Columns » Ernest Dumas

Sick health policy

The century-old drive to give everyone access to medical care has a new creed: Success is failure.



The century-old drive to give everyone access to medical care has a new creed: Success is failure.

We now measure the success of health care reform by how many people are driven off health insurance and denied reliable access to care. And success is raging in Washington, where President Trump and Congress have enacted legislation and rules they hope will drive up premiums and co-pays and force millions of people from the insurance rolls.

Governor Hutchinson boasted last week that his health team had canceled Medicaid coverage for 117,000 poor Arkansans in the last year. When Trump's bureaucrats give them permission in a few weeks, the governor can cancel insurance for another 60,000 who can't keep jobs or are deadbeats in some other fashion.

He hopes this will show that he is mean enough to satisfy the party's extreme right wing in the legislature so it will continue coverage for the remaining 285,000 poor men and women on Medicaid under the Affordable Care Act. If they don't, the failure to continue their health care will be just another success for the party.

Hutchinson gave legislators some impressive figures about how many state dollars were being saved by the state's rigorous bureaucratic efforts to find people who didn't respond to queries or otherwise did not seem to meet one or another eligibility requirements the state set up. Talk about a nightmare — that's what it's been for poor Arkansans to get enrolled in Medicaid or a commercial health plan under the Affordable Care Act and to stay enrolled.

From the start, the legislature barred the state from using $10 million sent by Washington to help people navigate the digital complexities of getting insured. If they are that dumb and/or poor, the state says, let them stay sick. It's been that way since the law passed in 2010. Trump last fall halted aid to help people sign up and shortened the enrollment period to make it even harder.

Regardless of the biblical injunctions, if you are poor, sick and unskilled you have no friends at the state Capitol or Washington.

It's worth mentioning here that the president and his party seem to have no interest in continuing the Children's Health Insurance Program, which insures millions of children whose parents earn a little too much to qualify for Medicaid, or continuing subsidies for low-income people who are buying insurance through the ACA exchanges. But men and women in both parties are scrambling to increase the $32 billion budget of the National Institutes of Health by $2 billion for research in genetics and regenerative medicine that may soon produce life-saving and -extending miracles for themselves and others rich enough to afford them.

Hillary Clinton and Sen. Ted Kennedy instigated CHIP in 1997, which may be why the president and his party have no ardor for extending it. CHIP and its Arkansas supplement, ARKids First (started by the liberal Mike Huckabee), have been a bonanza for Arkansas children.

Arkansas still has the unhealthiest population in America, but the Affordable Care Act, Medicaid expansion and Huckabee's little socialist program for children have helped. Arkansas has risen to 47th in infant mortality. It now is better than Mississippi, Alabama and Louisiana.

Arkansas is still No. 1 in obesity, the big killer of the poor. Delaware, where it is much less of a problem, has started to attack obesity and diabetes by having its Medicaid program cover obesity treatment visits.

Did I mention that a new study shows that medical care for the poor reduces crime? Most inmates are in prison at least partly because of substance abuse and most have histories of mental illnesses that are treatable in a good health care system. Arkansas locks them up more than about any state in the country.

But in Arkansas the big drive is to find reasons to deny Medicaid coverage, not extend it. See, those are just numbers, not people. The budget must be shrunk so that the legislature and the governor can further cut the taxes of the well-to-do.

There is some peril for Hutchinson and lawmakers even in that. Sharply reducing the Medicaid rolls reduces federal spending in Arkansas even more sharply — by a ratio of more than 9 to 1. All that federal spending, including paying more than $20 million a year in premium taxes to the state, spurred employment, put the state budget far into the black and allowed them to cut taxes in 2015 and 2017.

Hutchinson hopes Trump will soon grant waivers to impose steady work requirements to be insured and to kick everyone above the poverty line off Medicaid and let them buy ACA policies if they can afford them. A fair reading of the waiver law is that they shouldn't do it. Any proposal must be in line with Medicaid purposes (to provide more people, not fewer, with health care) and not cost the federal government more money. Kicking people above the poverty line off Medicaid transfers the state's costs to Washington.

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