I’ll never forget the first time I was exposed to Wisconsin’s progressive spirit on health care policy, probably because I was an Illinois high schooler who came north as part of an internship program to watch a hearing in the Capitol. It was my first real exposure to the legislative process, but I left with the impression Wisconsin just got it — that is, the understanding that serious health care policy reform was something you put off at your own peril.

But last week that image took a serious hit as it became clear the Healthy Wisconsin universal health insurance proposal was not going to be part of the state budget. Democrats in favor of the program seemed cautiously optimistic that the program would make its way onto the agenda in another three or four months, but with Gov. Jim Doyle opposed to the program, there’s reason to believe it won’t get a serious look.

Some people might be inclined to brush off this unfortunate development and to defend the omission of a serious plan for health care reform as sound, realistic budgetary strategy. I tend to see things the opposite way.

First, let’s consider the situation in Wisconsin. The last time systematic surveys of the Wisconsin population were taken (2007), about 9 percent of the population did not have health insurance at some point during the year. Of course, a lot has happened since then. Unemployment in Wisconsin in 2007 was 4.9 percent. Now it is hovering around 8 percent. According to some researchers, a mere 1 percent rise in national unemployment can lead to a 3-4 percent decrease in state revenues, a one million person increase in enrollment in Medicaid and CHIP and a 1.1 million person increase in the uninsured population. The effect of unemployment is presumably worse in states where the insured population depends on employers for their coverage. In Wisconsin in 2007, 77 percent of the non-elderly insured population got their coverage through their employer or the employer of a family member. In other words, Wisconsin’s health is likely to reflect the state of its economy.

In hindsight, it isn’t exactly clear how we all assented to the tethering of our health fortunes to our economic fortunes. Political scientist Jacob Hacker calls it the “Great Risk Shift,” a steady dissolution of secure traditional employer based insurance programs and an increasing reliance on privatized, inherently insecure programs. Even those who technically have employer-based health insurance and are lucky enough to keep their job through tough economic times aren’t exactly fully covered. As Hacker notes, since 2000, “the proportion of employers that finance the full cost of coverage — once the norm — has plummeted, from 29 percent to 17 percent for individual health insurance and from 11 percent to 6 percent for family health premiums.” It’s all happened against the backdrop of greater income volatility for the average American and the average Wisconsinite. In a sense, then, the statistics on the uninsured are misleading because it is only a snapshot; at any given time, people shift in and out of coverage, but the gaps are a real problem if disaster happens to strike at the wrong time.

But the issue isn’t just about the rather sad tales of people who have to forgo medication or medical care they need; it’s also about the economic ramifications of a strained health policy. When people lose their insurance, the health issues don’t stop. In the last three quarters of 2008 alone, Wisconsin hospitals lost 73.5 percent of their total margins compared to the same period in 2007 and that trend is probably continuing as the recession drags on. Moreover, they have had to increase their rate of charity care to 19.1 percent —an unsustainable level even for non-profit hospitals. As it is, Wisconsin hospitals currently get about 50 cents for every dollar they spend on Medicaid patients. As hospitals struggle to adapt to drastically shifting demand-scapes and patients’ diminished capacity to pay, the biggest risk is a massive scaling back of an industry which currently employs thousands and pumps money into the sputtering economy. One can clearly see how even a small pebble can cause a ripple, but this recession is more like a boulder and the ripples could be more like tsunami waves. We need to start seeing that the social safety net is a vital part of the economic picture, not just the moral picture.

Of course, there is always the political dimension to consider. It is likely that some of the Democrats’ reticence about pushing forward on a health care reform agenda now is a reflection of what is becoming an all-too-common “wait for the federal government” strategy. The problem is the federal government is inherently conservative. Building national coalitions to push reform of health insurance is difficult even when you have a popular president, and the programs that come out of the compromises necessary to pass them are difficult to tailor to state needs. Wisconsin knows what it needs, and it should take positive steps to meet them. If there are still things to be debated, surely the existence of a serious problem is not one of them. The state government has indeed done a lot to deserve the designation as a leader, especially in its attention to the problem of uninsured children. But it’s time for Wisconsin to live up to the reputation it gained in more promising times as a leader in health policy, and the first step is to reprioritize the budget and include the Healthy Wisconsin initiative in the budget or bring it up now in some other way.

Dan Walter ([email protected]) is a graduate student in political science