Tuesday, January 15, 2013

The Arkansas Republican dilemma on Medicaid

Posted By on Tue, Jan 15, 2013 at 9:16 AM

The Capitol is thronged with back-slapping Arkansas Republicans celebrating their ascension to the legislative majority.

Ernest Dumas sprinkles a few raindrops on the parade with the coming decision by the legislature on accepting the federal expansion of Medicaid. He includes a verse from that book the Republicans love to thumb to find an obscure passage that they think supports their general oppression of a sexual minority, even as they ignore the exhortations about helping the needy. He also references two former Arkansas Republican governors who did right by the sick and poor, though at least one of them might contemplate bolting to the Democrats if he were alive today and beheld what the current GOP believes.

(PS — Even wacky Arizona Republican Gov. Jan Brewer wants to expand Medicaid. She proposes a "circuit breaker" to scale back her state's contribution should future federal match diminish, a good suggestion for Arkansas Republicans.)

Dumas this week:

Can we spare a moment to commiserate with the Republican Party?

Not so much the poor national party, so in thrall to its extremist wing that it may sacrifice the nation’s well being by welshing on its debt to drive home the point that the country has been going to hell for 77 years.

No, let’s talk about the other one—the Arkansas party, which is resurgent and giddy over having won control of the state’s lawmaking for the first time in 135 years. As its moment of glory arrives, it finds itself weirdly trapped—trapped by the party’s national and Arkansas past, and trapped between what is unquestionably the state’s best interest on the one hand (and, I might add, what Jesus commands it to do) and on the other hand its hatred of the dark-skinned president and his signal achievement, health insurance reform.

This is the dilemma over whether to allow the federal government to provide medical insurance for some 215,000 poor working adults in Arkansas who in one year will be about the only people in Arkansas who can’t pay for medical attention when they are sick or injured. The U. S. Supreme Court said a state could choose not to accept help for poor workers promised in the Affordable Care Act, and that’s what the Republican lawmakers are—at least were—bent on doing.

Let’s deal with that past first. Not so much elsewhere, but in Arkansas Republicans have been the biggest champions of taking advantage of the promise of Medicaid, the insurance plan for the medically needy that was set up in 1965 to complement Medicare, which insured the elderly and disabled.

Yes, Arkansas’s Wilbur Mills, a Democrat, fathered the whole thing. He and Sen. Robert S. Kerr of Oklahoma wrote the Kerr-Mills Act, signed in 1960 by President Eisenhower, which was the first effort to provide medical help for old people who were too poor to pay for it. States had to help, but only rich states like New York and Massachusetts did much, although Arkansas (Gov. Orval Faubus) matched the 4-to-1 federal dollars to help about 4,000 people, mainly the poor in nursing homes.

Nearly everyone agreed it was a failure, so in 1965, with Mills as the mastermind and more than half of Republicans and most Dixie Democrats opposed, Congress passed Medicare and Medicaid, the first federally financed for the elderly and disabled and the second a joint state-federal program for the medically poor across all age groups. States could choose which categories of the medically needy they would help pay for. Rich states would pay half the costs, poor states like Arkansas as little as a fifth.

Winthrop Rockefeller, the first Arkansas Republican governor since Reconstruction, took office soon after Medicaid became law and asked the legislature for taxes to address what he considered the state’s gravest problems: Too many Arkansans were uneducated and unhealthy. With a few million state dollars Arkansas could take advantage of the Medicaid options and all the federal assistance. The Democratic legislature said no.

Arkansas for the next 30 years funded little more than the mandatory programs: nursing-home care, help for those on public assistance, crippled and mentally disabled children, and a few other categories of indigence.

Then in 1996, a new Republican governor, Mike Huckabee, asked a children’s advocate how he could help unhealthy children. Insure them, Amy Rossi said, and she explained that the state could insure children up to 200 percent of the poverty line and have the federal government pay 75 percent of it. Huckabee jumped on the idea and got a Democratic senator, Mike Beebe, to push it through the legislature for him. Thanks to Huckabee, some 325,000 children are insured through Medicaid. He claimed it as his greatest achievement. But here’s the difference: He wasn’t taking something that Barack Obama offered.

If a Republican governor proposed it or if it weren’t Barack Obama’s program, a lot the Republicans would be jumping to expand Medicaid to the last group of the needy—able-bodied working people whose earnings are below about 135 percent of the poverty line. Others just think it is immoral for the government, with our tax dollars, to be paying for poor people’s medical care and that all of that stuff since the enactment of Social Security in 1935 has been wrong.

Several Republicans raised the lame argument that it will wreck the state budget when the state must pay 5 percent of the costs in 2017 and 10 percent after 2020, but Obamacare’s shifting of other state expenses to Washington and the impact of billions of federal dollars on the health-care system, the economy and the state treasury will more than offset the higher matching. It’s not only a great deal for poor workers, medical institutions and the Arkansas economy but also a great deal for the state budget.

But, alas, you would be seen as surrendering to Barack Obama.

Oh, and for those who don’t think Arkansas or Washington should be helping the poor sick, there’s that commandment from Jesus.

Then he looked up at his disciples and said: “Blessed are you who are poor, for yours is the kingdom of God. Blessed are you who are hungry now, for you will be filled. Blessed are you who weep now, for you will laugh.

But when you give a feast, invite the poor, the maimed, the lame, the blind, and you will be blessed, because they cannot repay you. You will be repaid at the resurrection of the just.
—Luke 14

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