Arkansas Republicans in Congress keep voting to end the private option. That's probably not quite how they would put it. But they have continually voted for a full repeal of Obamacare, including ending all funding for the Medicaid expansion. That would mean that the billions in federal dollars coming in to cover the state's low-income residents would suddenly disappear. The funding for the private option would be snatched away and more than 200,000 Arkansans would lose their health insurance.
As Gov. Asa Hutchinson
explained to the Health Reform Legislative Task Force
today, he wants the private option (or whatever he wants to call it
) to stick around. "We need to continue the coverage for the expanded Medicaid population," he said.
So does Hutchinson, who wants to keep the Medicaid expansion going in Arkansas, support the efforts of Republicans in Congress to repeal Obamacare — which would end the Medicaid expansion in Arkansas and everywhere else? KUAR reporter Jacob Kauffman asked the governor today. He responded with the familiar hand-waving:
Everybody thinks it's inconsistent to oppose Obamacare at the national level but then participate in Medicaid expansion. You can make that argument if you wish, but obviously if they do away and make changes with Obamacare at the national level then they're going to have to find replacements and solutions to address what all the states are doing and give more flexibility to the states.
The trouble is, there is no plan to "continue the coverage for the expanded Medicaid population" offered up by the Republicans voting to repeal Obamacare. Kauffman asked whether the governor thought that solutions after repealing Obamacare should include funding to cover those currently covered by the private option in Arkansas.
We're dealing with the cards that have been dealt to us and right now it is the Medicaid expansion population in Arkansas under the framework that the previous administration gave me. We're making the best decision for Arkansas right now. If Congress makes different decisions, we'll deal with those circumstances at that time.
I actually think there's a coherent argument buried in this word salad. It's perfectly reasonable for a state lawmaker who opposes Obamacare to nevertheless decide that saying yes to Medicaid expansion is a good idea for the state. In order to pay for the coverage expansion, Obamacare does various things to raise revenues, such as cutting Medicare reimbursement rates and raising investment taxes on the wealthy. States are on the hook for the Obamacare pay-fors whether or not they accept Medicaid expansion — states that say no to Medicaid expansion pay in
but get nothing in return. That means that, for example, hospitals in a refusnik state like Mississippi get hit with Medicare reimbursement cuts but don't get the billions of federal dollars in Medicaid expansion money that was meant to offset those costs.
Under the circumstances, from the parochial interest of individual states, saying no to Medicaid expansion is just a terrible deal for state budgets and state economies — regardless of what you think of the national health care law. Some anti-Obamacare lawmakers nevertheless turned down Medicaid expansion, but as long as Obamacare is on the books, that amounts to cutting the nose off of state residents to spite Obama's face.
So if someone like Hutchinson wants to say that under current law, he thinks that Medicaid expansion is in the best interest of Arkansas residents even though he doesn't love that law, that's fine. But let's be clear: repealing Obamacare means ending coverage for more than 200,000 Arkansas residents. That's what Sen. John Boozman
and Sen. Tom Cotton
recently voted for. That's what all four Arkansas Republicans in the U.S. House have voted for countless times. They have voted, in practice, to eliminate the private option. They have voted to take health insurance away from the state's poorest residents and return the state to the days when one in four adults between the age of 19 and 64 was uninsured.
Hutchinson has often made a compelling case for maintaining health coverage for these Arkansans. Maybe he ought to convince Cotton, Boozman, and co., who keep trying to snatch it away.