Scott Walker Endorses ObamaCare-style Insurance Regulations, Suggests Possibility of State-Level Insurance Mandate


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. 

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  1. Maybe because most GOP members are as loath as Democrats to admit they shouldn't be trying to set up a solution. Both are statist, and increasingly statist about the same things.

    Admitting the past 50 years of tinkering with health care hasn't worked very well, and maybe we should undo some of that would be a refreshing change for either party.

  2. Fucking Republicans. Even their "rising stars" can't go a week without saying something atrociously stupid. If they're going to keep shooting themselves in the foot, they should at least do the rest of us the favor of aiming a few feet higher.

    1. At least you can sort of laugh when they shoot themselves in the groin.

  3. I fucking hate Republicans. Having to pick between them and the Democrats is like choosing between a sword in the stomach and decapitation.

    1. Which is which?

      1. Well, my rationale is that both want to destroy us, but the Democrats want to do it faster. So I guess they're decapitation. While that could be viewed as more favorable than the slow death offered by the Republicans, the point is that both are offering us death.

        1. I couldn't bring myself to vote for a Democrat, so the choice for me is between voting for a Republican, voting for a protest candidate, or refusing to legitimize any politician by refusing to participate.

          Still, I can't get shocked--shocked!--anymore when I see new evidence that Republicans really aren't libertarians--again. I think we've heard the Democrats denounce the Republicans AS IF they were libertarians so often and for so long that a lot of people who have straggled into the libertarian camp recently came believing that we libertarians really were some extreme form of Republican.

          It ain't so.

          It's even more annoying when Republicans are shocked--shocked!--to find that libertarians really aren't Republicans who wanna smoka de ganja.

          We eat our own for not being libertarian enough; why wouldn't we snarl at them? We remember the Bush years. His expansion of Medicare. We remember when the Republicans controlled both Congress and the White House. They broke the effing bank to outspend any who came before them, and they shit all over the Constitution. And then they called us traitors and worse for criticizing them while they were doing it!

          Why the hell would we ever identify with fuck-face Republicans again? The Tea Party formed outside of the Republican Party for a reason. The Republicans are a bunch of statist douche bags.

    2. sword in the stomach and decapitation.

      That implies one will be quick and painless. I see it more of a sword in the stomach or a sword in the back.

      1. These are quibbles. They kill us, either way. I prefer a non-death option.

          1. Extremism in not dying is no vice.

  4. 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.

    While I would love for the GOP to embrace free market reforms of the healthcare system, I don't view the Romneycare albatross as much of a problem since you guys at Reason are already demonstrating perfectly why Obamacare's implementation will be a disaster at the national level.

    1. Obamacare's implementation will be a disaster at the national level.

      Well, that's half of it, the other half is that just because it's a disaster wont' meant that people won't like and won't fight tooth and nail to keep it.

      See also: Every other giant government program.

      Not only that, but our top two
      presidential candidates endorse the Obamacare model. They may bicker of state vs. federal implementation but it's here to stay. Even if the SCOTUS overturns the mandate it's coming to a state near you soon enough.

    2. Massachusetts version will eventually collapse as well. People are already gaming the system, and they're having to introduce 2-year waiting periods before pre-existing conditions are covered.

  5. Tard ho!

  6. Jeebus, what an idiot.

    You can guaranteed issue, but no mandate?

    Well, maybe for a year.

    And what happens after the insurance companies all go broke, Scott?

    1. He's a Republican career politician...

      They tend to be too stupid to make it in the private sector.

    2. If you require insurance companies to guarantee insurance without a mandate in order to do business in Wisconsin, is the only possible result broke insurance companies?

      1. Good point, Occupado.

        A state that had guaranteed issue/community rating, with no mandate, would quickly find itself with no insurance companies offering policies at all.

        I stand corrected.

        1. Or companies offering policies with higher premiums

          1. Death spiral/Gresham's law kicks in at some point. With no mandate, if premiums get high enough, healthy people will decide that they're getting ripped off and are better of taking their chances without insurance. Because they're healthy, their leaving impacts lowers premium revenue but doesn't reduce health expenditures much. As a result, premiums have to increase on everyone left, which nudges more people to leave, and so on.

            That's assuming guaranteed issue and community rating (or some other sort of price fixing for high risk individuals). Without the latter, guaranteed issue is fairly pointless, since the insurance can just offer someone a million dollar a month policy and meet the requirement of the law.

