Asked what sort of health reforms he supported, Wisconsin Republican Gov. Scott Walker said he thought guaranteed issue, a rule which requires health insurers to sell to all comers and is a key part of ObamaCare, was a good thing at the state level. He also said that states could consider the possibility of imposing a health insurance mandate. Via TPM:
"Whether it's done through the Affordable Care Act or done separate from that with Congress and the states — I think that things that allow you to go over state lines, certain things in terms of guaranteed issue and things of that nature," Walker said at a breakfast in Washington, D.C. hosted by the Christian Science Monitor. "I think there are good elements. I just don't think you need the federal government to do most of those things."
Walker said that it was possible to keep "guaranteed issue," in which patients are guaranteed the ability to purchase coverage, but without a national requirement that Americans maintain health insurance.
"Certainly not a federal mandate," Walker. "I think those are debates people can have at the state level."
Is it a problem that Walker is endorsing state-driven versions of the president's health law? Yes. But the bigger problem is that the debates Walker imagines people having are debates that Republicans haven't really had — at the state level, at the federal level, or anywhere outside of a few think tank panels. And awkward comments like Walker's are the result.
Let's get a couple things out of the way: Regardless of whether or not a state-level insurance mandate is an objectionable policy or a bad idea, unlike ObamaCare's federal mandate it is not an obvious constitutional problem. That's why the Massachusetts mandate that GOP presidential nominee Mitt Romney fought for and signed into law is not threatened by any Supreme Court ruling against ObamaCare. And state-level mandates have the distinct advantage of federalism: A world in which some states choose to mandate health insurance coverage, and in which the details of the mandate vary by state, is more flexible and diverse than one in which the federal government forces the same policy on residents of every state.
But Walker's comments yet another reminder that the basic shape of ObamaCare — controls on the insurance market, mandatory purchase of insurance, and subsidies for private insurance delivered through government-run exchanges — was developed by Republicans and passed as RomneyCare by the party's presidential nominee. And they show that GOP officials, a number of whom have spent the last month or so trying to reassure people that of course they don't want to throw out the good parts of ObamaCare, haven't moved beyond those ideas except to oppose President Obama's federal version of them.
It remains a serious problem for the Republican party that a national figure like Walker, who has opposed the implementation of ObamaCare in his own state, doesn't have much in the way of answers about how to handle health policy except to endorse state-level versions of the plan that the GOP bitterly opposes at the national level.