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Madison — Only five lawmakers in the state Assembly — or less than one in 20 — have taken a public stance of any kind opposing a bill to help cancer patients afford chemotherapy pills, but the leader of that house has set the bill up to fail this week, a Milwaukee Journal Sentinel review has found.

Assembly Speaker Robin Vos (R-Rochester) is working to kill the proposal even though it has the support of at least three-fifths of his house. Sixty-one lawmakers in the 99-member Assembly support the bill, including all 39 Democrats and 22 Republicans. Thirty-one Republicans won't say whether they support or oppose the bill, and two say they're undecided.

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 pill form can be taken at home.

The fate of the bill in the Assembly is paralleling what has happened in the state Senate, where Majority Leader Scott Fitzgerald (R-Juneau) has gone to such lengths as setting up a sham hearing to prevent the bill from coming to the floor. At least 28 of the state's 33 senators support the measure.

Like Fitzgerald in the Senate, Vos is using procedural tactics to prevent the bill from getting a floor vote in which it would clearly pass. On Friday, Vos transferred the bill from the Health Committee to the Insurance Committee — a step taken solely to make it harder to get the bill to the floor.

Supporters would normally need a majority vote to bring the bill to the floor for a vote. But Vos' move means supporters would now need to marshal a two-thirds majority to force a vote on the measure. The higher threshold is needed for a bill that has been sitting in committee less than 21 days. By moving it to the Insurance Committee, Vos essentially re-set the clock.

It's unlikely backers of the bill could manage that, because lawmakers typically vote with their leaders on motions seeking to yank a bill out of committee for a floor vote. That means that many GOP lawmakers would feel pressure to side with Vos — even though they back the proposal — and oppose giving the proposal an up or down vote.

The moves to block the bill come as the Legislature wraps up its session for the year.

The Senate plans to be in session on Tuesday and on April 1, then quit for the year. The Assembly plans to meet just two more times — on Tuesday and Thursday. That means that the bill is essentially dead if it hasn't passed the Assembly by Friday morning.

Gov. Scott Walker won't say if he supports the bill, but he told reporters during stops Monday in Milwaukee and Janesville that he would not be surprised to see the Legislature vote on the bill this week.

"I don't know enough about it," Walker said.

Walker's opponent, former Trek Bicycle Corp. executive Mary Burke, has said she supports the bill.

Little effect on costs

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.

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 increases 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.

In the Assembly, the bill has support from a broad swath of legislators. Backers include some of the most liberal lawmakers — such as Mandela Barnes of Milwaukee and Melissa Sargent of Madison — as well as strong conservatives such as Don Pridemore of Erin, Dan Knodl of Germantown, Steve Nass of Whitewater and Joel Kleefisch of Oconomowoc.

"For many patients, a pill form of chemotherapy is the only variation that will be effective and typically offers less disruptions to the patient, including fewer side effects and fewer risks of infection and complications," Rep. André Jacque (R-De Pere) wrote in an email to the Journal Sentinel. "I also believe that the overall costs to our healthcare system will decrease once this legislation is enacted."

But Rep. John Nygren (R-Marinette) said the measure is not needed because the Affordable Care Act caps out-of-pocket expenses at $6,350 for an individual this year. That provision of Obamacare prevents situations that have occurred in the past where some insured patients faced tens of thousands of dollars in bills for oral chemotherapy.

"If you're a cancer patient, you're going to have $6,000 out of pocket," Nygren said. "So in reality, (oral chemotherapy) is completely covered — that's my theory. ...So why take the risk of potentially increasing health care costs, when it is covered under the Affordable Care Act?"

Nygren is one of just a handful of lawmakers willing to go on the record as opposed to the measure. Nearly three dozen Assembly Republicans did not respond to requests from the Milwaukee Journal Sentinel about where they stand on the bill.

By not stating a position, lawmakers can avoid controversy. Backing the bill could anger insurers who help fund their campaigns; opposing it could cost votes from some constituents.

In the Senate, the lines are clearer. There, four-fifths of the senators have said they support the bill, including 13 of the 18 Republicans in that chamber. Senate Republicans are expected to discuss the bill in a closed meeting Tuesday to decide whether they will advance the measure in their house.

Last week, Fitzgerald took the unusual step of setting up a phantom hearing in the Senate Committee on Organization, which he chairs. That committee exists to schedule bills and does not hold hearings, but Fitzgerald scheduled one because a Senate rule prevents pulling bills to the floor if they have a pending hearing. Once the Senate completed its work last week, Fitzgerald canceled the hearing, acknowledging he never intended to actually hold it.

Fitzgerald's brother Jeff, a former Assembly speaker, is lobbying against the bill for the Wisconsin Association of Health Plans, a trade group of health maintenance organizations. Scott Fitzgerald has said his brother's lobbying has not played a role in his work to thwart the bill.

Money from insurers

Insurers are major donors to GOP legislators.

In just the first six months of 2013, HMOs gave $20,625 to the campaigns of GOP lawmakers, more than twice as much as they gave to Democrats, according to an analysis done for the Journal Sentinel by elections tracker Wisconsin Democracy Campaign. The majority of that money went to the umbrella campaign committees for Senate and Assembly Republicans that are controlled by Vos and Fitzgerald, with the Senate leader also receiving $1,200 directly.

Details by industry group for donations made since July 2013 aren't available yet. In the first half of 2013, the HMOs also gave $9,350 to Democrats who support the chemotherapy proposal and $1,400 to the proposal's lead sponsor in the Senate, Alberta Darling (R-River Hills).

Vos said last week 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 then.

Steve Schultze of the Journal Sentinel staff contributed to this report from Milwaukee.