Columns » Ernest Dumas

$$$ over health

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More than 7,000 Arkansans are about to lose their medical insurance because they aren't holding down steady jobs or else they are so aimless and disconnected from today's digital-savvy world that they don't know what is happening to them.

The state assures us, though, that we need not waste any pity on them because they are either layabouts or else just too lazy to find a way to link up with the state's computer and satisfy the Department of Human Services' bureaucratic jargon.

The 7,000-plus who stand to lose their coverage Jan. 1 are just the first wave of poor people who are to lose their coverage because they can't satisfy the state's new work or exemption requirements to stay eligible for Medicaid. July 1 was the deadline for people 30 to 49 years old. Next, people 19 to 29 will have to satisfy the computer's commands.

Actually, that will be the third wave. Nearly two years ago, the state began to prune the Medicaid rolls of people whose lives were so aimless that the state bureaucracy had trouble keeping track of them. That ended coverage for about 60,000 Arkansans.

Governor Hutchinson assured us that the health bureaucracy was doing a great job trying to find and help all those people navigate the bureaucracy.

But, see, there is a silver lining if they all fail. It means the state won't spend millions of federal and state funds — 93 federal dollars for every seven state dollars next year — on the medical care and insurance of tens of thousands of the beggars. That is what appealed to many in the legislature when it adopted the work requirement. They said the state could not continue to spend so much money on the phase of Obamacare that offered medical care to people with family incomes below 138 percent of the poverty line.

The governor and Republican legislators are all trying to shrink the budget in anticipation of slashing the taxes of the well-to-do next January. You can't cut taxes and also continue to pay for education, prisons, law enforcement and poor people's medical care because, unlike Donald Trump, Hutchinson can't by law run a deficit.

The budget scare is something of a ruse. Obamacare, particularly the Medicaid option that Arkansas adopted in 2013, brings hundreds of millions of dollars annually into the Arkansas economy and into the state treasury in the form of income, sales and insurance premium taxes. Lopping 60,000 people off the Medicaid and state insurance exchange rolls means a drastic reduction in premium taxes for the state treasury — from $169 million at its peak in 2015 to $115 million in the fiscal year that ended the first of this month. More big reductions are coming.

Unlike legislators, Governor Hutchinson can't afford to make the budget argument for ending insurance for jobless people. Medicaid law has never, since its enactment in 1965, allowed such restrictions and neither does its amendment in the Affordable Care Act of 2010. The 2010 law allows states to obtain waivers from specific mandates in the law but only as long as they are in sync with the law's basic purposes, which are to bring health insurance to more, not fewer, people or improve the delivery of health care.

Arkansas and the governors of Kentucky, Indiana and New Hampshire asked for the work waiver on the grounds that they were forcing jobless people to get retraining or take other steps to get into the workforce so that they could afford medical care or to buy insurance. We are assisting them, not punishing them, the states argued. Perfect, the Trump administration said.

But a federal court in the District of Columbia ruled in June that Kentucky's argument and Washington's acceptance of it made no sense and halted its enforcement until the Trump administration could make a more convincing case for its legality.

The court will get Arkansas's case before long. The Trump administration will have a chance to make a better argument for Arkansas's tough-love retributions against the poor than it did for Kentucky.

No one who reads this is apt to be in peril of losing his coverage, or even a little sleep, however the legalities of the work requirement come out. But that could change if Republicans prevail in their case to quash the Affordable Care Act in its entirety. Attorney General Leslie Rutledge has joined other Republican attorneys general in seeking to strike down the law as a violation of the commerce clause now that Congress has abolished the tax provisions and insurance mandates in Obamacare.

That would end health insurance for perhaps 400,000 Arkansans, including tens of thousands with pre-existing conditions or with age or sex restrictions that drove up their premiums, all of whom regained coverage in the private market in 2013 when the law halted insurers from discriminating against them. For the disbelieving budget hawks in the state government, it would end a billion-dollar revenue stream from Washington.

But everyone could revel in the destruction of another Obama legacy.

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