Columns » Jay Barth

GOP health care

There is this little thing called the Affordable Care Act that screams "danger ahead" for Republicans in Arkansas.



For much of the past decade, a collection of those of us who study Arkansas politics convene at the annual meeting of the Arkansas Political Science Association for a roundtable where we analyze where Arkansas is politically and where it's heading. We did so again last weekend in Russellville. As our tradition has taken place over a period of unprecedented partisan change, it's been a fascinating ride with insightful scholars of politics. In contrast to previous years where the future of the state's politics was somewhat blurry, we all were clear-eyed last Saturday about the state's probable ruby-red future. While demographic change in Northwest Arkansas may create a point of entry for the state's Democrats over the long haul, in the short run Arkansas feels like a sure-bet for Republicans from the top of the ticket to the bottom.

But, as I noted on Saturday, there is this little thing called the Affordable Care Act that screams "danger ahead" for Republicans in Arkansas. Because of the dramatic success of the Medicaid expansion in the state through Arkansas Works, Arkansas's innovative bipartisan program that has been central to the sharpest decrease in uninsured residents in the U.S., any disruption to the ACA that would bump significant numbers of Arkansans off the rolls could bite Republicans who support it. Moreover, because beneficiaries of health care benefits are disproportionately in counties where white rural Arkansans who have swung so emphatically toward the GOP in the Obama and Trump eras, the impact could be particularly consequential.

On Monday evening, House Republicans released the draft of their replacement to the ACA —the American Health Care Act. Immediately, detractors on both the right and left converged in pejoratively calling the multifaceted bill "Obamacare Lite." Both sides will likely be given ammunition for their arguments when, in the coming days, the Congressional Budget Office presents its analysis that will inevitably highlight the increased price tag and decreased numbers of those covered by the plan as compared to Obamacare.

Most significantly from an Arkansas perspective, new recipients for the Obamacare expansion of Medicaid would no longer be added starting in 2020. Arkansas (and other states) would continue to receive moneys to cover those who were part of Medicaid expansion for as long as they are eligible, but any federal dollars covering their Medicaid coverage would disappear at the moment that they became ineligible. Moreover, a reduction in federal match rates from Obamacare levels almost ensures that Medicaid expansion would come to an end in Arkansas. The changes to Medicaid don't stop there under the House bill. Traditional Medicaid — covering the disabled, elderly population and children — would shift from providing the dollars to states needed to provide comprehensive benefits to recipients to a formula-based funding program. Understandably, many are concerned that such monies would not keep up with increasing health care costs, forcing a reduction in services.

The release of the federal legislation followed an announcement only hours earlier by Governor Hutchinson that his team was seeking significant shifts in Arkansas Works. Most importantly, the Hutchinson administration is asking for a series of waivers from the Trump administration's Department of Health and Human Services to alter how the Arkansas program works. They will almost certainly be approved. Most relevant is the desire to shift those Arkansas Works recipients between 100 percent and 138 percent of poverty — approximately 60,000 Arkansans — away from the program and onto the health exchange where federal tax credits would cover most — but not all — of the insurance costs. Obviously, while much remains unclear about the future of health care reform, what is clear is that a decent chunk of Arkansans will see dramatic changes to their health care insurance in the coming years and some will lose coverage altogether.

The electoral dynamics throughout the Obama years indicates the potency of health care debates in reshaping politics. It seems logical that the threat to coverage found in the AHCA creates similar electoral ramifications, this time to the Democrats' advantage. Four Republican U.S. senators representing states that have expanded Medicaid have already voiced their fundamental opposition to a "replacement" bill that is harsh on Medicaid expansion. No members of the Arkansas delegation have voiced such concerns, despite the success of Arkansas Works. Thus, it will be good politics for Arkansas Democrats to play this health care card nonstop in the coming years. However, Arkansas Democrats can only take advantage of a new political opportunities created by the debate over health care reform at both the federal and state levels if they have viable candidates. That remains a fundamental challenge to Arkansas's minority party as it tries to pick itself up.

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