This report will be used in the legislature by opponents of expanding healthcare coverage to the Wisconsin's 530,000 uninsured. The report may be an effective political instrument, but it is flawed social science.
The report resurrects the spectre of welfare migration which the WPRI helped promote as a major political issue in the late 1980s and 1990s when it released two reports on the issue. (For a good analysis of these WPRI reports and its flawed assumptions read "The Wisconsin Welfare Magnate Debate" by Thomas Corbett)
The WPRI's projections of Healthy Wisconsin motivated migration to the state rests on two questionable assumptions.
First, the authors assume that the decision to relocate is a rational economic choice -that people relocate because a state or community has a more attractive package of public goods and services than their current location. Second, they assume that there will be expansion of healthcare coverage at the national or state level before 2015.
The WPRI report assumes that relocation is essentially an individual economic decision driven by the following factors:
cost of living
spending on public education
growth in employment
presence of hazardous waste sites
comfort level of the local climate
state taxation of income
percentage of the population with health care coverage through employers
percentage of the population with health care coverage through Medicaid
The report ignores a body of research that has identified family ties as one of the prime factors in the decision to relocate. Yet, a cursory review of Milwaukee's historic immigration patterns indicates that large numbers of Milwaukee migrants came and come from places like Porticello, Sicily and Crystal City, Texas because they have family connections in Milwaukee. As Corbett noted in his paper on Wisconsin's welfare migration:"... people moved for a number of reasons; the relocation decision was not one-dimensional. Some reasons for relocating-proximity to family and friends, the desire for a better life, and the hope of finding a job-appeared significantly more important than the size of welfare payments."
If the authors are correct that universal healthcare will lure 143,000 to Wisconsin, they need to explain why we haven't experienced a similar migration of U.S. citizens to Canada where health care is a public good accessible to all. Even if we assume that Canada's cold weather is a sufficient disincentive for those from states with more temperate climates, surely tens of thousands would have migrated from northern states such as Wisconsin, Minnesota, the Dakotas, Vermont, and Western New York. That migration simply has not occurred.
Second, the report's projection assumes there will be no other progress in expanding healthcare coverage to the nation's uninsured and that Wisconsin would remain the only state with a universal healthcare program through 2015. Both are highly unlikely.
Only yesterday the U.S Congress allocated $127 billion to provide healthcare coverage for nearly 8.5 million newly uninsured people, the very folks the WPRI fears will move to Wisconsin if Healthy Wisconsin is passed.
Other states like Massachusettes, have already begun expanding health care coverage. If only one other state adopts a universal healthcare program, the WPRI projections would necessarily be cut in half and if 3 or 4 other states enacted similar legislation there would be further proportionate decreases. If Illinois or the Obama administration follows through on its commitment to provide access to healthcare for every American, the migration would disappear entirely.
hroughout American history reforms has often are initiated at the state level. Unemployment compensation, worker's compensation, child labor laws and minimum wage increases were originally developed at the state and even local level. Fortunately, the proponents of these successful reforms were not paralyzed by the fear that raising standards and or expanding coverage locally would attract hordes of unproductive people. But that is the WPRI paradigm.
There are other problems with the WPRI approach. They project increased costs associated with in-migration, but fail to factor in any savings associated with providing universal healthcare to the state's half a million uninsured despite the overwhelming evidence that caring for the uninsured is one of the factors now causing healthcare premiums to soar in the state.
It is not surprising that the WPRI would sponsor a study that undermines efforts to make healthcare a public good. The WPRI is an ideologically driven organization that promotes studies that reinforce its commitment to laissez faire economics. But should we really withhold healthcare from 530,000 uninsured Wisconsin citizens because some ideologues imagine a healthcare invasion?