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Tuesday, January 27, 2009

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.

Posted by Richard Esenberg on January 27, 2009 at 10:59 AM | Permalink

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Comments

Rich, if you're interested in the mobility/residency-requirement/local social welfare conundrum, there's a fairly brilliant article by Richard Stewart from the 80's that's directly on point. I thought about writing such an article at one point, read Stewart, concluded that he had already said everything (including, of course, much that had never occurred to me), and stopped.

Posted by: BDG | Jan 28, 2009 10:13:29 AM

I agree this

Posted by: health | Jan 28, 2009 12:12:45 AM

"..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..."

I cannot agree more. It's hardly that employees will even favor this program.

Posted by: shieldon | Jan 27, 2009 9:17:21 PM

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