Columns » Ernest Dumas

Obamacare, finally


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The Patient Protection and Affordable Care Act, aka Obamacare, celebrated its third birthday Saturday, and you get the feeling that the infant that was so widely unwanted after its difficult birth is gaining family adulation as it develops a personality and character.

Even diehard Republican legislators who demanded an abortion and then, after President Obama signed it into law, wanted it euthanized are showing signs of accepting the little girl as part of the family.

They aren't saying so, mind you, but they are claiming to have imparted some winning personality to the creature themselves. They got Governor Beebe to go to Washington and talk the secretary of health and human services into having poor adults obtain coverage from private insurance companies on the Obamacare exchange rather than through the state-operated direct Medicaid program, which must have been one of the easiest feats any governor ever undertook. The federal government, i.e., taxpayers, will pay for it either way (quite a bit more under the Republican plan), but 250,000 poor working adults will for the first time be insured against illness and accident, which was all that presidential candidate Obama had promised in 2007, when he outlined a plan for universal coverage.

Now, what only a month ago seemed impossible — three-fourths of the legislature voting to spend federal money to insure poor working men and women — may be in reach. Hospitals, doctors, many employers, businessmen who see a windfall in the huge federal stimulus and, yes, the insurance industry are thrilled.

Simply because they personally are benefiting, tens of thousands of Arkansans have become converts since March 23, 2010, when Obama signed it and made a few provisions effective immediately. The rest will take effect on Jan. 1.

Thanks to Obamacare, perhaps 20,000 young Arkansans through age 26 were added to their parents' policies. Tens of thousands of people have received at least one free preventive service, like a mammogram or a flu shot, because Obamacare guaranteed free preventive care. Insurance companies have been required for two years to cover children with pre-existing conditions, and the companies have had to send millions of dollars in rebates to Arkansas policyholders because they kept excessive profits from premiums last year. The state has gotten money to expand community health centers. New retirees and their families have retained coverage from employer plans through Obamacare's reinsurance program. The law stopped insurance companies from canceling the policies of people when they get sick.

The happiest of all should be those of us on Medicare. Obamacare already has provided prescription discounts to many beneficiaries. Most Medicare clients have had their payouts for drug coverage reduced by Obamacare, which will continue until the hated "doughnut hole" is closed in 2020.

Obamacare ended the lifetime limits on the amount of payout by private plans for any patient. After roaring through the Bush years, medical inflation has flattened, but no one can be sure how much Obamacare is responsible.

Hundreds of thousands of Arkansans who have been helped by all those and other changes may not know that Obamacare was responsible, but many do.

When Obamacare was enacted, it was unpopular in many parts because the chamber of commerce, some industry groups, the Republican Party and right-wing groups saturated the media with attacks that told people it was going to destroy Medicare, deny people their choice of a doctor and a hospital, and sentence old people to die if they got sick. None of those was even remotely true, but the propaganda worked.

If you attended one of the town-hall meetings conducted by congressmen in 2010 you heard people wailing about losing their Medicare, being required to go to a doctor they didn't like or having treatment ended when they got to a certain age.

Can we review the political history briefly? All the Democratic candidates for president in 2008 promised to enact universal insurance quickly if they were elected, just as every Democratic candidate had for more than two decades. Polls showed overwhelming national and Arkansas support for it. Obama was the first to outline an actual plan, and it was based on Mitt Romney's Massachusetts law and the Republican plan of 1993-94, which First Lady Hillary Clinton, who was in charge of her husband's health initiative, had rejected.

Her plan and her intransigence were blamed for the Democratic Party's losses in the 1994 elections, which brought the Republicans to power in Congress for the rest of her husband's presidency.

Oh, that matter of how to treat the 250,000 poorest adults: Obama's original plan, outlined in 2007, was to provide private coverage to the uninsured through federally regulated markets and to expand eligibility for Medicaid for those too poor to afford insurance. Medicaid permitted low-income people to obtain coverage through private plans, though states rarely implemented it because private policies were expensive. That's why the HHS secretary said "sure, no problem" when Beebe offered the Arkansas Republican plan.

It was true Obamacare.


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