MADISON — The U.S. Supreme Court’s decision on whether the federal health-care law is constitutional may be imminent, but that doesn’t mean Wisconsin has a clear path forward.
The justices are expected to rule soon, perhaps as early as Monday, on what University of Wisconsin-Madison assistant law professor Andrew Coan calls “the most significant constitutional case that certainly the court has decided in the 21st century, and I believe it’s one of the most significant cases the court has decided in the past 50 or 60 years.”
But, Coan said, “the potential array of outcomes is dizzyingly complex.”
The 2,200-page Patient Protection and Affordable Care Act, which some have dubbed “Obamacare,” covers things such as requiring people to buy health insurance to expanding Medicaid to offering tax credits to help people purchase insurance.
The justices may rule that all, none or some of those provisions are unconstitutional, and those rulings may have a number of effects.
The Center for Medicare and Medicaid Intervention, for instance, has offered the Pharmacy Society of Wisconsin a nearly $4.2 million grant aimed at improving pharmacists’ ability to educate patients about taking their medication, noted Rick Abrams, CEO of the Wisconsin Medical Society, which represents about 12,000 medical doctors.
If the Supreme Court’s ruling means money isn’t available, he said, “that would be a terrible disappointment, if not a disservice, not only to the pharmacy side, but to the patients.”
WMS likes some parts of the federal law — and not others — but has yet to take a stance on the legislation as a whole, Abrams said.
Michael Richards, executive director of external affairs for La Crosse-based Gundersen Lutheran Health System, said he and his associates aren’t panicking.
“It’s been a longtime coming, so I think we’re fine,” he said. “It’s not like the end of the world is going to be coming. It’s going to be a decision. We’re going to read it, and we’re going to move forward. That’s all we can do.
“There are a lot of moving parts that we’ll have to work through, and I don’t think the decision Monday is going to be the end of it. There are going to be a lot of things litigated.”
Several people in the health-care industry, including Abrams and Richards, said Wisconsin’s health-care system already is better than most states,’ regardless of whether the Affordable Care Act remains the law of the land.
One of the biggest selling points for the federal law has been that it provides a path toward health-insurance coverage for the estimated 50 million Americans without coverage now.
But Wisconsin’s coverage rate is high, largely due to BadgerCare, which helps provide health coverage for low-income families, said Jim Diestsche, chief financial officer for Bellin Health System in Green Bay.
“We cover nearly all citizens in Wisconsin today, so that impact (should the court uphold the health-care act) is going to be minor to us,” Dietsche said.
If the Supreme Court upholds the law, one of the most pressing issues for states will be the creation of health-insurance exchanges, which the nonpartisan Kaiser Family Foundation describes as “new organizations that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options.”
Under the federal law, states have until Jan. 1, 2013, to declare their exchanges.
States then have a year to get those exchanges ready. If they don’t, the federal government steps in to run the exchanges.
Wisconsin seemingly has made little-to-no effort, however, to prepare for that — largely because Gov. Scott Walker and Attorney General J. B. Van Hollen have been strong and enthusiastic opponents of the federal health-care plan.
Hollen tried, unsuccessfully, to sue the federal government over the law just days after it was passed.
He and other critics believe it is unconstitutional for the federal government to require people to have health insurance.
One of Walker’s first actions as governor was authorizing Van Hollen to join other states in suing the federal government over the health-care plan.
On Jan. 31, 2011, U.S. District Judge Roger Vinson ruled against the new law, prompting Van Hollen to say, “For Wisconsin, the federal health care law is dead — unless and until it is revived by an appellate court. Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.”
In January, the state returned a $37.7 million federal Early Innovator grant for a state health exchange.
Walker said the state would be innovative without the grant, and already has created the Office of Free Market Health Care, intended to respond to the federal health-care plan and find alternatives to its implementation in Wisconsin.
If the Supreme Court rules in favor of the law, expect Republicans and other critics to keep up the fight, including electing officials who might repeal the legislation.
State Rep. Jeff Stone, R-Greendale, chairman of the Assembly Committee on Health, said he hopes the Supreme Court tosses the federal health-care law out completely.
Then, Wisconsin can move forward on improving health care in the state, including encouraging a competitive insurance environment, Stone said.
“I think we can continue to improve on that if the federal government gets out of the way and allows us to do the kind of innovation we’ve done in the past,” he said.