Maybe only because it has been six months since the last TV commercials and newspaper ads brandished Frank Luntz's poll-tested slogan "government takeover of health care" national health insurance is enjoying a modest rebound.
Even in Arkansas, where a massive ad blitz to influence Arkansas's pivotal congressional delegation turned the popular idea of universal health insurance into an abomination, the Patient Protection and Affordable Care Act of 2010 is gaining acceptance, sometimes verging on enthusiasm. Arkansas hospitals look forward to its full implementation in four years, when much of their charitable write-offs and cost shifting will end. The medical profession, which once viewed any move toward expanded coverage as socialism and a loss of control over medical decisions, largely favors the new law.
The state government, which must administer big parts of the law, has plunged into the details since its enactment in March and found much that it welcomes, including a huge infusion of cash into the Arkansas economy and even some relief for the severely stressed state budget.
Far from bankrupting the state when Medicaid is expanded to cover poor adults in 2014, as some state officials worried during the furious final deliberations over the bill in the late winter, the law should ease state budget problems until late in the decade, when the state will begin to kick in a small match for billions of dollars in federal assistance for medical treatment and hospital care for low-income adults. Meantime, under an unpublicized provision of the new law, the federal government will pick up nearly the full cost of the original ARKids First, the expanded government-insurance program for children that Gov. Mike Huckabee always proclaimed to be his proudest achievement. Mike Beebe, a state senator in 1997, sponsored the bill that expanded government coverage for children of low-income families.
Governor Beebe said immediately after the Affordable Care Act's passage that he probably would have voted against it had he been in Congress because he feared that it could increase demands on a state budget that was already stressed. He wouldn't say the other day whether he has changed his mind — "water under the bridge," he said — but he acknowledged that the law could produce some dividends for the state government as well as the public. He still is concerned that a sharply expanded Medicaid program will put a significant burden on the state, even if it is eight or nine years away.
"It would be easy for me to say that it will be fine until 2017 or later since I won't be here," Beebe said. "I may not be here next January and for sure I won't be here in 2017. But I have a responsibility to look at the impact things will have long after I leave."
"To be fair," he continued, "the counter argument is that all that federal assistance for health services will produce additional tax revenues because of the increased income for providers." A study of the Medicaid provisions last month concluded that more than $12 billion could be pumped into Arkansas's health-care system in the six years after the law's major provisions are implemented.
If the Affordable Care Act succeeds in insuring nearly everyone — Arkansas is going to administer it better than Washington or anyone else in the country, Beebe promised — then it should reduce uncompensated care and the shifting of costs for indigent care to insured and paying customers and the taxpayers.
When nearly everyone is insured, through Medicaid, one of the other government insurance programs or private insurance, unreimbursed care at hospitals and other providers should be curtailed and that will benefit both state government and people who are currently insured because those costs will not be passed along to them.
"I chaired a hospital board for 10 years," Beebe said. "I know what uncompensated care does. I know they say they don't shift costs, but they do. If you don't cost shift, you're going to be out of business."
Seniors, who according to polls turned heavily against health reform last year owing to reports that they would lose Medicare coverage or see higher co-pays, have been discovering that it wasn't true. The law expands rather than shrinks Medicare benefits. For instance, starting the first of the year Medicare will waive the deductible and co-insurance charges for screenings and other preventive benefits and all 506,000 Arkansas enrollees will be able to get a free annual wellness visit.
The American Association of Retired Persons (AARP), Families USA, a national nonprofit organization that promotes good, affordable health care for everyone, and ministerial groups in many communities have worked to educate people on what the law does and does not do.
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