MARGARET WARNER: This past year, the struggle to enact health care reform was fought by the president and the Congress in Washington. Now, with the law on the books, the battle to shape it has expanded to include states and the courts.
This week, we report from two states that are taking sharply different approaches since the election -- first, Wisconsin. New resistance there is aimed at many aspects of the law, especially at a program the law aims to expand to cover more people: Medicaid.
NewsHour health correspondent Betty Ann Bowser has our report.
BETTY ANN BOWSER: Every December, children flock to the Capitol Building in Madison to see Wisconsin's state holiday tree and its sea of dazzling colors.
But inside the halls of power these days, there's only one color that resonates: red. That's because, on Nov. 2, Republicans made a political clean sweep, taking the governorship, the state Legislature, two U.S. congressional seats and a U.S. Senate seat away from the Democrats.
And one of the issues that turned Wisconsin from blue to red was health care.
SCOTT WALKER (R-Wis.), governor-elect: We all live in Wisconsin together.
BETTY ANN BOWSER: Within days of his election, Governor-elect Scott Walker made it clear he will go to court to challenge the new federal health care reform law.
The incoming leadership in the Legislature is behind him 100 percent.
Forty-six-year-old Republican Scott Fitzgerald is the new majority leader in the state Senate. His younger brother, Jeff, will be speaker of the Wisconsin Assembly.
SCOTT FITZGERALD (R-Wis.), state senator: We now have, obviously, with the Republican governor, the ability to allow our attorney general to join in on the nationwide lawsuit.
BETTY ANN BOWSER: They expect the state to join 20 others in a federal court case in Florida. That suit challenges the constitutionality of the provision in the new law that requires most Americans to buy health insurance.
SCOTT FITZGERALD: What it will do is, you know, kind of change the debate here. And so far, that debate has been about: How will it be implemented? How will we adapt? What effect will it have on the programs that we already have in place?
WOMAN: Under your tongue, please.
BETTY ANN BOWSER: Both brothers fear the new law will mean higher health care costs, at a time when Wisconsin has a $3 billion budget deficit, high unemployment and a ballooning Medicaid population.
SCOTT FITZGERALD: We're scared to death about what's coming down the pike as we still try to grasp exactly what impact Obamacare will have on Wisconsin.
BETTY ANN BOWSER: What are you scared of?
JEFF FITZGERALD (R-Wis.), state representative: We have a problem with the cost of health care. That's the real problem at hand. And there's nothing in there that's going to curb costs. We would like to see a market-driven health care economy put some stuff into place that will make it consumer-driven again. And, unfortunately, what we see is just more bureaucracy.
WOMAN: Like, my leg is visibly swollen.
BETTY ANN BOWSER: One of the programs Republicans want to cut is Medicaid. In Wisconsin, it's called BadgerCare. Jason Stein covers the statehouse for The Milwaukee Journal Sentinel.
JASON STEIN, The Milwaukee Journal Sentinel: Medicaid here in Wisconsin is a multibillion-dollar program. One in five people in Wisconsin are on some form of Medicaid, whether they're in a nursing home or they're receiving long-term care at home or they're receiving health care, what we would typically think of health care, at a doctor, at a clinic, at a hospital. Right now, this program has expanded dramatically over -- since 2007.
BETTY ANN BOWSER: The recession has driven thousands of the unemployed to sign up for the first time, dramatically increasing the size of the program.
BOBBY PETERSON, health care activist: It is a very challenging thing for politicians to take away health care coverage from people.
BETTY ANN BOWSER: Bobby Peterson is among a group of health care activists who think Republicans will make it harder for people to qualify for Medicaid. They have organized Save BadgerCare, bringing in advocates from all over the state to lobby against cuts.
MAN: Mistakes are made, and we certainly would not want you to fall through the cracks.
BETTY ANN BOWSER: The new recipients are childless adults, a category not covered in most states. But under a waiver obtained from Washington last year by outgoing Democratic Governor and health-care reform supporter Jim Doyle, BadgerCare was expanded to include them -- 64,000 new people qualified for the program. Today, another 80,000 are currently on waiting lists.
BOBBY PETERSON: They're going to increase the hoops and hurdles for people who are trying to get through the program.
BETTY ANN BOWSER: Like what?
BOBBY PETERSON: More administrative barriers. So, instead of saying, you know, we can let you sign up online on the Internet, we're not going to do that anymore. You have to go to the county office to sign up. Instead of paycheck verifications for the last two paychecks, we will say the next four paychecks.
