New Health Care Marketplace

Posted on Mar 26, 2013 by Steve Kagen

Steve Kagen, M.D.

Former Member of Congress – Wisconsin

American Sustainable Business Council – Advisory Board

In 2006, I ran for public office for the first time in my life to end discrimination against my patients with pre-existing medical conditions – and I succeeded. After a century of trying, we finally established health care as a Civil Right. Beginning next January, no insurance company anywhere in these United States will be allowed to decline insurance coverage to any citizen. In other words, if you’re a citizen, you’re in. As a physician, I know that is a really big deal.

The Patient Protection and Affordable Care Act was signed into law nearly three years ago, yet most families and small business owners are still unaware of all the benefits they have won. Families can now have peace of mind, for no longer will they go broke and lose their home just because a child becomes seriously ill. Small business owners are now receiving tax credits to help pay for their employees’ insurance coverage. Simply put, the Affordable Care Act is good for your health and good for business.

Our new law puts patients first, holds insurers accountable, strengthens Medicare, and levels the playing field for small businesses. Putting patients first means physicians can do what is best for patients, not insurance corporations. No thoughtful person can oppose the freedoms we have won, twelve of which are listed below. But these new freedoms will be yours for only as long as you can hold on to them.

We’ve begun to fix what’s broken and improve upon what we already have. But there is more work to do. This year, we must create a truly competitive health insurance marketplace here in Wisconsin. Under our new law, Governor Walker had the authority to do so, but he refused. So it’s up to us to write the rules Wisconsin’s new Health Care Marketplace.

What do you want our new insurance marketplace to look like? Do you want to be free to choose your own doctor and your family’s insurance coverage? Would you like to know the price of a pill before you buy it?

To guarantee we receive the care we need at a price we can afford to pay, there are eight essential elements we must have in Wisconsin’s Health Care Marketplace.

  1. Patients must always be the center of the universe, and the only question is this: What is best for the patient?
  2. Wisconsin’s Health Insurance Marketplace must establish Essential Benefit Plans, which must be available to all patients within the Marketplace.
  3. All prices that are accepted as payment in full for all medical products and services shall always be openly disclosed to the public, including on the Internet.
  4. All patients must be treated equally and at the same price for the same service or product, where the lowest price accepted as payment in full at any given facility is everyone’s price – excluding products and services provided under Medicaid, Medicare and Tri-Care.
  5. Citizens must be engaged in the process of establishing the Marketplace and agree to be responsible for living healthy lifestyles.
  6. Patients must always have the freedom to choose their own doctors, health benefit plans, hospitals, medical clinics and other health care facilities.
  7. Patients must receive full coverage for medically necessary products and services as prescribed by their providers, including from any provider who accepts the terms and fee schedules of specific Agreements within the Marketplace.
  8. Insurers may apply to participate in statewide Health Care Marketplaces, as determined by the Secretary of Health and Human Services or state governments as prescribed in the Affordable Care Act.

These essential elements will establish a highly competitive medical marketplace in which we will all have the freedom to choose our own caregivers based upon their quality, price and service.

The rules for statewide health care marketplaces are about to be written. This is the time for every family and every small business owner to participate in creating Wisconsin’s Health Care Marketplace. Take a few minutes today to see what’s in it for you by visiting these informational websites: and

As a physician and co-author of the Affordable Care Act, I am proud to say this life- saving law was written with the best interests of my patients in mind. It’s good for your health and your business. It was an honor serving everyone in Wisconsin and the nation by ending discrimination against citizens with pre-existing medical conditions. I have done my part; now it’s your turn.


Health Care is a Civil Right
If you’re a citizen, you’re in, with no discrimination against any citizen due to pre-existing medical conditions.
Privately Run Health Care
Families are free to choose their own private doctors and insurance coverage.
Standard Insurance Benefits
All insurers must offer the same policies in a competitive marketplace.
Small Business Tax Credits
Small business owners receive tax credits to help pay for their employee’s insurance.
Coverage for Young Adults
Children can now be covered on their parent’s insurance plan through age 26.
Competitive Marketplace
Insurance companies will compete transparently in 2014.
Equality for Women
Being a woman is no longer a “pre-existing” medical condition.
Coverage for Prevention Services
There are no co-payments or deductibles for prevention services, like mammograms.
Closing the Donut Hole
Costs for prescription drugs went down in Medicare.
No Annual or Lifetime Caps
You will not go broke if you become ill.
Higher Pay for Wisconsin Caregivers
Wisconsin hospitals will be rewarded for the high quality care they deliver.
Guaranteed Insurance Renewal
If you pay your premiums on time, you will never be dropped by your insurer.


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