Now that the U.S. Supreme Court has ruled that the federal Affordable Care Act is constitutional, there is a lot of talk about how President Obama and Mitt Romney will wrangle over the issue of its implementation or repeal.
That will be the marquee battle of the fall.
There is a very real chance, however, that the edgiest political struggle over health care reform will play out not at the federal level but in the states.
That is because, unfortunately, Republican governors are determined to play politics with health care. And the high court’s complicated decision to scrap the ACA requirement that states expand Medicaid — while it can likely be addressed by congressional action — is ripe for abuse.
Predictably, the most extreme governors were the most abusive.
Wisconsin Gov. Scott Walker, who has already been making moves that restrict access to BadgerCare and SeniorCare, is said: “Wisconsin will not take any action to implement ‘Obamacare.’ I am hopeful that political changes in Washington, D.C., later this year ultimately end the implementation of this law at the federal level.”
That’s objectionable. But it also creates an opportunity.
It is clear that the national Republican Party plans to change its name to “Repeal” for the fall campaign. Instead of offering a health care agenda, they’ll talk about what they want to undo: the dreaded “Obamacare.” And Walker will be front and center with the GOP.
But Wisconsin Democrats do not have to simply defend the ACA. They can and should develop their own agenda for how to preserve and extend the array of Medicare- and Medicaid-linked programs that former Gov. Tommy Thompson developed in collaboration with Republican and Democratic legislators in the 1990s.
Because of Thompson’s commitment, because Govs. Scott McCallum and Jim Doyle forged bipartisan coalitions to extend and improve the programs, and because Wisconsin’s representatives in Washington — including Congresswoman Tammy Baldwin and Congressman Paul Ryan — worked to obtain proper waivers and structural supports, Wisconsin has a great infrastructure on which to be a leader in health care reform.
Walker just wants to say “no.” But Wisconsin Democrats, who now control the state Senate and who will be competing for control of the Assembly in the fall, have an opportunity to do a lot more than that.
It is no secret that Wisconsin Democrats could use some focus as they pivot from the recalls to the fall campaign. To get that focus, they should develop smart plans for:
1. Defending and extending BadgerCare, SeniorCare and Family Care — sound programs that work well but that can be improved. The strength of these programs has been their flexibility, and their accessibility. Walker is trying to undermine that strength and Democrats need to develop smart, effective strategies for preventing him from doing more damage.
2. Working with federal representatives to implement the Affordable Care Act in a way that is best for Wisconsin. Like many federal laws, the ACA will have different implications for different regions of the United States. It is important that Wisconsin, which has been an innovative state, be rewarded for that innovation. This is no small matter, as federal programs often provide more funding to states that need to catch up, effectively penalizing states that have tackled challenges. It is vital that Walker’s resistance not be allowed to put Wisconsin in a weak position — as has been the case with federal transportation and broadband Internet build-out funding.
3. Developing models for improving not just health care access but health care outcomes. New York City, under independent Mayor Mike Bloomberg, is making great strides in addressing obesity, high blood pressure and other issues that contribute to poor health. Wisconsin does not have to mirror New York’s approaches, but this is a state with a well-developed infrastructure of local, county and regional public and private health services, educators and community programs.
Let Scott Walker just say “no.”
Democrats can be the leaders in the fight to make Wisconsin the healthiest state in the nation. That’s winning politics.