The Medicaid charade explained | Arkansas Blog

Tuesday, May 2, 2017

The Medicaid charade explained

Posted By on Tue, May 2, 2017 at 11:35 AM

These are perilous times for the working poor and others who now enjoy health care coverage thanks to Obamacare. At the state and federal level, decisions of consequence are being made. Ernest Dumas explains how harm is likely, accompanied by blame-shifting by those in power to the unworthy layabouts, not excessive tax-cutting

By Ernest Dumas

This is another perilous week for the 30 million Americans, including some 550,000 Arkansans, whose health and financial conditions form a nexus that torments their daily existence.

That does not overstate the importance of the quick little session of the Arkansas legislature called this week by Gov. Hutchinson and also of Congress's haste to give President Trump something—anything—that he can claim fulfills his pledge to repeal "Obamacare," the disparaging nickname that was supposed to sink the health-care reform known as the Patient Protection and Affordable Care Act.

Nothing that passes in the Arkansas legislature or the U.S. House of Representatives will actually repeal the law, but they will undermine it in the guise of preserving popular features while shifting the blame to somebody for all the eventual harm.

As Trump remarked in February after someone tried to explain to him what repealing Obamacare entailed, "Nobody knew health care could be so complicated."
Private insurance, which is how Obamacare arranges for people to pay for their medical care, is indeed complicated—and too expensive, as Trump and other mental giants have observed.

It's no simpler, but let's deal with Arkansas's part of this little political crisis. Leave the spectacle over repealing or thwarting Obamacare to another day after it is clearer what mess the president and a feckless Congress make of it.

Arkansas is a shining example of Obamacare's success. Some 400,000 Arkansans were insured under some feature of Obamacare, dropping the share of people who are uninsured under 9 percent. The market and premiums remain stable in spite of the Republican-controlled state government's efforts to keep people uninsured. Unlike Social Security, Medicare or your employment insurance, signing up for an "affordable" insurance plan is daunting, but the legislature in 2013 blocked the use of $10 million in federal assistance or any other funding to help people find a suitable plan and calculate the tax credits that would help them enroll.

Still, some 350,000 poor Arkansans enrolled in the Medicaid feature of Obamacare, the vast majority in private plans where premiums are paid by government. To prove his conservative and Trumpian bona-fides, Hutchinson wants to boot 60,000 and probably many more off insurance, to save some taxes down the road and because he is sure that lots of these poor people are layabouts who don't deserve medical care. Good medical care should be reserved for solid Americans who can afford it or at least can hold a steady job.
Obamacare tries to make insurance affordable by offering subsidies in the form of tax credits to people whose incomes are between 138 percent and 400 percent of the poverty line. Studies showed that people below 138 percent of poverty could not afford any premium payment and those above 400 percent could begin to handle premiums without help. Those below 138 percent of poverty would be treated through Medicaid.

The legislature is adopting Hutchinson's plan to cut off help at the poverty line, forcing people up to the 138-percent threshold to buy the same pricey policies as those above it, probably with no extra federal subsidy. Few will be able to do it. Federal law does not permit the state to lop people below 138 percent of poverty off Medicaid, but everyone is sure the Trump administration will OK it anyway, because it achieves the goal of leaving more people without insurance, demonstrating Obamacare's "failure."

The major goal of healthcare reform was to get more people insured, including the unemployed, people with mental or physical disabilities and pre-existing conditions, young folks with marginal earning capacities and people in the jobless countryside without the skills or wherewithal to seek their fortunes elsewhere. Hutchinson is setting up a worthiness scale—a regular job, which is popular with people who think the poor are irresponsible and undeserving of society's succor.

The special Medicaid session is happening because the legislature since 2008, then under the leadership of Gov. Beebe, began cutting taxes, leaving the state increasingly unable to keep up with the needs of education, law enforcement, highways, corrections and the bare social services the state tries to provide. They starved the treasury of $455 million while promising that the tax cuts would produce economic miracles that would fill the treasury to overflowing.

Obamacare and Medicaid expansion were a savior. They flushed a billion federal dollars into the state treasury and the economy. When Obamacare kicked in, in 2014, it helped add 46,000 to the work force, often as people got their disabilities treated and returned to the job market, and some 10,000 jobs in the health industry were created.

All that and Hutchinson's tax savings may be for naught, if Trump and Congress succeed this month or later in torpedoing Medicaid and crashing the insurance exchanges by making policies unaffordable for the poor and those with pre-existing conditions, all for the sake of claiming they undid something else wrought by the illegitimate black occupant of the White House.

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