Columns » Ernest Dumas

Obamacare's good news boon to its GOP backers



News on the health care front lately seemed heaven-sent for Republican politicians who found themselves on the defensive in this week's primary for having implemented one of the two big features of Obamacare — actually both of them.

It was all good news. After only three months of Obamacare's big initiatives — expanded Medicaid for the very poor and subsidized insurance for those with modest incomes — Arkansas hospitals reported that emergency-room visits were down, the number of uninsured patients treated at the hospitals was down a dramatic 24 percent and the number of uninsured people who had to be hospitalized was down an amazing 30 percent. After the original March 31 cutoff, in spite of efforts by the legislature to stop people from getting insurance, tens of thousands more enrolled in insurance plans, and by the end of 2014 the number of Arkansans without insurance and ready access to medical care will be cut in half. That will be truly historic for a state that throughout its history has ranked at the bottom of unhealthy populations.

Arkansas's rural and regional hospitals have been saved, the charity care they had to write off or pass along to the rest of us in the form of charges and premiums sharply reduced and soon to be virtually eliminated when the rest of the working poor are insured.

It also turned out that, in spite of the insurance companies' alarms and efforts by the Koch brothers and others to discourage young people from getting insurance, lots of them enrolled through Arkansas's private Medicaid insurance or the subsidized exchange, which may mean that insurance premiums in the next sign-up period will not rise and may even fall.

And the nonpartisan Congressional Budget Office projected that Obamacare will cost $104 billion less over the next 10 years than originally forecast and reduce the projected federal budget deficit even more than it had figured when the Affordable Care Act passed. The CBO calculated that Obamacare would cover more people over the next 25 years — roughly 25 million — than it had first forecast.

But most of that is the kind of good news, human news, that Republicans figure to be useless in a primary where true believers — Obama is evil, his deeds malevolent — would dominate. So the Republicans who were targeted by the Koch brothers and others because they voted to implement Obamacare and the private option braved it in the election without recounting how much good they had already done for tens of thousands of Arkansans and the medical institutions that are central to the life of the state.

By now, all the scare stories about Obamacare — pulling the plug on grandma, reduced Medicare benefits, ending doctor-patient relations, government control of medical procedures — have been abandoned and in Arkansas it's down to one: It's going to bankrupt the country and saddle Arkansas with mammoth obligations when the federal government withdraws funding for Medicaid.

That was the attack on the majority of Republicans who had voted to expand Medicaid to poor childless working adults. You will remember that they came up with the idea of converting the Medicaid expansion into basic Obamacare by pushing the uninsured poor into the costlier private insurance exchanges, which was a bonanza for the hospitals and doctors — and patients, too, because doctors are more likely to see them if they will be paid at the higher rates of private carriers.

If the critics were wrong about the original scare stories, they were even more off base with the budget bogeyman. While Medicaid expansion will increase federal spending, overall the health reform act will reduce the federal deficit and, in the case of Arkansas, also improve the state government's bottom line.

The federal government is an unreliable partner, the argument went, and the state one day will be left holding the bag for all or a much bigger share of Medicaid costs. The opposite is true. Owing precisely to the reliability of Uncle Sam, the dollar cemented its future as the world's reserve currency in the global financial crash, counter to conservative economic predictions.

The U.S. has never faltered on its social obligations: Social Security, Medicare, Medicaid or any the rest. The threat, such as it is, comes from the Republicans, including the whole Arkansas House delegation, who have voted to privatize Medicare and turn more of the costs over to elderly patients and to shift Medicaid to the states with declining block grants. If Republicans were to gain a big congressional majority and a cold-hearted president, the threat to the state's budget solvency could come to pass. Otherwise, an Arkansas budget crisis will be of legislators' own making, not Obamacare's.

But the real good news for the GOP Samaritans of the private option lay in the thousands of stories of Arkansas people whose lives were changed since last fall by gaining access, finally, to life-saving and life–improving surgery and therapy. David Ramsey gave the accounts of a number of them in the Arkansas Times, and only the most flinthearted could fail to be touched. Some were returning to the workforce, their optimism restored.

Could it be that when the Kaiser Foundation does its analyses in 2017 Arkansas will no longer be around the bottom in all the indices of health, like deaths per 1,000 people and treatment availability?

Though only private citizens by then, the Republican private-option folks can take quiet satisfaction.

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