Senate Majority Leader Scott Fitzgerald (R-Juneau) listens during a 2011 session of the state Senate. Credit: Associated Press

By of the

Madison — More than two-thirds of GOP senators and four-fifths of the state Senate now publicly support a bipartisan bill to help cancer patients get critical treatments, but the measure is still being blocked by the head of that house.

Senate Majority Leader Scott Fitzgerald (R-Juneau) said Wednesday he's going to unusual steps to block the proposal because a majority of his GOP caucus opposes it, not because his brother is lobbying on behalf of influential insurers to kill the bill.

But a review by the Milwaukee Journal Sentinel shows that as of Friday, at least 13 of the 18 Republicans in the state Senate and all 15 Democrats have taken a public stance in support of the legislation. In the Senate, Fitzgerald is now the main force holding back the bill, drawing on one of his body's most arcane rules to keep the legislation trapped in the committee he chairs.

"The result of that bill passing would be chemotherapy would be cheaper for many families and people would have healthier lives," said Senate Minority Leader Chris Larson (D-Milwaukee), asking why Fitzgerald was using the rare maneuver to prevent that. "He and his (Republican) caucus owe families an explanation for why that is."

The proposal would require health plans to provide the same coverage for expensive chemotherapy drugs taken as pills as they do for the expensive chemotherapy administered through IVs. The bill will be all but dead if it doesn't reach the floor of the Assembly by Thursday, the day that house is scheduled to adjourn for the year.

In the Assembly, the bill has 18 Republican sponsors and would likely draw support from all or nearly all of the 39 Democrats. That's more than enough to reach the threshold of 50 votes needed to pass the bill, but it falls short of the 66 votes that supporters would need to force the measure to the floor.

Assembly Speaker Robin Vos (R-Rochester) opposes the bill and on Friday used a procedural move of his own to lock a companion bill in his house in committee until after the session ends. His strongly conservative caucus is unlikely to press him to bring the bill up for a floor vote or even a committee vote in that house, despite the fact that the proposal's lead sponsor, Republican Pat Strachota of West Bend, ranks second only to Vos in the Assembly.

All that means that the chemotherapy bill appears marked to become one of those proposals that fail to pass the Legislature even though they have the votes.

Twenty-nine states — including neighboring Iowa, Illinois and Minnesota — have passed laws requiring insurance companies to treat oral chemotherapy drugs the same as they do other chemotherapy, with little or no effect on premium costs.

Jim Graven, 63, thinks Wisconsin ought to join them. He had surgery a year ago after being diagnosed with kidney cancer and is now taking oral chemotherapy to keep it from recurring. His pills are covered because he is part of a clinical trial, but he said in other cases a supply could cost up to $10,000 a month.

He said he was frustrated GOP leaders are going to such lengths to stop the bill.

"To a normal person, I just don't think this makes any sense at all," he said. "It's obvious this isn't the way government should work."

Health plans typically cover oral chemotherapy under prescription drug plans that can have high copays, and for some health plans, those copays could run into many thousands of dollars. In contrast, when chemotherapy is administered at a hospital or clinic, it is covered as part of a health plan's standard medical coverage with no additional cost after the deductible is reached.

Supporters say requiring equal coverage for oral chemotherapy hasn't been shown to lead to big hikes in health insurance premiums.

A review done by the Washington Department of Insurance found an increase of 0.2% as a result of the state's oral chemotherapy law, according to the International Myeloma Foundation. In Indiana, the Department of Insurance found no increase in premiums after it passed similar legislation in 2010.

A retired financial consultant, Graven lives outside Sheboygan in the Town of Wilson. He said it's a "no-brainer" that all chemotherapy should be covered the same and noted he was bothered Republicans first arranged and then canceled a phantom hearing Wednesday to prevent the bill from getting to the floor.

"I have really a low tolerance for it," Graven said. "I hate to see technicalities used in a wrong way. I don't like a lot of legalism in society, especially when they use it to get an unintended result. I don't like it at all."

On Wednesday, Fitzgerald said he was using that unusual blocking technique because the chemotherapy bill had a "majority of the body (of senators supporting the bill) but not a majority of the Republican caucus."

Fitzgerald dropped that reason Friday after the Journal Sentinel gave his aides a list showing that a majority of GOP senators now publicly support the bill.

