Not to elevate the obvious, but, as Saturday Night Live's "Emily Litella" might have asked, "What's all this fuss over free mason health care? Excuse me? You say it's actually free market health care? Oh, that's different. Never mind!"
Office of Free Market Health Care is what Scott Walker's administration has decided to call the state agency charged with establishing new health insurance exchanges as required by the federal health care reform law -- you know, the law Republicans like to refer to as Obamacare.
Under the Doyle administration, the agency was called the Office of Health Care Reform, which is only polemical if you believe the new federal law doesn't seek to change anything. Changing over to "Office of Free Market Health Care" on the other hand is sort of like renaming the State Insurance Commissioner's Office the "Office of Free Market Health Insurance," or changing the DNR to the Department of Private Natural Resource Exploitation. A turd by any other name would smell as bad. At least we know exactly where the Walkerites are coming from.
Indeed, a prototype web site set up by Walker's new "free market" office proclaims that, "Wisconsin has a strong, competitive health insurance market that should be preserved and protected." Doesn't sound much like reform, especially if you regard private insurers as a major part of the problem and not just another special-interest campaign donation engine.
Indeed, the prototype site (which doesn't offer any real services yet) further proclaims that the Office of Free Health Care's mission includes exploring "all opportunities and alternative approaches that would free Wisconsin from establishing a health benefit exchange, including federal waivers." Which exchange, of course, is supposed to be its mission.
Also, as the site ominously proclaims, "The exchange ... will be a be a primary vehicle for Medicaid eligibility determination and enrollment." Strange wording, that. After all, the office just told citizens it's out to kill such an exchange. Just like Walker Inc. would like to kill Medicaid. More about which, below.
In sum words, this is an office whose goal is to make itself unnecessary by resisting the law that set it up. But the state will still take federal health care reform dollars in service to that anti-reform mission, thank you.
The background here is that state-run health insurance exchanges were considered by Democrats and health reform advocates as critical to reform measure that still heavily relies on the nation's existing private insurance industry. The health reform legislation makes coverage more affordable for many low- to moderate-income Americans and small businesses by capping the percentage of income they must contribute towards insurance, providing subsidies to help cover the cost of premiums and providing cost-sharing support to limit out-of-pocket costs such as deductibles and co-pays.
The state insurance exchanges, which would have to meet certain minimum federal requirements, are intended to make all these changes more effective by helping consumers make better sense of the private health insurance options. Knowledge is power, and through easier to understand, one-stop comparisons of different plans, the exchanges are intended to help drive down private insurance costs through increased competition. States must submit plans for their exchanges by 2013 or the federal government will take over the process.
Now, despite GOP rhetoric, the health care reform law is not a "government takeover" of health care. It relies heavily on the existing private insurance system but tries to streamline it by making it more understandable and by spreading costs -- which has the other, nationally beneficial advantage of helping tens of millions of more Americans acquire health coverage and at lower cost.
But Republican governors and legislatures around the country have resisted the entire effort and have been screaming that the mandated insurance exchanges amount to federal intrusion into state affairs. President Obama recently called their bluff, saying that if any state had a better way to accomplish the actual intent of the insurance exchanges, they could seek waivers from the federal mandate.
Republican House leaders in Washington are trying to derail the insurance exchanges -- which would greatly limit the effectiveness of the overall health care law -- by rejecting money set aside for state insurance exchange planning grants. Meanwhile, of course, a number of GOP-controlled states including Wisconsin are mounting a frontal assault on the health care reform law in the courts.
But if all that fails, the Walker administration has covered its bets by trying to subvert the purpose of the exchanges while seeming to actually implement them. Its key goal: To get the feds to agree that Wisconsin could move the state's Medicaid recipients into private plans offered on the exchange. Such a move admittedly could reduce state costs but it's just another rendition of Rep. Paul Ryan's bill, passed in the GOP-led House, to "save" Medicare and Medicaid by privatizing them, very probably at higher cost and lower benefit to recipients.
Republicans surely have a penchant for politicizing even the most mundane and bureaucratic of chores. When you "implement" a federal law by designing state policies that only serve to undermine that law, isn't that actually just a violation of the law? And isn't that increasingly the GOP tactic of stalling reform? Ask the next Republican politician you see, and ask often. Preferrably at a town hall meeting.