. Again, pretty soon. With our regularly scheduled program. We got some really good interviews coming up. That are going to cover. A broad spectrum of things that are gonna affect you and it gonna affect your health. In the city of Milwaukee and instead of Wisconsin, So would that be inset?

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as always take care of yourselves, take care of each other. And if you need me. Come and see me.