"As far as scheduling a bill that doesn't have unanimous Republican support within the caucus, there is no hard and fast number in terms of senators opposing the bill," Fitzgerald said in a statement. "It is taken on a case-by-case, bill-by-bill basis. I expect a lengthy discussion on this bill in (our GOP) caucus on Tuesday, and I hope to come out of that with some sort of resolution on the issue, whatever that may be."

Fitzgerald has said that his actions have nothing to do with the fact that his brother, Jeff Fitzgerald, has served as a contract lobbyist for the Wisconsin Association of Health Plans. That HMO trade group opposes the bill along with individual insurers and another trade group, the Alliance of Health Insurers.

Insurers are major donors and have a history of giving to the Senate Republicans' campaign committee and to GOP legislators on both sides of the chemotherapy issue, such as Fitzgerald and the proposal's lead sponsor in the Senate, Republican Alberta Darling of River Hills.

Two conservative GOP senators have come out vocally against the bill — Paul Farrow of the Village of Pewaukee and Leah Vukmir of Wauwatosa.

"I have a consistent record of opposing insurance mandates," Vukmir said in a statement. "A state mandate would only impact the insurance companies regulated by Wisconsin and not those regulated at the federal level, creating an uneven playing field and driving up costs for consumers."

Farrow expressed similar concerns.

"It's a mandate," he said. "If we're going to say we're going to mandate this one area, what's the next area we're going to mandate?"

Insurance industry groups also have said the law is not needed because many health plans cover oral chemo and the Affordable Care Act caps out-of-pocket expenses at $6,350 for an individual this year. That's a big change from past years in which even some insured patients could face tens of thousands of dollars in costs for their oral chemotherapy.

Earlier this session, Scott Fitzgerald allowed a bill to get to the floor that divided the GOP caucus. That measure — which would create a regional transit authority in the Fox Valley — passed 25-7, with 11 Republicans joining all Democrats in favor of it.

Fitzgerald can also point to the chemotherapy bill's slim chances in the Assembly as one reason not to bring it up in his house.

Vos said he believes his Republican caucus opposes the bill, even if the Assembly as a whole supports it when the votes of Democrats are counted.

"In the past, I have not voted for any mandates that would increase the cost of insurance plans in the private sector that's already too expensive. So I guess I will wait to see what happens in the Senate, but I have serious concerns," Vos said.

The Wisconsin Health Plans Association has also stressed that the bill would raise premiums, but so far opponents have not backed up those statements with specific figures.

Gov. Scott Walker has heard more about the chemotherapy proposal in recent days but is focused on his "worker training bill and his Blueprint for Prosperity" — the governor's $541 million tax cut bill, spokeswoman Jocelyn Webster said. He will consider the chemotherapy measure "when and if" it reaches his desk, she said.

Walker's Democratic challenger, Mary Burke, said as governor she would sign the bill "as soon as it reached" her.

"This should be an easy, common sense decision. Unfortunately, it seems like once again we see special interests taking precedence over the needs of the people of Wisconsin," she said in a statement.

On Friday, Vos made a move to effectively kill an Assembly companion bill to the chemotherapy measure in the Senate, transferring the proposal from the health committee to the insurance committee. Because of that transfer, it will take a two-thirds vote to bring that Assembly bill to the floor, something the bill's opponents currently can't muster.

If Vos did move the bill forward, Assembly Minority Leader Peter Barca (D-Kenosha), a sponsor of the measure, believes he could deliver the great majority of his 39 Democrats and perhaps all of them.

"It probably has as strong of bipartisan support as anything we've done this session," Barca said of the bill. "It's one of those issues whose time has come."

Sen. Tim Cullen agrees. The Janesville Democrat is a cancer survivor, former Blue Cross Blue Shield health insurance executive and a former Senate majority leader — the post Fitzgerald now holds. Cullen doesn't believe Scott Fitzgerald is holding up the bill to benefit his brother, but Cullen doesn't believe that Fitzgerald is right, either.

"The bill ought to become law. The insurance industry's problem is a technical one and I think they can solve it," Cullen said.

