Governor Tony Evers plans to audit insurance companies to tackle claim denials, aiming to reduce healthcare costs and improve accessibility in Wisconsin.
Groundbreaking Healthcare Reform Initiative
In a landmark announcement on February 19, 2025, Governor Tony Evers unveiled a comprehensive healthcare reform package as part of the 2025-27 Executive Budget, positioning Wisconsin to become the first state to systematically audit insurance companies over healthcare claim denials [1]. This pioneering initiative comes amid growing concerns about healthcare accessibility and affordability, with the proposed reforms projected to save Wisconsin residents approximately $70 million over the next two years through various cost-reduction measures [1][3].
Comprehensive Oversight and Consumer Protection
The governor’s plan includes establishing a dedicated consumer protection office to assist Wisconsinites with denied insurance claims [1]. This unprecedented move responds to alarming healthcare access issues, supported by American Medical Association data showing that over 90% of physicians report unnecessary care delays due to prior authorizations, with approximately 25% noting serious adverse health events resulting from these delays [1]. The reform package also introduces strict standards for insurance companies, requiring transparency in coverage decisions and implementing maximum wait times for medical appointments [1].
Financial Impact and Healthcare Accessibility
The broader healthcare initiative is part of a $55.5 billion state budget [4], which includes significant investments in healthcare accessibility. The plan aims to expand BadgerCare coverage to approximately 95,000 additional residents while generating substantial fiscal benefits, including $1.9 billion in state savings and securing $2.5 billion in federal funding [1][3]. The proposal also addresses prescription drug affordability through the creation of a new Prescription Drug Affordability Review Board and caps insulin copays at $35 [1].
Implementation and Future Outlook
While the proposal has garnered support from healthcare advocates, it faces potential challenges in the Republican-controlled state Legislature [2]. Assembly Speaker Robin Vos has expressed opposition to the broader budget proposal [2][4]. However, Evers remains committed to the healthcare reforms, emphasizing that ‘healthcare should not be a privilege afforded only to the healthy and wealthy’ [1]. The administration projects the state will maintain a $646.3 million surplus by June 2026 while implementing these reforms [4][alert! ‘Implementation timeline and specific audit procedures are pending legislative approval’].