By Kirsten Adshead | Wisconsin Reporter
MADISON — Gov. Scott Walker’s decision not to implement President Barack Obama’s federal health care law might be politically savvy — even, some would say, principled.
But Walker’s move is also a high-stakes gamble that could limit Wisconsin’s choices and may force the Badger State to join the federal government’s one-size-fits-all, health-care exchange in lieu of devising one that best fits Wisconsinites’ needs.
“There is no doubt in my mind that if Wisconsin waits until after the election, it will be too late for Wisconsin to bring up its own exchange,” said Alan Weil, executive director of the National Academy for State Health Policy, a nonprofit that researches health-related issues.
The group has a list of 100-plus milestones guiding state government officials who want to implement the federal Patient Protection and Affordable Care Act.
Fifteen states have passed laws or otherwise moved to implement the health-care law, according to the National Conference of State Legislatures, a bipartisan organization that provides research, technical assistance and opportunities to lawmakers on state issues Another seven, including Illinois and Michigan, have legislation pending.
States can opt out of much of the law, Weil said, but face federal consequences for inaction.
And states, Weil said, don’t have to create health-care exchanges, which have been compared to travel sites but designed, instead, to help consumers comparison shop for health insurance.
But if they don’t, the federal government will put its own in place, he said.
That is what will happen in Wisconsin if the state doesn’t start implementing the Affordable Care Act now, Weil said.
“It’s not that you can’t wait. It’s if you choose to wait … I just don’t think there’s any way to meet the deadlines,” he said.
When the U.S. Supreme Court upheld most of the ACA last week, conservative governors were placed in an awkward spot: Do they implement a law they believe is an expensive, prime example of government overreach and risk alienating conservative voters? Or do they delay implementation and risk having greater federal oversight of state health programs?
“I think the biggest risk for states is that if you say you’re not going to do it and the law says if the federal government will if you don’t, then you don’t have any control over what the federal government does,” Weil said.
That’s the argument Michigan Gov. Rick Snyder used in saying he’d start implementing the ACA.
“While I may not agree with everything in the law, now that the Supreme Court has essentially upheld the Act, we must act quickly to avoid an undue burden on Michigan residents and job providers,” Snyder said in a statement. “Working with our legislative leaders to establish the MiHealth Marketplace will allow Michiganders to make decisions regarding what will be covered as opposed to Washington, D.C. making those decisions for us. It will also allow us to draw down federal dollars to assist with the costs of complying with the law.”
Walker is among a handful of governors who have said they won’t implement the law until after November, including Louisiana Gov. Bobby Jindal.
Walker has opposed the health care law consistently and hasn’t been shy about rebuffing the federal government — turning down federal grants for high-speed rail and information technology related to ACA.
States have to decide by Jan. 1, 2013, if they will create their own health-care exchanges.
They have one year, then, to get the exchanges up and running. If they miss the Jan. 1, 2014, deadline, the federal government will step in with its own exchange.
States, though, only have until Nov. 16 — just 10 days after the general election — to tell the U.S. Department of Health and Human Services whether they will form their own health-care exchanges.
A 10-day window might be enough if all Wisconsin had to say was “yay” or “nay” on a state-run site.
But it’s not, Weil said. Rather, states have to have details and supporting documentation regarding how the state-run exchange would function.
And even if the state could meet that window, getting the exchange up and ready by Jan. 1, 2014, would be difficult, he said — contacting insurers, deciding what information is necessary for the site, telling insurers what information is needed, waiting for them to respond, making sure the information from each insurer is comparable to that provided by other insurers’, designing the site, providing a way for people to sign up and interact with you, etc.
“Insurance is an incredibly complex product, so we’re not talking about Craigslist, where you can say, ‘I have a used charcoal grill that I want to sell you,’” Weil said.
Walker’s office did not respond to an email asking whether the governor agrees that, by not acting now, Wisconsin faces federal government oversight if the law isn’t repealed.
His office also didn’t answer why, if that’s true, Walker believes it’s a risk worth taking.
University of Wisconsin-La Crosse political scientist Joe Heim, though, has an answer.
“Unfortunately, you have to identify this as a partisan political decision, quite frankly,” Heim said.
Walker is betting on a scenario with a low probability, Heim said — that presumptive GOP nominee Mitt Romney wins the November election, that Republicans take control of the U.S. Senate and that, come January 2013, they can get around a likely Democratic filibuster in the Senate to repeal the health-care law.
Heim would prefer that states move forward in implementing the law, which he said may be flawed but marks a first step toward addressing the entitlement programs such as Medicare and Medicaid that are consuming an ever-larger chunk of governments’ budgets.
Democrats and Republicans have waffled on addressing entitlements for fear of angering voters, he said.
“If this fails, we’re going to have another 20 years before something happens again,” Heim said.