But as a former leader, Cullen sees why neither Fitzgerald nor Vos would want to take floor votes on the bill and see it pass. Doing so, Cullen said, would deprive Republicans in their house of the credit — and potential campaign support — they could receive from opponents for killing the bill.

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Cancer drug bill

A bill requiring oral chemotherapy drugs to be covered the same way as IV treatments has overwhelming support in the state Senate but is being blocked by Majority Leader Scott Fitzgerald.

Democrats for the bill

Tim Carpenter (D-Milwaukee),

sen.carpenter@legis.wisconsin.gov, (608) 266-8535

Tim Cullen (D-Janesville),

sen.cullen@legis.wisconsin.gov, (608) 266-2253

Jon Erpenbach (D-Middleton),

sen.erpenbach@legis.wisconsin.gov, (608) 266-6670

Dave Hansen (D-Green Bay),

sen.hansen@legis.wisconsin.gov, (608) 266-5670

Nikiya Harris (D-Milwaukee),

sen.harris@legis.wisconsin.gov, (608) 266-2500

Bob Jauch (D-Poplar),

sen.jauch@legis.wisconsin.gov, (608) 266-3510

Chris Larson (D-Milwaukee),

sen.larson@legis.wisconsin.gov, (608) 266-7505

Julie Lassa (D-Stevens Point),

sen.lassa@legis.wisconsin.gov, (608) 266-3123

John Lehman (D-Racine),

sen.lehman@legis.wisconsin.gov, (608) 266-1832

Mark Miller (D-Monona),

sen.miller@legis.wisconsin.gov, (608) 266-9170

Fred Risser (D-Madison),

sen.risser@legis.wisconsin.gov, (608) 266-1627

Jennifer Shilling (D-La Crosse),

sen.shilling@legis.wisconsin.gov, (608) 266-5490

Lena Taylor (D-Milwaukee),

sen.taylor@legis.wisconsin.gov, (608) 266-5810

Kathleen Vinehout (D-Alma),

sen.vinehout@legis.wisconsin.gov, (608) 266-8546

Bob Wirch (D-Somers),

sen.wirch@legis.wisconsin.gov, (608) 267-8979

Republicans for the bill

Rob Cowles (R-Allouez),

sen.cowles@legis.wisconsin.gov, (608) 266-0484

Alberta Darling (R-River Hills),

sen.darling@legis.wisconsin.gov, (608) 266-5830

Mike Ellis (R-Neenah),

sen.ellis@legis.wisconsin.gov, (608) 266-0718

Rick Gudex (R-Fond du Lac),

sen.gudex@legis.wisconsin.gov, (608) 266-5300

Sheila Harsdorf (R-River Falls),

sen.harsdorf@legis.wisconsin.gov, (608) 266-7745

Frank Lasee (R-De Pere),

sen.lasee@legis.wisconsin.gov, (608) 266-3512

Mary Lazich (R-New Berlin),

sen.lazich@legis.wisconsin.gov, (608) 266-5400

Joe Leibham (R-Sheboygan),

sen.leibham@legis.wisconsin.gov, (608) 266-2056

Terry Moulton (R-Chippewa Falls),

sen.moulton@legis.wisconsin.gov, (608) 266-7511

Luther Olsen (R-Ripon),

sen.olsen@legis.wisconsin.gov, (608) 266-0751

Jerry Petrowski (R-Marathon),

sen.petrowski@legis.wisconsin.gov, (608) 266-2502

Dale Schultz (R-Richland Center),

sen.schultz@legis.wisconsin.gov, (608) 266-0703

Tom Tiffany (R-Hazelhurst),

sen.tiffany@legis.wisconsin.gov, (608) 266-2509

Republicans against the bill

Paul Farrow (R-Village of Pewaukee),

sen.farrow@legis.wisconsin.gov, (608) 266-9174

Scott Fitzgerald (R-Juneau),

sen.fitzgerald@legis.wisconsin.gov, (608) 266-5660

Leah Vukmir (R-Wauwatosa),

sen.vukmir@legis.wisconsin.gov, (608) 266-2512

Republicans who have not stated their positions

Glenn Grothman (R-West Bend),

sen.grothman@legis.wisconsin.gov, (608) 266-7513

Neal Kedzie (R-Elkhorn),

sen.kedzie@legis.wisconsin.gov, (608) 266-2635