No Republican presidential aspirant has a stake in the Supreme Court case that could invalidate the Affordable Care Act’s tax subsidies for millions of Americans quite like Wisconsin Gov. Scott Walker.
The Midwestern executive who is enjoying some of the biggest 2016 hype looks intent on keeping his distance from King v. Burwell and its consequences—but liberals in his state sound equally insistent on making sure that Walker pays a political price if a decision he made two years ago costs tens of thousands of people their health coverage.
Back in 2013, Walker used Obamacare in a one-of-a-kind way, directing an estimated 77,000 people who had been enrolled in a state Medicaid program to Obamacare’s subsidized private coverage. But the Supreme Court’s ruling could put those people at risk of losing their tax credits and by extension their health insurance, possibly leaving them with nowhere to go.
“I certainly hope that this would be a conversation that the national media would pick up on,” Democratic state Rep. Melissa Sargent said. “I can’t begin to understand why he’s making the decision that he is.”
Walker made his move because Wisconsin’s Medicaid program was actually more generous than Obamacare’s for that group of people. He changed the state program’s eligibility so that anybody who qualified for the federal law’s tax credits would get coverage that way instead of enrolling through Medicaid. He also declined to set up a state marketplace, which means that Wisconsinites had to enroll through the federal HealthCare.gov, where the law’s opponents now argue the tax credits are illegal. (An important note: Walker’s plan did extend Medicaid coverage to people too poor to qualify for Obamacare’s subsidies, enrolling tens of thousands other low-income residents, though not through the federal law’s Medicaid expansion, which Walker declined as part of his reforms).
The governor’s predicament, in a way, is a microcosm of the entire King case. As Justice Sonia Sotomayor asked the attorney representing the law’s opponents during oral arguments last week, in a likely play to swing vote Justice Anthony Kennedy’s federalism concerns: “Do you really believe that states fully understood that their citizens were not going to get subsidies if they let the federal government” set up their exchange, as Wisconsin did?
Bloomberg Politics’s Joshua Green pointed out King‘s implications for Walker last week, and that raises the question of how Walker’s opponents might use it against him. Sargent and another Democratic legislator introduced a bill last week to create a state-based exchange, which would prevent people in Wisconsin from losing their tax credits, but she said she didn’t expect Walker’s support.
Walker’s office is indeed laying those potential consequences at the feet of the federal government and not signaling any interest in a state-based fix.
“While we continue to monitor the federal court case and the pending outcome later this year, ultimately, the responsibility rests with the federal government to fix this federal law,” Walker spokeswoman Laurel Patrick said. She also defended the governor’s 2013 plan.
“As a state, we have to make decisions based on the reality of living within the parameters of the federal Affordable Care Act and the Obama administration’s implementation of it,” Patrick said. “Our reforms do just that. The reforms preserve Medicaid as a safety net for our state’s neediest, while protecting our state’s taxpayers from uncertain federal funding.”
Now it might be hard to imagine how refusing to implement or otherwise acquiesce to Obamacare would be a political problem for Walker, especially during the Republican primary season. But that doesn’t mean that in-state agitators won’t try to make it one.
Robert Kraig, executive director of the liberal Citizen Action of Wisconsin, said they would work to paint a more general picture of Walker having trouble in his state—and emphasizing that he was responsible for those people’s plight. Kraig also held out some hope that Walker might be willing to play ball on a state-based fix to avoid any 2016 complications.
“It’s going to make it easier to lay the blame on him if these people loses their subsidies,” Kraig said. “The leverage is him having huge difficulties in his home state “¦ And you do have a situation: We’re not talking about not providing health care to somebody provisionally having it in the future. We’re talking about taking it away from people who have it.”
“He is running to the extreme,” Sargent said of the governor’s presidential posturing. “I don’t think he’s interested in having a conversation about health care.”
It isn’t just Wisconsin liberals thinking about this either. “This could get really tricky,” Collin Roth, managing editor of the conservative Right Wisconsin website, told National Journal. He had written back in January about how Democrats would likely try to make any King fallout a political problem for Walker.
But whether they’d be successful is another matter entirely. Roth pointed out that Walker’s opponents, including 2014 Democratic gubernatorial candidate Mary Burke, had attacked the governor for rejecting the law’s Medicaid expansion as part of his 2013 plan with no electoral success.
“They have paid no political price,” he said of Walker and legislative Republicans. “To me, this suggests that the Democrats and left-wing infrastructure at the state level have been pretty ineffective at turning Medicaid expansion into a costly issue for Walker and Republicans.”