The New Health Dialogue

Six months ago, when I was researching an article on health reform implementation in the states, I had to choose three states to focus on -- red, blue, and broke (California). I also did a separate little story on Connecticut's path to a public option.

Red was Georgia -- we know health reform has an uphill battle there (although it's gotten more uphill since last spring).

California is turning out pretty much as I expected; Republican Schwarzenegger and the Democratic legislature have passed a framework for an exchange, Jerry Brown will replace Schwarzenegger, the legislature is still Democratic -- and the state is still broke but moving ahead in an admirably determined fashion.

The surprise of course was Wisconsin. That was the blue state -- which has had its share of Republican governors but not extreme right-wing Republicans, in fact they've had some progressive Republicans in their time -- that was already racing ahead of others in terms of coverage, and getting ready for 2014. Outgoing Gov. Jim Doyle was committed; the state's Medicaid director Jason Helgerson was getting national attention for being both innovative and effective. I have never lived in Wisconsin so I did a lot of reporting for that piece -- spoke to activists, professors, researchers, analysts, officials and tracked the political coverage in the Milwaukee paper. And I looked then, and later, at the candidates' web sites. People I spoke to were either pretty confident a Democrat would win -- or they thought there might be a mild conservative swing. But then that was back in May. None of us -- including Russ Feingold -- were prepared for a tectonic shift.

Kevin Sack in the NY Times has a good article on where things stand. Incoming governor Scott Walker (who people had described to me at the time a conservative with a pragmatic streak because he had been a county executive and had actually run things) has scrambled aboard the anti-health reform bandwagon with great enthusiasm. Particularly interesting was just a few days before the election, when I had to give a talk in New York on state reform, I double-checked the coverage and his website. The health section was skimpy; what he stressed was his strong pro-life stance. At that time, the last week in October, I didn't see a word about repeal, lawsuits, etc. And when I googled recent news coverage, I found stories about him wanting to cut back Medicaid spending. But not the full-throated opposition to reform that we're now seeing. Was he a sleeper repealer? Did I miss something on the web site (I don't think so, but it is a possibility). It will be worth watching how far he goes. (He isn't ruling out an exchange, he want a more market-oriented one -- which is what I had expected a number of Republican states to do.) It's relatively easy to not build something. We'll have to see how successful he is in tearing Doyle's achievements down.