The Republican presidential primary calendar is hitting the midway point, and health care continues to be an on-again, off-again issue for the candidates.
Throughout the contentious primary season, all of the candidates have pummeled President Obama for his signature domestic policy achievement – the Affordable Care Act (ACA). And in turn, many of the GOP candidates have tried to damage front-runner Mitt Romney by attacking the health care insurance mandate he supported as governor of Massachusetts. Experts say voters may be in for more of the same in the upcoming contests in Wisconsin, Maryland, and the District of Columbia on April 3.
Health care will likely be one of the "subplots" of the April 3 primary, said Christopher C. Hull, Ph.D., a Republican strategist and a former adjunct professor of government at Georgetown University.
The remaining Republican candidates will continue to assert that Mr. Romney’s support of the individual insurance mandate in Massachusetts will undermine his ability to attack President Obama and the federal law in the general election. And Mr. Romney’s public comments on the federal law have given his opponents more ammunition, Dr. Hull said. Mr. Romney has used careful language in talking about what he would do about the ACA if elected, saying he would direct his Health and Human Services secretary to give all 50 states a waiver from the law’s requirements. That’s short of an outright repeal of the law, Dr. Hull said.
These charges are most likely to surface in Wisconsin, he said. "Wisconsin is kind of ground zero in the debate that is playing out in the U.S. over the role of government."
The ACA has been a polarizing issue in the state, said Larry Pheifer, executive director of the Wisconsin Academy of Family Physicians, which has members on both sides of the law.
The Wisconsin Academy of Family Physicians has tried to focus on advancing primary care and getting policy makers to address the workforce shortages in the state, Mr. Pheifer said, through better reimbursement for the patient-centered medical home, loan forgiveness, and payment reform.
If health care is able to break through some of the other issues, Mr. Pheifer said he hopes that workforce issues will be part of the discussion.
Another hot-button health care issue that GOP candidates are likely to hear about when they arrive in Wisconsin is the future of Badgercare Plus, a state program that offers health insurance options for uninsured individuals and families who earn too much to qualify for Medicaid. The program, which was originally created as Badgercare in the late 1990s, was expanded in 2008.
Republican Gov. Scott Walker is seeking to raise premiums and tighten eligibility rules for Badgercare Plus to help close a budget shortfall in the state’s Medicaid program.
Mike Herl, chairman of the Republican party in Dane County, Wis., said the discussion surrounding Badgercare Plus is likely to feed into the larger debate over the ACA.
"We don’t want some behemoth program coming down our throats from the federal level," Mr. Herl said.
Gov. Walker opposes the ACA. When he took office in 2011, he immediately authorized the state’s attorney general to join the multistate lawsuit against the health law that was just heard by the Supreme Court. And in January, Gov. Walker refused to accept federal grant money to help establish a state-based health insurance exchange under the ACA.
The April 3 primary also includes GOP presidential contests in Maryland and the District of Columbia, two strongholds of support for Democrats.
Health care is likely to be dwarfed by the economy in these areas, said Elizabeth Rigby, Ph.D., an assistant professor of public policy at George Washington University, Washington. Although health care is a major issue in policy circles, it is not rising to the top of the list for voters.
"The economy is more what is driving people at this point," she said.
The other reason health care is unlikely to emerge as a key issue, Dr. Rigby said, is that D.C. and Maryland are moving forward with their implementation of the ACA with little or no resistance.
The rhetoric around repealing the ACA is unlikely to garner the same reaction in Maryland as in other places, said Gene M. Ransom III, CEO of the Maryland State Medical Society.
"I don’t see it as a big issue," he said.