If GOP in, Medicaid out 

A few people in the government and even a few elements of their constituencies have started to contemplate two unnerving questions.

Will Republicans take over the Arkansas legislature after the election next month, and, if they do, will they actually do what they say they will do? They say they will repeal or cut state income taxes and perhaps other taxes and curtail government medical help for the poor and disabled, those programs created in Lyndon Johnson's Great Society and expanded ever since, not just by Barack Obama but even the occasional Republican — e.g., Mike Huckabee.

The first is more than a distinct possibility; Republicans say it is a cinch. The second, that they will whack taxes and public charity, defies logic but you have to take them at their word. This is not your father's Republican Party or, for that matter, even the Republican Party of Mike Huckabee. The ranks have been cleansed of moderates and pragmatists or else they have by necessity become true believers.

Especially in the medical field, people are exploring scenarios for preserving assistance for the poor, aged, disabled and mentally ill if the Republicans gain a majority in even one house, which will give them effective control of the state budget. There are no reliable good scenarios. Taxes are off the table. Governor Beebe has the veto, but in Arkansas it is trumped by a simple majority vote in the Senate and House.

Ironically, the voters who will put them in power are the consumers of all those services that are jeopardized. They like the talk of lower taxes and smaller government. The freeloaders, Mitt Romney's 47 percent, are always someone else, although their parents and loved ones are in nursing homes or institutions and community programs for the mentally and physically disabled, the groups that consume the largest shares of Medicaid, or else Medicaid insures their children for hospital and doctor care.

Medicaid, which serves 800,000 Arkansans and affects that many more family members, faces two big questions when the legislature gathers: (1) Can the state make up a $350 million to $400 million shortfall in state Medicaid match? (2) What will happen when Republicans block the expansion of Medicaid under the Affordable Care Act, which carries some relief for the state's Medicaid crisis as well as insurance for the largest share of the state's uninsured?

Because the state has fared a little better than much of the country since 2006, lowering its poverty rate against the country as a whole, its matching share for Medicaid has risen from 25 to about 30 percent, but only theoretically. President Obama's stimulus act pumped $750 million into the state's coffers for Medicaid from 2009 through 2011, reducing the state's match to 20 percent. It produced state budget surpluses and let the state's Medicaid trust fund grow for two years. Now the trust fund is vanishing and the state will enter the 2013 fiscal year next July needing an extra $350 million or more to maintain nursing home care, the institutions and community services for disabled children and adults and hospital and physician care for low-income children.

To tea-party Republicans, like many Republicans of old, Medicaid is socialism at its worst, the giveaway established in the Medicare act of 1965 that created the "culture of dependency." Because they don't want to be seen as kicking grandma out of the nursing home, there are Republicans who defend Medicaid. Even Mitt Romney seemed to praise it in Monday night's debate although he wants to dump it on the states. But not one Republican will vote next year to levy a tax to maintain medical services, as Huckabee did 10 years when Medicaid faced a similar crisis. They will say take the money from somewhere else; the only prospect is education, and college presidents are contemplating that scenario.

The Affordable Care Act, aka Obamacare, will supply the state another $65 million a year to cover part of the shortfall, but the Republican legislators and candidates have for the most part said they would block the Medicaid option in Obamacare. Mainly, that will prevent medical insurance — fully paid for by the federal government until 2018 — for some 400,000 able-bodied adults who earn too little (up to $30,000 for a family of four) to afford even a fraction of insurance premiums. Blocking the Medicaid expansion would be an economic disaster, keeping hundreds of millions of job-creating dollars out of the state — the equivalent of halting 500 Keystone XL pipelines, a favorite trope of the Republicans.

Then consider the repeal of the income tax, although some Republicans would be satisfied with a gesture — cutting the taxes of higher-income people. A Republican champion of eliminating the tax said last week that it would require a little belt tightening here and there, eliminating the waste and fraud, you see. Some would replace the income tax with a higher sales tax, but no Republican will be caught voting for any tax next year.

The sales tax has been riddled with so many exemptions, the latest being Governor Beebe's groceries exemption, that the income tax now accounts for more than half the state's general fund, which pays for public education (including charter schools), colleges and universities, prisons, law enforcement and all the human services the state provides for the needy and the unlucky.

The good news: I am assured that there will be a half-dozen levelheaded Republicans in the new majority, enough to thwart the outright repeal of the income tax.

So never fear.

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