Tom Hefty
Tom Hefty, a retired Wisconsin lawyer and former CEO of Blue Cross Wisconsin, follows legal issues in public health policy, especially as they affect the coming attorney general election Nov. 5.
The 2026 race for governor is wide open with nominees and major issues still up in the air. In contrast, the Wisconsin Attorney General’s race is set with a rematch of the 2022 contest between incumbent Attorney General Josh Kaul and challenger Eric Toney, Fond du Lac county district attorney.
While the AG opponents are a repeat, the issues are changing, beyond the traditional law and order topics. The Attorney General has broad, often overlooked duties.
For instance, the issue of the climbing Wisconsin opioid death rate is real, but so far unnoticed. Wisconsin has an opioid death rate above the national average, twice the level of neighboring Iowa and 25% higher than Minnesota. There are more opioid deaths each year here than murders and auto deaths combined
The Wisconsin Attorney General is the master the national opioid litigation settlements with over $700 million coming to Wisconsin. What happened to those funds? Why has Wisconsin not improved in opioid death rankings?
A second missing issue is the role of the AG in high cost of hospital care in Wisconsin. The attorney general enforces the Wisconsin laws on mergers and anticompetitive practices in health care, which both serve to jack prices. The Rand Report in 2024 noted that Wisconsin has the highest hospital charges in the Midwest.
The 2025 Wisconsin WMC report, the Wisconsin chamber of commerce, was titled “an arm and a leg,” a reflection of the soaring Wisconsin health care costs.
Wisconsin has experienced a rash of hospital mergers in the last four years, many of them transferring control of Wisconsin non-profit hospitals to out-of-state holding companies. Over one-half of Wisconsin non-profit hospitals are now under out-of-state control, with new headquarters in North Carolina, Missouri, South Dakota and Minnesota. Every other Midwestern State at least held hearings to review those mergers. Wisconsin was mute.
A recent 2025 University of Chicago economics report, which included as UW Madison professor as co-author, affirmed that those mergers frequently resulted in higher prices.
Perhaps not surprisingly, as control of Wisconsin non-profit tax exempt health care shifted out-of-state, Wisconsin’s national ranking on public health outcomes continues to decline. Under the Wisconsin Charitable Trust Doctrine, the AG has the primary responsibility for examining whether those non-profit organizations are fulfilling their Wisconsin mission, along with examining whether the $1 billion in public health endowments at the two medical schools are fulfilling their intended purposes.
There is a third issue in the Attorney General’s race. The Biden administration in 2023-2004 urged tougher antitrust compliance in health care in reports from both the Federal Trade Commission in 2023 and the Department of Justice in 2024.
In particular, those reports cited the hospital price sharing agreements common in provider-controlled HMO’s and health insurance plans and are widespread in Wisconsin. Even though the price-sharing agreements are a public record at the Insurance Commissioner’s office, there has been no action taken by the AG’s office.
Provider controlled HMO’s now dominate many local health markets. The largest health insurer in Wisconsin is owned by UW Health in Madison. Believe it or not, in violation of normal business practice, the seller of health services owns the buyer—the HMO.
Finally, one issue remains the same as 2022— the management of the State Crime Lab. A recent audit report noted that the State Crime Lab is handling fewer cases with slower response times. The Attorney General’s administration blames the lack of funding, but those funds are available from the national opioid litigation settlements, and drug deaths are a major part of the lab’s work.
The issues of accountability for handling the multi-million opioid settlements, oversight of provider consolidations, the management of the state crime lab should be central in the AG race.
