Some highlights of Republican Gov. Scott Walker’s record on health insurance:
Sued the federal government to overturn a massive government incursion, the Affordable Care Act, into the private health insurance market.
Refused to set up a state-government-run health insurance exchange under the ACA.
Turned down an expansion of the federal government health insurance plan for the poor, Medicaid, in favor of pushing people into private insurance.
Now this man who favors selling off public buildings and providing public money for private schools, and who comes from a party that was able to keep the government-run health insurance option out of the ACA, is talking about shifting some 236,000 state workers and their family members from 18 private health insurance plans to one big government plan.
I am very confused by this.
For some clarification, I talked to Eric Schutt, the governor’s chief of staff.
If people are trying to characterize a self-insurance model for state workers as a kind of Canadian-style single-payer health care model, “that is not what this is,” he assured me.
Rather, “government here is the employer,” he said, and like any employer that self-insures would hire an outside administrator to oversee the day-to-day operations of the plan and also could hire a back-up, “stop-loss” insurer to make sure that if claims spike, the state wouldn’t lose its shirt.
Walker has said the state is considering a self-insurance model largely because new taxes on health insurers under the ACA could be passed on to the state should it keep its existing system.
“The government’s working to make sure costs are controlled,” Walker spokeswoman Julie Lund said.
Well, OK. Certainly government-as-a-business and controlling costs sound a little more up Walker and the Republican Party’s alley, and Cheryl DeMars, head of Madison-based The Alliance, which helps companies self-insure, vouched for Schutt’s characterization of a state self-insured model.
“The state is acting as a purchaser of health benefits,” DeMars said, “but they’re still the customer that is buying on behalf of employees.”
It represents no less a reliance on the private sector than does a state buying outside insurance for its employees, she said.
Still, I can’t say I blame left-leaning Walker critics who take the opposing view, as it’s hard to see how self-insuring doesn’t at least bring the state closer to providing a kind of basic service Republicans frequently prefer the private sector to provide.
Stop-loss insurance or not, it still would be the state on the hook for paying benefits, not a third-party, private insurer.
“I find it amazing that this governor, who refused to take federal dollars for health care because he wanted people to be more independent, now is about fully government-run health care for state workers,” said Marty Beil, executive director of the Wisconsin State Employees Union.
Other left-leaners who normally might be amenable to the public-ification of insurance and other vital services take a dim view of self-insuring state employees.
Robert Kraig, executive director of Citizen Action of Wisconsin, agreed that taking a look at self-insurance seems like a puzzling move for a governor who generally has been opposed to public meddling in the health insurance marketplace.
He also pointed to his group’s research showing that a competitive bidding process among private insurers for state employee business probably drives down health insurance costs.
“It doesn’t seem like (self-insurance) could be better because you’re losing some of the competition,” said Bobby Peterson, executive director of ABC for Health, a Madison-based public interest law firm that works to get people health insurance.
Scot Ross, executive director of the liberal advocacy group One Wisconsin Now, pointed to Walker’s alleged propensity for “kicking people off of their health care” and said now he’s “trying (to) lay cover” for when the ACA succeeds in Wisconsin.
To be clear, Schutt and Walker have emphasized that self-insurance is far from a sure thing at this point.
There still is much study to be done and, so far, precious little evidence that a self-insurance model would be cheaper or more effective than the state’s current model.
But if self-insuring state employees in Wisconsin does become reality, I don’t know whether I could keep myself from calling it “Walkercare.”