BETTY ANN BOWSER: Matt Vogel is a childless adult who signed up last summer. He suffers it from chronic pancreatitis and has been unable to hold a steady job. Before he qualified for the program, he had no insurance.
MATT VOGEL, Wisconsin: I don't have to worry if I have to go to the E.R. because I'm having an attack. I can look them in the eye and I know they're going to get paid. I know, and that's a big help. I don't feel like a pariah.
BETTY ANN BOWSER: But Vogel and thousands like him could be dropped from the program next year if he makes too much money.
DR. Ian Gilson, internist, Medical College of Wisconsin: How you have been?
Dr. Ian Gilson is an internist who has been seeing a rash of new BadgerCare patients like Vogel. He says many of them hadn't been to a doctor in years, although they suffered from serious conditions, like diabetes and hypertension.
DR. IAN GILSON: We got these people, for the most part, straightened out. We got proper lab testing. We got them on the proper medications. Their diabetes improved. Their blood pressure came down. In some respects, they're actually feeling better. But we also knew that, as we were doing this, we were preventing disasters down the road.
BETTY ANN BOWSER: Governor-elect Walker has not been specific about what cuts he would make to BadgerCare, but he gave a hint at one of the gubernatorial debates this fall.
SCOTT WALKER: I think it's appropriate over time to move people into jobs, so that the dollars we do have for Medicaid could be spent on people truly needy in our state. And I will continue that as governor.
BETTY ANN BOWSER: The NewsHour tried repeatedly to get a one-on-one interview with the governor-elect, but a spokesman turned us down, citing scheduling problems.
And although Wisconsin Republicans complain about the growing Medicaid population, federal stimulus money is helping pay for much of it. That money protects family coverage, so states cannot change eligibility standards right now.
But when the stimulus money runs out next July, Wisconsin then would be allowed to change some categories of eligibility, potentially ending coverage for about 70,000 parents and childless adults. Then, in 2014, when key parts of the federal health reform law kick in, federal money is expected to cover nearly all of the new people who qualify for Medicaid in most states for three years.
Until then, states are struggling to close large deficits, and they must follow the rules to continue receiving their current and new federal assistance.
JON RICHARDS (D-Wis.), state representative: One of the big issues that we have here in Wisconsin is money.
BETTY ANN BOWSER: Democratic state Assemblyman Jon Richards, who's about to lose the chairmanship of the assembly's Health Committee to a Republican, says there's a lot of money on the line for Wisconsin, $4 billion a year in federal-matching funds the state could lose if it tampers too much with Medicaid.
JON RICHARDS: We're running a huge budget deficit. And every time they talk about turning back the federal health care law, they're talking about blowing a huge hole in our budget that they're going to have to fill because our constitution requires to us have a balanced budget.
BETTY ANN BOWSER: Besides Medicaid, states like Wisconsin will also be able to control how they set up health insurance exchanges, places where people can go online, compare insurance plans, and buy affordable coverage.
Pam Herd is an associate professor of public affairs at the University of Wisconsin.
PAM HERD, associate professor of public affairs, University of Wisconsin: Scott Walker has made it pretty clear that he wants a very, very limited regulation of plans that participate in the exchange. And the state, it doesn't look like, at least, will get really involved in terms of negotiating on behalf of citizens for things -- for -- for benefits and the cost of the plans.
BETTY ANN BOWSER: The Fitzgerald brothers want the exchanges to be free market-driven, with a minimal amount of state government involved.
SCOTT FITZGERALD: The slower we can proceed and kind of get our ducks in a row, the better off we will be. If the exchange is driven by, ultimately, you know, government bureaucrats making the decisions that are currently made by some of the private sector health insurance corporations, it's going to put us in a bad position.
BETTY ANN BOWSER: And brother Jeff doesn't want to see Wisconsin have to do what some say the federal government will have to do, hire more people to administer portions of the law.
JEFF FITZGERALD: Just the -- the figure that's staggering to me is just to -- you know, from the IRS standpoint, 15,000 new employees have to be added just to, you know, administer Obamacare and look at the tax implications.
BETTY ANN BOWSER: Democrats in Wisconsin say they will fight efforts to turn back health care reform, including cuts to Medicaid. So, the winter ice may be long gone before the future of the state's medical plan is clear.