If Rep. Tom Cotton and the rest of the tea-party coalition got their way and actually repealed Obamacare before its new insurance market goes into business Jan. 1, would they be the dog that caught the car?
Over the past 30 months, the House of Representatives has voted 40 times to repeal the law. Now the strategy is to withhold a budget and shut down the government or, as a last resort, refuse to raise the debt ceiling and shove the country into bankruptcy until the president and the Senate go along and repeal the health law.
There is no chance that will happen. Unlike Cotton, most Republicans in Congress don't want to go to the brink because they have seen how the public reacts to such juvenile politics.
But simply to raise the question of what would happen if they overturned the Affordable Care Act illustrates the Hobson's choice that Republicans face with the law that they convinced most Americans to fear.
How would repeal work? Let's narrow it to Arkansas.
The obvious big result is what won't happen. Some 250,000 Arkansans, mostly working adults and their families whose incomes fall below 138 percent of the poverty line, would not get health insurance wholly subsidized by the government except for some out-of-pocket expenses. About that many more people who make more than 138 percent of poverty but are uninsured could not buy an affordable policy in the new private market set up by the Affordable Care Act. Most of them stand to get government help paying the premiums. That option would disappear.
The immediate crisis would belong to the Republican-controlled Arkansas legislature, which will convene in January to adopt a state budget for fiscal 2015, and, of course, to Gov. Beebe. As a result of losing the Medicaid changes in Obamacare, Arkansas's budget for this fiscal year would suddenly be in arrears, and the budgets for the next four years would be about $550 million short.
Remember that Republican lawmakers jumped on the Medicaid expansion in Obamacare, which not only would insure 250,000 of the working poor but save the state's taxpayers hundreds of millions of dollars over the next few years. Obamacare will shift much of the state's share of Medicaid to the federal government and also save the state-supported hospitals tens of millions of dollars a year in charity care. Anticipating the savings, the legislature last spring reduced funding for the University of Arkansas medical center, prisons, the Medicaid division and the Health Department and Human Services Department, which help fund community mental health centers.
Then to soak up the budget savings, the legislature enacted Republican-sponsored tax cuts for the rich and manufacturers. So with all the Medicaid savings suddenly lost with Obamacare's repeal, would the legislature repeal the tax cuts? Not likely, but it would have to raise taxes elsewhere (on working folks) or else make huge program reductions at prisons and colleges or Medicaid programs like nursing homes and children's health care — some $550 million over the next four years alone. That sum represents the loss of Obamacare's state savings on Medicaid, the loss of insurance payments to hospitals for indigents and the loss of tax revenue from premium taxes and income taxes that are to flow into the treasury as a result of Obamacare.
About 31,500 Arkansans on Medicare have saved $42.9 million on their prescription drugs since 2011 as a result of the discounts ordered by Obamacare, and the numbers will grow much larger until the infamous "donut hole" is closed in 2020. If the law were repealed, seniors would see big increases in their drug bills.
About 120,000 Arkansans have gotten rebates from their insurance companies totaling $11.3 million for premium overcharges. They may have thanked the thoughtful insurance companies, which are ordered by Obamacare to do it every year.
Thirty-five thousand men and women ages 19 to 26 got back on their parents' policies as a result of Obamacare. The insurers could cut them off if the law were repealed.
About 1 million insured Arkansans, principally women and the elderly, can get cancer screenings and preventive care free of copays, thanks to Obamacare, but no longer if it were repealed.
Firm numbers aren't available, but up to 170,000 Arkansas children with chronic health problems can no longer be denied insurance coverage on their family's policies. Repeal would end that protection.
Obamacare has lifted the lifetime caps on benefits from the policies of a million Arkansans, and it will remove the annual caps on Jan. 1 — unless it is repealed.
Surely, at some point, Cotton and the others will tell people that these are the horrors they are intent on protecting them from.