Governor’s budget plan cracks down on insurance companies and prescription price gouging, lowers out-of-pocket healthcare costs, aims to red
From a press release from the governor's office:
"Gov. Tony Evers... during his 2025-27 Biennial Budget Message, announced his 2025-27 Executive Budget will make sweeping changes to the healthcare industry in Wisconsin to address the frustrating challenges Wisconsinites face every day simply trying to get the healthcare they need.
Gov. Evers tonight announced several key initiatives to crack down on insurance companies and prescription price gouging; reduce appointment wait times and enable Wisconsinites to get care closer to home; lower out-of-pocket healthcare costs for medication and insulin; require health insurance companies to automatically cover more healthcare services and procedures with no delays and hassles; prevent surprise medical billing and reporting unpaid medical debt to collections and credit bureaus; and provides new hospital investments to improve healthcare access statewide, including in Wisconsin’s rural communities. As part of Gov. Evers’ comprehensive plan to lower costs for working families, he is also proposing to eliminate the sales tax on over-the-counter medications, which would save Wisconsinites a projected $70 million over the next two years.
Gov. Evers hears from Wisconsinites who feel like they are not getting a fair shake from the healthcare industry, especially their health insurers...
Gov. Evers is proposing solutions to address the frustrating challenges Wisconsinites face with sweeping changes to the healthcare industry in Wisconsin:
Gov. Evers is proposing to make Wisconsin the first state in America to start auditing insurance companies over denying Wisconsinites’ healthcare claims. If an insurance company is denying Wisconsinites’ claims too often, we’re going to audit them.
The governor also proposes creating an office that, for the first time in state history, would be devoted to helping Wisconsinites hold health insurers accountable and ensuring folks get the health insurance coverage they pay for.
Gov. Evers is proposing to create new standards to expand the healthcare services and procedures that insurance companies are required to cover. This means more healthcare services and procedures will be covered by Wisconsinites’ health insurance automatically—no delays, no hassle, no questions asked.
Gov. Evers is proposing to require health insurance companies to be more transparent with Wisconsinites up front and before Wisconsinites purchase their health plan. Under Gov. Evers’ plan, health insurance companies would have to tell Wisconsinites from the get-go which services and treatments will require prior approval so Wisconsinites can find a health plan that is right for them.
Wisconsinites should not have to wait weeks and months to get an appointment or have to travel long distances to get the care they need. The governor’s plan also helps to make sure Wisconsinites can get the healthcare they need when and where they need it—quicker and closer to home—by enabling the creation of statewide standards for maximum wait times for scheduling appointments. Gov. Evers also proposes to make sure the services healthcare insurance companies cover are available within a minimum time and distance of the Wisconsinite buying their health plan.
Gov. Evers also proposes cracking down on surprise medical bills and the healthcare industry sending unpaid medical bills to collections or reporting to credit bureaus. Gov. Evers’ plan would require health providers to give Wisconsinites notice of unpaid medical bills and would give Wisconsinites a six-month grace period by banning healthcare providers from reporting unpaid medical debt to collections or credit bureaus during that time.
No one should be in a mental health crisis wondering whether insurance will cover an in-patient stay to get help. Gov. Evers also proposes banning health insurance companies from requiring pre-approval for in-patient mental health services so Wisconsinites in crisis can be safe and get life-saving care."
As part of Gov. Evers’ plan to lower out-of-pocket costs for working families, make healthcare more affordable, and crack down on price gouging, Gov. Evers last month announced his “Less for Rx” plan to lower prescription drug prices, improve oversight of drug companies, and protect consumers from price gouging on their medications, including removing the sales tax on over-the-counter medications, which will result in a projected total of $70 million in annual savings, setting price ceilings for prescriptions, capping the cost of insulin copays to $35, and protecting Wisconsinites from price gouging on prescriptions."
-Press release from the office of the governor, via WisPolitics, February 18, 2025
