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Blame Arkansas 

If the last chance for health-insurance reform in this generation perishes, our little state and its quailing delegation in Washington will take a large measure of the blame — or the credit, if you think the 481,000 uninsured Arkansawyers and the insurance industry deserve mutually to be left alone.

Last week, Rep. Marion Berry bailed out on health reform after casting a vote in November that gave the most liberal version of reform its narrow victory in the House of Representatives. Like his East Arkansas colleague, Sen. Blanche Lincoln, who has seemed to be backpedaling after voting for and helping write the Senate reform bill, Berry got an earful from constituents in his native Delta who are enraged that he would side — on anything — with the black president with the alien name.

Mike Ross, the delegate from South Arkansas, reaffirmed that he would not be caught voting for any health bill that his party might produce although the bill that may go to a vote in the House next week meets just about every precondition that Ross ever raised: It expands coverage to nearly everyone in his district, lowers the nation's budget deficit, stops insurance abuses, helps small businesses afford insurance, protects Medicare beneficiaries, hospitals and doctors from cuts, imposes tax obligations on only a few hundred of the richest people in his district and starts to stem the spiral in health-care costs.

No one in the Arkansas delegation has been more forceful or eloquent in championing comprehensive health reform than Ross, who has chronicled stories about people in South Arkansas who suffered unbearable hardship from the loss of insurance. You can still hear him talk earnestly about the urgent need for reform on a TV show that he taped last fall. But since he could not satisfy both militant sides in the health-care debate Ross resolved to go with the loudest and meanest side and vote against any bill that came out of the crucible.

To say one thing, do exactly the opposite and get credit for both is a marvelous political skill, but it will earn you no due beyond the next election.

Senator Lincoln hasn't fully recanted her vote but she says she will fight a procedure that would allow a final vote in the Senate.

That leaves Sen. Mark Pryor and Rep. Vic Snyder as the only unapologetic advocates of a reform that most people in Arkansas have wanted for 40 years.

With Republicans and Southern Democrats pretty much united to stop any initiative, Arkansas's little delegation is likely to be the one that kills it just as it was the one that passed the bills in November and December.

The distinction for Arkansas will be perversely ironic in a couple of ways.

The more stalwart forebears of the Arkansas delegation gave the country the great pillars of economic security for the elderly, Sen. Joe T. Robinson of Lonoke when he guided old-age, survivors, disability and unemployment insurance into law in 1935, and Rep. Wilbur D. Mills of Kensett, who drove Medicare and Medicaid through a bitterly divided House 30 years later. Only a few tea partiers and Republican candidates for the Senate would reverse those achievements.

Had Mills and Richard Nixon not almost simultaneously fallen to scandal in 1974 they would have produced a universal health insurance system, and 35 years later it would be as politically inviolable as Social Security and Medicare. The bills in the House and Senate today are close replicas of the Republican and Mills-Kennedy plans of 1974.

But the crueler paradox is that Arkansas would be the runaway winner among all the states if some version of the Senate health bill became law. Because family incomes in Arkansas are so low and current programs so weak, a larger proportion of people would qualify for new Medicaid coverage in Arkansas than any other state, another 323,000 would get help or tax credits to pay insurance premiums, 89,800 elderly seniors would see their drug costs drop, and 506,000 seniors would get preventive health services.

Very little of the burden of paying for all those benefits for Arkansawyers would fall on Arkansas. An excise tax on so-called Cadillac insurance plans, typically written for big union shops or for individuals with no concern for the cost, would touch only a handful of people in Berry's and Ross's districts. Those are policies valued at $24,000 a year for families and $8,900 for individuals, and people in high-risk occupations or who are retired would have even higher thresholds. The tax would be levied on insurance companies or administrators.

The other tax would be a small Medicare payroll levy on couples earning more than $250,000 a year and individuals earning more than $200,000, and the tax would apply only to income above those thresholds. Berry and Ross can name nearly everyone in their districts who would pay new taxes. Their federal taxes have fallen dramatically the past 10 years.

Berry and Ross said they couldn't vote for the Senate bill because of its “liberal” abortion provisions. The bill is tougher than the current federal law. No tax money could ever be used to pay for abortions. The bill would allow states like Arkansas to ban abortion coverage in private insurance policies, including those bought with federal subsidies, and it would require that if any policy bought with a federal subsidy through the insurance exchange added abortion coverage to a policy it would have to be bought out of pocket in a separate rider.

Abortion is a transparent figleaf. If life were their big concern they would be thinking about the hundreds in their districts who die each year because they cannot afford medical care. They don't buy ads railing about government takeover of health care.

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