Health care magnet?

Last January, I published a piece in WI Interest, the journal of the Wisconsin Public Policy Research Institute, arguing that the drafters of a plan called Healthy Wisconsin — or any similar program purporting to enact a universal entitlement to health care in a single state — could not constitutionally impose a residency requirement, creating the risk of health care migration and the associated problems of adverse selection. I did not seek to explore whether such migration would occur or who would migrate. I speculated, in fact, that the migrants would not be poor people, but those who are older or high risk.

Healthy Wisconsin is a plan that would fund universal health care for all state residents by imposing a payroll tax on all state employers. There is disagreement about the amount of the tax but the most frequently mentioned numbers seem to range between 16 and 18%.

WPRI has now published a study evaluating the probability of such migration. I have not yet carefully examined it, but I continue to believe that such migration (and the Supreme Court precedent that protects it) is a serious obstacle to state efforts to enact some form of universal health care and, for that matter, a variety of other initiatives that states may undertake in their once honored roles as “laboratories for democracy.”

Cross posted at Marquette University Law School Faculty Blog and Shark and Shepherd.