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Health choices loom over elections

By Matt Pommer

Health insurance coverage could become an overriding topic for the Legislature that will be elected in November.

Republican presidential front-runner Mitt Romney said health insurance questions should be answered by each state separately. Romney also would give state governments block grants and let them decide how to fashion Medicaid, the program of health care for the poor.

By June, the U.S. Supreme Court will rule on the constitutionality of Patient Protection and Affordable Care, dubbed “Obamacare” by its critics. The high court has scheduled five days in March for oral arguments from the administration and opponents, including every Republican presidential hopeful.

Central to the debate is whether the federal government can require citizens buy and be covered by health insurance. If that provision is struck down, the rest of the law may collapse.

Republican presidential candidates denounce Obamacare, but it could turn out that they may be happy if the Supreme Court rules it constitutional since it is always easier to run against something than to propose an alternative.

Dumping health care decision on the 50 state legislatures surely is the easiest answer, at least for those who proclaim the central problem in America is the federal deficit. It would be kicking the deficit can down the road to the 50 legislatures.

Two broad topics — financing health care and specific program benefits — would be left to state governments.

Abortion probably would be an even bigger topic in the Wisconsin Legislature. The public is familiar with the debate between anti-abortion forces and those who argue for women’s rights. Would the state prohibit any insurance coverage for medical efforts that could or do lead to an abortion?

Yet there are other questions without such clear dividing lines. Should Wisconsin require health insurance carriers cover autism or chiropractic services? What if neighboring states decide against such requirements?

Many suggest the answer to health financing is to let the free market decide. Let insurance carriers, including those from other states, compete for customers. But should the state require them to take “bad risks” with those who have health problems or whose families have a history of health problems?

What happens if Wisconsin requirements for health insurance or benefits under Medicaid are more favorable than those for Illinois residents? Wisconsin experienced that debate in the 1980s over AFDC welfare benefits. Critics said Wisconsin was attracting Chicago residents to move to Wisconsin.

Then there is Medicaid. If less money is available under a grant program, then who would get priority? The probable choices for priority are the poor, elderly and disabled.

If the federal role disappears, could the poor without insurance still get care at Wisconsin hospitals?

Matt Pommer worked as reporter in Madison for 35 years. He comments on state political and policy issues.

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