      2. No. The other possible results are no insurance companies doing business in Wisconsin, and no policies anyone can afford being sold in Wisconsin. I'm guessing state level insurance regs prohibit the latter, so the former is much more likely.

        1. Be interesting to see what a premium would cost for catastrophic coverage of about a ~6,000,000 person pool. Of course Walker didn't say they should be debating about contraception so I'm not sure if he advocates mandating coverage for that either.

          1. Well, first, of course, you'd have to repeal a bunch of mandates so you could offer a catastrophic coverage policy.

            And the trick with guaranteed issue/no mandate is that you go instantly into a death spiral, since you will soon find yourself with lots of sick people, and not very many well people, paying premiums.

            Your pool isn't really all 6mm Wisconsin residents. Its however many Wisconsin residents are sick enough to need a catastrophic care policy, plus a few suckers.

            1. I fail to see the difference between the consequences of a state pool of insured and a pool of workers at a company. When our company provided insurance benefits, the majority didn't suddenly get sick at the expense of the rest of pool. If that were the case, insurance wouldn't serve a purpose at any level.

              And since you've chosen to debate this topic at an internet level, I assume you are now supporting guaranteed issue.

              1. "When our company provided insurance benefits, the majority didn't suddenly get sick at the expense of the rest of pool"

                Unless your company allowed people to take the full value of whatever insurance it was offering in cash and go without, you basically had a mandate.


  8. The talking heads have been talking about him as a possible VP choice for Romney.

    I'm thinking they're more right than they realize.

  9. "Certainly not a federal mandate," Walker. "I think those are debates people can have at the state level."

    He's advocating the individual mandate by encouraging state level debate. Yes, it's right there

  10. This country would be perfect if we located all of our health care on high-speed trains.

    1. think access warren. high speed access.

    2. ...high speed trains running on green energy.

      1. . . .taking Republicans and libertarians to concentration camps.

  11. Walker has outlasted his usefulness.

  12. Ok now recall Scott Walker!

  13. I wonder: If he had made this idiotic pronouncement two weeks ago, would he still be governor today?

  14. State-level insurance mandates absolutely do have a constitutional problem, the 13th amendment. Then again 99% of what governments do is illegal under the 13th so I doubt that will stop them.

    1. Why do you hate slavery?

      1. I never said I hate slavery. I just said it was unconstitutional.

  15. doesn't have much in the way of answers about how to handle health policy

    They did have the answer of HSAs plus CDHPs, which got implemented by the Medicare Part D law. As I recall, Peter, you claimed that those were actually working to hold down costs.

    I'm still fairly skeptical of the overall law, but I would like a study in how much their creation by the law affected their spread and use, and whether if that bending of the cost curve could somehow outweigh all the extra Medicare Part D spending.

    Unfortunately, it doesn't seem like anyone is interested in trying to answer that question, including Peter.

  16. Barmittscott Obamneywalker, ladies and gents.

  17. The federalist idea is all well and good, but if the State doesn't break out pre-existing conditions, companies may indeed bail out or jack up the rates into the stratosphere. Pre-existing condition coverage is welfare not insurance. That said, my preference is no government involvement in healthcare delivery or insurance at all.

    1. The real problem isn't that insurers exclude pre-existing conditions, it's that people lose their coverage when they change jobs or lose their job, even if they are already sick. So the insurer has an "escape" from the insurance contract that doesn't exist otherwise.

      We could fix most of the problem by requiring insurers to cover complete treatment for an illness, even if the individual is no longer covered for future illnesses.

  18. Any attempt to implement "universal" healthcare is doomed to be a fiscal disaster, absent some sort of government rationing.

    The real debate people should be having is about whether they want universal healthcare, with rationing, with restrictions on what kinds of treatments they can get, or a system where not everyone is covered, but those who can afford it can buy any treatments they wish.

    Obviously, I prefer the latter. But politicians on both sides keep feeding people the illusion that it's possible to give everyone everything they want and it won't cost anyone anything. Immortality for everyone, and perpetual prosperity, with our next four year plan.

  19. This is better, Suderman. You acknowledge the differences between Mass Care and Obamacare. Consider yourself given a gold star on your report card.

  20. Guaranteed issue is not really something new:

  21. Je sais que tout le monde aime avoir des conceptions propres sur le t-shirt. Par cons?quent, cet article va vous aider ? acheter un tel t-shirts sur Internet.

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