Groups want Walker to have state-run exchange

MADISON, Wis. (AP) - An array of interests that don't normally agree - from the state's conservative chamber of commerce to liberal health care advocates - are united in pressuring Gov. Scott Walker to create a state-run exchange under the federal health care law.
    
But Walker, who faces a Friday deadline to tell President Barack Obama's administration what he intends to do, has been secretive in what approach he intends to take. Walker met privately with advisers immediately after Obama won re-election and had no plans to publicly announce what direction he's headed until after Monday.
    
"The Walker administration is feeling it's still too radioactive for them to touch," said Bobby Peterson, head of the Madison nonprofit ABC for Health, a public interest law firm.  "There's been so much energy placed into repeal and replace Obamacare, to do the 360 required is going to be tough politically. ... It's really hard for them to accept the reality, but they're going to have to at some point."
    
Walker late last year said Wisconsin would not move forward with implementation of the law, pending the U.S. Supreme Court's ruling on its constitutionality. When the court upheld the law in June, Walker said he would wait until after the November election in the hopes Republicans would win the presidency, take over the Senate and overturn the law.
    
But Obama's win has forced Walker and other governors that haven't taken action to decide what to do next. Walker has three choices: create a state-run virtual marketplace for the public to shop for private insurance; let the federal government set it up; or a combination approach.
    
Walker won't say which approach he's taking. Those with interest in the process contacted by The Associated Press say they have not been involved with Walker's administration on coming up with a plan.
    
On Friday, Obama's administration reiterated that states must decide by Friday whether they planned to create the exchange, but further details wouldn't be due until mid-December.
    
Many of those with an interest in the health care law, including Wisconsin's hospitals, insurers, the Wisconsin Medical Society, advocates for the poor and Democratic lawmakers, are unified in calling for Walker to have the state create the system.
    
"Wisconsin must retain authority, flexibility and leverage - tools that will keep us on the path to achieving true reform and preserve our leading edge health care system as a Wisconsin strength," said Eric Borgerding, executive vice president of the Wisconsin Hospitals Association. "WHA believes the correct choice for Wisconsin is steering its own course. That means, to the greatest extent possible, operating a Wisconsin-run health insurance exchange."
    
That is a view shared by Wisconsin Manufacturers and Commerce, the state's chamber of commerce, the Wisconsin chapter of the National Federation of Independent Businesses, as well as the Wisconsin Association of Health Plans, which represents 12 community-based health plans, and advocacy groups that push for even more government control of health care.
    
"Our preference all along has been to encourage Wisconsin to support a state-run exchange, as opposed to a federally facilitated exchange," said Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans, which represents health plans covering about 1.1 million people in Wisconsin. "We think that would put Wisconsin in the best position to preserve and build on the strengths of a strong, competitive market."
    
On Thursday, 18 Democratic state lawmakers wrote Walker a letter urging him to create a bipartisan working group to draft a plan.
    
Wisconsin Citizen Action, an advocacy group that supports a single-payer system, is also calling on Walker to create a state-run exchange but only if it's one that meets certain standards and doesn't allow the sale of inferior insurance.
    
"This could set up a showdown between Walker and federal authorities that could further delay planning for the implementation of health care reform in Wisconsin," said Citizen Action's director Robert Kraig.
    
Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.
    
A recent AP poll found that 63 percent of Americans want states to run the exchanges, with 32 percent favoring federal control.