Health & Human Services

Wisconsin Senate Passes Bill to Require Insurers to Cover Oral Chemotherapy

by | April 2, 2014
 

By Patrick Marley and Jason Stein

Cancer patients taking chemotherapy pills could see their costs ease under a bill approved by the Senate Tuesday amid a hectic final day of work this year.

Senators passed the bill on a bipartisan vote of 26-7, with 16 Republicans and 10 Democrats supporting the measure and five Democrats and one Republican opposing it because they didn't believe it went far enough. In addition to those no votes, Sen. Leah Vukmir (R-Wauwatosa) voted against the measure because she opposed putting what she sees as state mandates on insurers. The measure now goes to Gov. Scott Walker, who has said he will sign it.

Among the scores of proposals, senators also are poised to approve bills providing independentreviews when people die in police custody; setting up a new program for handling emergency mental health detentions in Milwaukee County; and tweaking the state's new law that will require police next year to take DNA from felony suspects at arrest instead of conviction.

All those measures -- as well as a host of others that senators will take up Tuesday -- already have passed the Assembly. If the Senate approves the legislation as expected, the bills will next go to Walker for his approval.

Tuesday marks the last day of the regular session for the Senate this year and likely for the Legislature as a whole. Four state senators will give their last floor speech in long careers Tuesday -- Dale Schultz (R-Richland Center), Bob Jauch (D-Poplar) and Tim Cullen (D-Janesville) are all retiring and John Lehman (D-Racine) is running for lieutenant governor.

Lawmakers are not expected to come back again until next year, though some have said they may return if courts do not reinstate Wisconsin's voter ID law or if the Assembly decides to to expel Rep. Bill Kramer (R-Waukesha), who is accused of sexually assaulting a woman in 2011 and groping a legislative aide at a recent fundraiser.

Here's a look at the bills the Senate was working through Tuesday: --Oral chemotherapy. The bill on oral chemotherapy appeared dead just three weeks ago, with legislative leaders taking arcane procedural steps to prevent the measure from coming to the floor. At one stage, Senate Majority Leader Scott Fitzgerald (R-Juneau) arranged a phantom hearing on the bill so supporters couldn't force the bill to the floor when a public hearing was on the books, even though Fitzgerald never intended to hold it.

As public pressure mounted, though, the Senate on March 18 passed the bill 30-2. The bill would require insurers to cover oral chemotherapy the same way they cover chemotherapy administered through IVs at hospitals or clinics. The Assembly followed suit on March 21, passing it 75-18 but conservatives such as Assembly Speaker Robin Vos (R-Rochester) pushed to scale it back to allow insurers to charge patients up to $100 a month for chemotherapy pills.

The $100 cap would be allowed to increase each year at the rate of inflation. People with high-deductible plans would still have to fulfill those large deductibles before the cap would apply. Because of those changes, senators had to revisit the matter Tuesday.

Cullen, a former insurance executive and cancer survivor, sharply criticized the Assembly amendment, saying that it greatly weakened protections in the bill for cancer patients.

Cullen said that the language in the Assembly amendment didn't mirror laws in other states such as Missouri, Louisiana and Florida as the amendment's supporters have claimed. The amendment, for instance, lacks protections present in the laws of those other states to explicitly prohibit other patient costs in addition to the copay, such as coinsurance, Cullen said.

In addition, Cullen also questioned patients taking a so-called "cocktail" of multiple chemotherapy pills could have to pay a $100 per month copay for each one.

"Who put this bill together? Where did it come from?" Cullen said. "What bothers me is not only is the Assembly bullying us, they're bullying the (patient) advocacy groups...It's a giveaway to the insurance industry."

A memo from the Office of the Commissioner of Insurance, however, said that in enforcing the law, the agency would limit patient costs in insurance plans to either the same as traditional chemotherapy or to a flat $100 copay each month. Sen. Alberta Darling (R-River Hills), the measure's lead sponsor, said that memo gives advocates for cancer patient some comfort.

"Look, I'm not happy with this amendment. I like our bill a lot better," Darling said. "But the amendment that (the Assembly) put in, I'm happy we got that far."

Darling said that rejecting the bill now would risk that the Assembly would not come back to deal with it and the proposal would die altogether.

--Doctor apologies. Apologies and other statements of contrition could not be used as evidence against doctors in lawsuits and other proceedings under a bill the Senate passed on a mostly party-line vote of 19-14.

Democratic Sens. Tim Cullen of Janesville and Kathleen Vinehout of Alma joined most Republicans in voting for the bill, while Republican Sen. Glenn Grothman of West Bend voted against the measure.

The Assembly approved the measure, which doctors have sought for years, in February on a voice vote and it now goes to Walker.

Democrats argued the measure went too far, providing protections for doctors even when they admitted they were at fault for medical errors.

"So the doctor says...'I'm sorry, I made a mistake...I amputated the wrong thing.' ... Why would we find that that's OK?" said Sen. Lena Taylor (D-Milwaukee).

But Sen. Leah Vukmir (R-Wauwatosa), a nurse practitioner and co-sponsor of the bill, said the measure would allow doctors to provide details about incidents at a time when they need to be comforted.

"The reason that professionals zip their lips is that they're afraid of being sued," she said. "But at these difficult times people want, need and deserve compassion."

--Cannabis oil. A marijuana byproduct could be used as a potential treatment for seizures in children under a bill the Senate plans to take up.

