Efforts to alter health insurance in Wisconsin will likely go nowhere in the remaining part of the 2007-08 legislative session, only to become a source of further contention in the fall elections.
Republicans blast the Democrats' ambitious Healthy Wisconsin plan as a government "takeover" of health care; Assembly Speaker Mike Huebsch (R-West Salem) has promised to keep it from coming to a vote. Meanwhile, Democrats charge that the GOP's "Consumers First" plan is a thinly disguised set of tax breaks for people who are for the most part wealthy and healthy.
Those are the battle lines being drawn.
"My Democratic colleagues want more government involvement, and we want a more consumer-driven approach," says state Rep. Leah Vukmir (R-Wauwatosa), a nurse who chairs of the Assembly's Health and Health Reform Committee. "Government mandates have driven up health-care costs. We want fewer regulations and mandates so that the market can function."
The Dems say their Healthy Wisconsin plan would deliver universal-health-care coverage to Wisconsin residents while cutting costs. It's been called "the boldest and most comprehensive health reform from any state" by the Progressive States Network policy group.
The state Senate, controlled by Democrats, included Healthy Wisconsin last year in their version of the state budget. But the Republicans, who control the Assembly, blocked it from becoming part of the final budget bill.
Now it may be the Dems' turn to frustrate the Republicans, by shooting down tax breaks for Health Savings Accounts, a key component of "Consumers First."
"Basically, [the Republicans] are just saying, 'If you lose your job, take two tax breaks and call us in the morning," cracks state Sen. Jon Erpenbach (D-Middleton). "The Health Savings Accounts don't do anything for those without insurance, or anything to bring down the cost of insurance."
Under Healthy Wisconsin, employees could choose between cost-efficient private health network plans or a public plan. And private health-care providers and hospitals would remain private.
The plan would require all state employers to pay about $370 per worker into an employee health fund each month, matched with a worker's contribution of about $100. For a large number of employers, this would represent a huge savings from current health-care costs.
And by creating a huge coverage pool, the plan would significantly reduce the state's overall health-care costs, according to the Lewin Group, a prestigious accounting firm widely used by major corporations.
"The Lewin analysis shows $750 million in first year and $13.8 billion over 10 years even when you cover 500,000 people who are now uninsured," says Robert Kraig of Citizen Action of Wisconsin. "People gain access to preventive care, instead of overuse of expensive emergency-room care. We save nearly $200 million a year on bulk purchases of drugs."
Wisconsin's health premiums are rising far faster than wages and are now among the highest in the nation. That has spurred calls for reform from within some segments of the business community.
But the state's leading business lobby groups are leading the charge against Healthy Wisconsin.
Wisconsin Manufacturers & Commerce dubs it "the largest tax increase in state history," amounting to $15 billion. Backers of Healthy Wisconsin say WMC neglects to note that this tax hike would be offset by a larger drop in insurance premiums - except for employers like Wal-Mart that currently provide insurance to only a small portion of their workforces.
David Newby, president of the state AFL-CIO, says the WMC's claims have upset or confused many potential backers of the plan: "Even though we had anticipated sharp attacks, the notion that there would be a $15 billion tax increase was very effective."
The Patients First plan backed by Vukmir and the Republicans would promote coverage plans with high deductibles (typically $1,500 or $2,000) and create tax advantages for money put into Health Savings Accounts.
Vukmir, the Republicans point person on the health-care debate, says this approach will cut overall costs, by reducing overuse of medical care.
"Health care is so expensive because it is so 'cheap,'" Vukmir argues. She asks what would happen if people went to the grocery store with the same deal as for health care, with their employer paying 85% of the cost. "Obviously, there's distinctions that are very personal and important, but there are similarities." If people are more in charge, she says, they'll be more careful how they spend.
Proponents of Health Savings Accounts also think they will encourage more healthy behaviors.
"The single largest determinant of health status is personal behavior, and obviously one's health status drives the health-care costs one incurs," says R.J. Pirlot, governmental affairs director of Wisconsin Manufacturers & Commerce. "Personal behavior trumps other issues like access to care, genetics, or environment."
But health experts including Dr. Marcia Angell of Harvard Medical School warn against a "blame the victim" approach, saying most health problems are beyond an individual's control.
Senate Majority Leader Erpenbach suggests state lawmakers are among the last people you'd want setting health-care policy.
"Many legislators are so insulated from the realities of everyday life because they have such good health-care benefits," he says. "When I go out in my district, I hear from people like a guy in Mineral Point who's paying $198 a week for a high-deductible plan."
In contrast, "Leah Vukmir's health-care coverage is extremely inexpensive for her, because legislators pay $40 a month for single coverage or $54 for family."
Erpenbach says the Dems will try to ease the health-care burden of small businesses as much as possible. And they'll be working to get Democratic Gov. Jim Doyle to embrace the Healthy Wisconsin plan.
"This past year, the governor basically shepherded BadgerCare Plus through the budget, but thought Healthy Wisconsin was too much too soon," Erpenbach says. "Thanks to the governor, we now will have kids and low-income adults covered. But it doesn't deal with the health-care problems of the vast majority faced with rising costs. So I think he'll play a greater role with us in the next session."
But, in what is perhaps an acknowledgement of the gridlock they anticipate, both parties expect health care to emerge as a central issue in the fall legislative elections. Predicts Erpenbach of the Republicans, "I think that they're in for a rude awakening at the polls."
Newby also thinks the issue will work in Democrats' favor. "In a number of marginal Republican districts, a Democratic candidate can say, 'My Democratic colleagues voted for affordable health care for you and your family, and the Republicans voted to take it away from you."