This month - possibly as soon as Thursday - the U.S. Supreme Court is expected to rule on the Affordable Care Act, branded by opponents as Obamacare.
Conservatives revile the law as socialism, while liberals see it as the best hope for creating universal health coverage and holding down health costs.
Gov. Scott Walker makes no bones about where he stands. Not only does he hope the Supreme Court overturns the law, even if it doesn't, he says he won't begin implementing it until after the presidential election in November. "I don't read anywhere in the Constitution that defines the federal government demanding health insurance on me and my family," Walker told Gannett newspapers recently. (Walker spokesman Cullen Werwie did not return a request for comment.)
Two key elements of Obama's health care law have conservative roots: insurance exchanges and the so-called individual mandate. The mandate requiring individuals to have insurance was first proposed by the conservative Heritage Foundation, and later embraced by several Republicans (including presidential hopeful Mitt Romney) as a counter to President Bill Clinton's proposal in the 1990s.
"It's amazing that a moderate centrist policy that was an alternative to the Clinton plan is now viewed as a socialist takeover," says Robert Kraig, executive director of Citizen Action of Wisconsin. He adds that the individual mandate is needed to make the act's other provision - forbidding insurance companies from denying anyone coverage - work. Without it, many people will wait until they get sick to buy coverage.
Insurance exchanges - entities that regulate insurers and allow individuals to comparison shop for insurance coverage - use the free market to foster competition and increase enrollment. Walker rejected this idea by returning $38 million in federal dollars intended to help establish a health insurance exchange. Under the Affordable Care Act, if states don't establish their own exchanges by 2014, the federal government will do it for them.
J.P. Wieske, a spokesman for the state's Office of the Commissioner of Insurance, says the Walker administration opposes Obama's health care reform law because "The feds don't understand the state market."
Wieske says that while an insurance exchange can utilize the free market, it can also be set up to limit it. "If you're going to talk about an insurance exchange, what does that mean? How invasive do you get?"
Kraig says that the Walker administration, if serious about boosting the economy, should be working on reducing health costs because they're a big drain on business growth. He says that U.S. health care costs are double what they are in other developed countries: "It makes it harder to create jobs and greatly restricts economic mobility."
Health costs especially hurt small businesses. In 2000, about 60% of small businesses provided employees health insurance - today just one-third of them do. These businesses routinely lose employees to larger companies that provide insurance.
So what will the Walker administration do to control health costs if the Affordable Care Act is overturned? Wieske says he can't speak for the governor. "We really can't have a hypothetical conversation until we know what we're dealing with."