The proposal is significantly different from efforts in other states to legalize marijuana, or to permit the sale of so-called medical marijuana. The substance in this case, cannabis oil, won't actually make users high because it's extremely low in THC, the chemical agent that produces that effect.

Lawmakers who support the measure were swayed by emotional stories from parents whose children are suffering from uncontrolled seizures.

The parents include Amylynne Santiago Volker, whose son, Nic, was the subject of the Journal Sentinel's Pulitzer Prize-winning series of articles "One in a Billion" in 2010. He has an intractable seizure disorder -- a side effect of the treatment that saved his life -- and averages about 100 seizures a day.

Under the bill, cannabis oil also would be administered under the care of a doctor as an experimental treatment for children whose frequent seizures can't be controlled by other means.

The federal Food and Drug Administration would have to approve a research drug permit for a physician prescribing the substance; also the oil extract could be dispensed only by physicians and pharmacies who had been approved by the state Controlled Substances Board.

The Assembly approved the measure last month on a voice vote. --Credit card debt. Private-label credit card companies would receive state refunds for bad consumer debt on their sales taxes paid, under a bill that narrowly passed and didn't fall strictly along party lines.

The measure passed 19-14, with most Republicans for it and most Democrats against it. Four Democrats -- Jauch, Vinehout, Jennifer Shilling of La Crosse and Senate Minority Leader Chris Larson of Milwaukee -- voted for the bill, while three Republicans -- Schultz, Rob Cowles of Allouez and Sheila Harsdorf of River Falls -- voted against it.

The bill would reduce state sales taxes by $12 million through June 2015, according to the nonpartisan Legislative Fiscal Bureau. Supporters say retailers with their own banks can already receive these refunds. The bill would help certain Wisconsin-based retailers such as Kohl's and Menards that contract with outside lenders for their store credit cards, they say.

"It's an issue of fairness," Jauch said in an interview. "They should be getting reimbursement for it. There's no excuse that they're not."

The fiscal bureau has found that few other states allow for these refunds and that the bill would violate certain provisions of a streamlined sales tax agreement between different states. That could prompt some out-of-state companies to stop voluntarily collecting another $4 million a year in state sales taxes, the agency said.

--Drones. Police and private individuals would be barred from using drones equipped with cameras to intrude on people's privacy under a bill passed by the Senate on a voice vote. The measure now goes to Walker.

The bill would sharply reduce the ability of police to use evidence from unmanned aircraft in court, requiring a search warrant unless the drone is being used in a public place.

Other exceptions to the search warrant requirement include active search and rescue efforts, pursuit of an escaped prisoner or an urgent threat to a person or evidence.

The Senate approved the bill in February, but the Assembly changed it in March to say material gathered from drones could not be used in instances where people had a reasonable expectation of privacy. --Restitution. The Senate unanimously approved paying $90,000 to Robert Lee Stinson, who spent 23 years in prison for a rape and murder he didn't commit.

The Senate in November unanimously approved giving him $136,000, but the Assembly last month instead decided to give him the lower figure. The Senate then had to return to the measure.

If approved by Walker, the $90,000 payment would come on top of a $25,000 Stinson received from the state Claims Board.

--Wedding officiants. Those performing weddings would have to be at least 18 under another bill the Senate signed off on with a voice vote.

People younger than 18 do sometimes perform weddings now, lawmakers have been told, and they are trying to plug what they say is a loophole.

The bill is a response to people's use of Internet for ordination so that they can preside over weddings. The Assembly approved it in February on a voice vote.

Fond du Lac County Clerk Lisa Freiberg testified before an Assembly committee in February, telling lawmakers 24% of the 540 marriages licensed in her county in 2013 were conducted by ministers with online credentials.

The Wisconsin County Clerks Association, which pushed for the bill, says having children handling weddings erodes the institution of marriage.

--Milwaukee County treasurer. The Senate likely killed a measure that would turn Milwaukee County's currently elected post of treasurer into an appointed position.

The proposal has had bipartisan support, with Milwaukee County Treasurer Dan Diliberti backing the move. But Sen. Tim Carpenter (D-Milwaukee) -- a co-sponsor of the plan -- pushed through changes to the proposal Tuesday that almost certainly doom its chances of taking effect.

Diliberti had been pushing for the change for several years and has argued that the county's $1.3 billion budget should be overseen by a skilled professional -- not the most electable candidate.

The measure calls for the Milwaukee County Board to decide whether to elect or appoint the treasurer's position, which pays $83,800 a year. The treasurer is already an administrative position with no voting authority or ability to make policy.

The proposal would require a change to the state constitution. To amend the constitution, legislators would need to pass identical resolutions this session and again in the session that starts next year; then, voters would have to approve the idea in a statewide referendum.

The Assembly took the first step to do that in February, approving the plan 88-9. But Carpenter offered a change to the resolution on Tuesday that would allow Milwaukee County to decide whether to make the treasure's job elected or appointed, but prevent the Legislature from making that determination once the constitution had been changed.

The Senate went along with Carpenter's changes, but the Assembly has already ended its legislative session for the year, meaning it is unlikely to agree to the new version of the proposal. Unless the Assembly makes a surprise decision to revisit the issue, supporters of changing the constitution would have to start from scratch next session.

Lee Bergquist of the Milwaukee Journal Sentinel staff in Milwaukee contributed to this report.

(c)2014 the Milwaukee Journal Sentinel

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