By now, you’ve heard plenty about the Wisconsin Senate Democrats’ government-run health care proposal which was added to the state budget. News articles to this point have essentially just run the talking points – Democrats promise health care as good as elected officials receive, while Republicans deride the plan as a $15 billion tax increase.
The speed at which the plan was introduced and passed has left little time to ask some important questions about the program. For instance, one might ask an obvious question – what will poor, sick people in other states do when they find out Wisconsin has universal health care?
Essentially, the program offers free health care to everyone in Wisconsin who has a “substantial” presence in the state, is under 65, and who isn’t eligible for other government-subsidized health care. There is a provision that requires an individual to live in Wisconsin for 12 months to be eligible for health care, unless any of the following apply:
1. The person is “gainfully employed;”
2. The person is a pregnant woman;
3. The person is under 18 years old and their parent lives in Wisconsin; regardless of whether the parent has been in the state for 12 months.
Deeper in the bill, it grants the newly-created health board the power to define what “gainfully employed” means, although it specifically mandates that farm workers and the self-employed must be included in the definition.
In looking at the eligibility requirements detailed above, does anyone seriously believe that Wisconsin won’t be flooded with the nation’s poorest, sickest patients? Why would any poor person in Illinois or Minnesota with a serious illness not immediately pick up, move to Wisconsin, and get a job at Dairy Queen? How hard can it be to claim you’re “self employed” or work for a farm? OB/GYNs could be flooded with out of state pregnant women seeking free care, as they are immediately eligible.
In fact, if you need free health care, you don’t even have to be the one that gets a job. Once one person is deemed “gainfully employed,” their entire immediate family is eligible for free health care, funded by taxes on Wisconsin employers. Think of Wisconsin’s 1990s welfare debacle, times ten. When people flood our borders to take advantage of the plan, it won’t be healthy people – it will be mobile, sick individuals that use the health care system the most.
Even people with a sincere desire to provide near-universal coverage can’t take this plan seriously. When Wisconsin opens its arms to the sickest, poorest people in America, it will jam our hospitals and result in rationed care and long waiting lists. According to the bill, it will then be up to the Secretary of Administration (who usually has no experience in health care issues) to come up with a plan to “control health care costs.” In other words, it will be up to an unelected bureaucrat with no health care experience to ration care to Wisconsinites – in large part due to the health care that must be provided to out-of-staters.Â
This is why even intelligent observers who are committed to a single-payer plan can’t honestly believe that such a plan can be implemented on a state-by-state basis.  Overuse of the system is one major reason why health care plans in states that have tried various permutations of universal coverage have collapsed. (For a good list, click here.) If America were to go to any kind of universal plan, it would have to do so nationally – the cost of moving from one state to another just isn’t enough of a deterrent from keeping a state from being flooded with the nation’s sickest individuals. (The Massachusetts plan requiring everyone to purchase health insurance may have the opposite effect – who wants to be forced to buy health care?)
It goes without saying that poor people with serious illnesses need good medical care. But it isn’t the responsibility of Wisconsin businesses to pay higher taxes to treat Arkansas’ mentally ill. Senate Democrats pushing the Wisconsin universal plan brag that it will give everyone the same health care as their elected officials. They may actually be correct. Unfortunately, it will ensure that everyone’s health care service is equally atrocious.
 UPDATE: Rick Esenberg adds a little legal perspective to this argument here.Â
When you see Turkey Lurkey, tell him I said “hey.”
Comment by folkbum — July 17, 2007 @ 12:56 pm
I left the same comment at Rick’s blog, but I thought I’d toss it up here, too.
The out-of-state poor could move to Wisconsin today and qualify for BadgerCare, and they don’t even need to get a job to do so. As long as their income upon entering the program isn’t above 185 percent of the FPL ($38K for a family of four), and it doesn’t go above 200 percent while they’re in ($41K for a family of four), they can get all the health care they need on the state dime (the FPL percentages would be even higher if BadgerCare Plus passed). So where’s the exodus?
Maybe they’re not coming because they can probably already qualify for Medicaid in their home state.
Comment by Seth Zlotocha — July 18, 2007 @ 5:01 am
That’s America’s Waiting room (emphasis added).
I never thought that after W2 became ingrained into the national scene, that Wisconsin would become a welfare island again. Looks like I was wrong.
Comment by steveegg — July 18, 2007 @ 9:22 am
Seth, BadgerCare doesn’t cover single people with no dependents under a certain age, so the exodus could come from those people. It sure wouldn’t take much for someone to move from Chicago or the Twin Cities to WI for free health care especially considering this demographic’s situation.
Comment by Bohannon — July 18, 2007 @ 12:09 pm
Bohannon,
That’s quite a different story than what Christian writes about in the post; it’s not quite as scary as OB/GYNs being flooded out of the state by pregnant women looking for free care. And the bulk of the population you’re referring to is young single people. You think health care that could run up to 4% of their wages plus a $300 annual deductible is going to bring these young people to Wisconsin in droves? Even if it did, the cost of care for this group is miniscule compared to caring for people with chronic ailments, particularly when you consider the deductible.
And Doyle’s BadgerCare Plus plan would extend BadgerCare to childless adults up to 200% of the FPL. Are people worried that plan is going to result in a similar line of uninsured childless adults tearing across the state’s borders?
Comment by Seth Zlotocha — July 18, 2007 @ 12:53 pm
I don’t think the healthy ones would be tearing across borders anywhere but what we would see is individuals possessing chronic medical conditions and ineligible for care in their home state seeking relocation to ours. Those are the most costly patients to cover and now they would be our responsibility. Any allocation of services provided to them would hurt the true Wisconsinites this plan is designed to protect.
Comment by Bohannon — July 18, 2007 @ 1:27 pm
Assuming those people are childless and making above 200% of the FPL (and therefore aren’t eligible for BadgerCare or BadgerCare Plus), wouldn’t it be easier for them to find a new job that offers decent employer-sponsored coverage in their home state than it would be for them to up and move to Wisconsin (and find a new job, anyway)? Plus, if they’re making more than 200% of the FPL, they’ll still be paying 4% of their SS wages (and their spouse’s, if they have one who works) under the Healthy WI plan, plus a $300-$600 deductible and other cost sharing.
Bottom line, most people aren’t going to move across state lines just to get health coverage, even if it’s important to them. There are thousands of uninsured people in states with less generous Medicaid programs that stay there in spite of the fact that they could get coverage by moving to a more generous state. And I’m sure some of these people have expensive chronic conditions, yet they stay put for any number of reasons, even if those reasons may not be rational in a purely economic sense.
What’s more likely is that the bulk of out-of-state people who are interested in a centralized system like Healthy WI would place increased pressure on their home states to pass their own fundamental health care plan. Wisconsin wouldn’t be the only one for long.
Comment by Seth Zlotocha — July 18, 2007 @ 2:16 pm
Hola faretaste
mekodinosad
Comment by AnferTuto — July 29, 2007 @ 6:34 am
Interesting article!
Where can I find more on this theme?
Comment by MalkEvange — August 6, 2007 @ 1:08 pm