If that happens, how should America respond to the health needs of the poor? Should America continue the policy of letting the poor to go to hospital emergency rooms to get care?
According to federal law, hospitals that get any government financial help cannot turn away people because they don’t have money. Hospitals are aggressive about collecting fees from those who come through the emergency rooms, but often the institutions end up with bills that patients can’t pay.
Bankruptcy is just around the corner for even the working poor who get caught with high hospital-related charges and no insurance.
Hospitals make up their losses by shifting them to those who can afford to pay or have private insurance.
America seems to like this approach. Some think it’s swell because they don’t have to buy insurance and can game the system.
But taxes are involved because millions of Americans are covered by Medicaid, which is paid by both state and federal taxes.
In Wisconsin there are about 1.2 million people getting help through such government health-insurance programs. That’s in addition to Medicare which provides some health insurance for the elderly.
Traditionally the federal government has paid about 58 percent of the Wisconsin Medicaid program.
Health care for the poor is the fastest growing government expenditure. Those trends are a key factor in soaring federal deficits. But big changes may be on the horizon as early as next year.
With Obamacare seemingly in legal trouble, one Republican solution gaining attention is to provide each of the 50 states with a grant and turn over the whole program to the 50 governors and legislatures. They would then establish what services would be available, what co-pays and fees would be required, and how to pay for the whole program.
The Republican plan would help the GOP solve the federal deficit without increasing federal income taxes. But it amounts to kicking the problems down the road.
Different Medicaid programs in the 50 states present some interesting challenges. Should Wisconsin provide a better set of benefits than neighboring states? Would the poor move from Illinois and Michigan to get better coverage in Wisconsin?
That would be a replay of the 1980s when it was alleged that single Chicago mothers were moving to Wisconsin because of better benefits for their children. Wisconsin answered in part by scaling back its welfare program.
Health care is trickier.
The debate could swing to the rationing of care for some. That’s far better, some will say, than increasing taxes.
Matt Pommer worked as a reporter in Madison for 35 years. He comments on state political and policy issues.