WASHINGTON — Two years after President Barack Obama signed a health-care overhaul into law, and on the eve of extended arguments at the U.S. Supreme Court to test its constitutionality, the tug-ofwar over the act continues as feverishly as ever.
As provisions of the law have started to take effect, such as a prohibition against denying coverage to people with pre-existing medical conditions, proponents of the law argue that it will becomea popular mainstay of the federal government.
But opponents of the law, including every member of Arkansas’ congressional delegation except Democratic Sen. Mark Pryor, say the program will be too costly. They argue that the law’s “individual mandate” requirement that people buy insurance represents a power grab by the federal government.
Today, the Supreme Court will start three days of oral arguments in a series of cases that challenge the individualmandate.
Arkansas’ U.S. Rep. Steve Womack, a Republican from Rogers, said the entire law ispredicated on the mandate - something he called “an overreach of government.”
If the court finds the mandate unconstitutional, the Affordable CareAct “becomes more or less a house of cards,” making it easier for Republican lawmakers to repeal all or some of the act, Womack said.
Supporters of the overhaul, including Rich Huddleston, president of Arkansas Advocates for Children and Families, say the law has already helped “thousands of Arkansans.”
Huddleston said other major pieces of legislation, such as the creation of Medicare in 1965 or the Civil Rights Act of 1964, also were controversial early on.
“Whenever we’ve had big policy changes, at first there was opposition,” he said. “The more people experience the benefits of the health-care law, the more they’ll like it.”
Last week the Obama administration released figures showing that at least 23,837 Arkansans became insured under a provision in the law that allows parents to keep their children under age 26 oninsurance plans provided at the parents’ jobs.
The figures showed that 36,178 Arkansans on Medicare received $250 rebates to help cover pharmacy costs when they reached the “doughnut hole” - a gap in coverage under the federal program. The rebate, along with a 50 percent discount on prescription drugs for those people resulted in a total savings of just under $20 million for Medicare recipients in Arkansas, the administration said.
Womack isn’t convinced that the law’s benefits will become a valued “entitlement” like Social Security or Medicare. Those programs have been called the “third rail” of politics. Because of their popularity among recipients, it is politically difficult to change them.
If the Supreme Court finds the individual mandate constitutional, rolling back the law “becomes a little more problematic,” Womack said. “But I don’t think you can make it a third-rail item.”
Arkansas’ U.S. Sen. John Boozman, also a Republican, agreed.
Boozman said the law’s supporters thought it would become more popular over time. “I think the exact opposite has happened,” he said.
Boozman said that for small businesses the uncertainty surrounding the law’s potential cost is their “number one concern and one of the chief reasons for not hiring people.”
In January 2011, the Republican-controlled House voted to repeal the entire law. Since then, they’ve taken on bits and pieces of the law, such as a successful vote Thursday to abolish the Independent Payment Advisory Board, a panel created by the law to try to control Medicare costs.
Arkansas’ U.S. Rep. Tim Griffin, a Republican from Little Rock, said that insteadof making systemic changes in Medicare, creation of the board will result in cost cuts and, eventually, the rationing of medical services.
“That is atotal cop-out,” Griffin said.
Griffin said that if the Supreme Court finds the mandate unconstitutional, Republicans will continue to press on their attempts to change or repeal the law. That effort won’t become more difficult as more Americans receive benefits, he predicted, but the outcome will depend greatly on which party wins control of both chambers of Congress and the White House.
“That will obviously have a huge bearing on what happens,” he said.
Pryor defended the Independent Payment Advisory Board panel.
Before passage of the law, he said, “people were at themercy” of private insurers.
“The huge insurance companies are either denying coverage, or nickel and diming them.”
Arkansas’ U.S. Rep.Mike Ross, a Democrat from Prescott, voted against the bill two years ago.
Although he said there are some good things about the law, such as the mandatory pre-existing condition coverage and the extension of coverage to young adults whose parents are on an insurance plan, the perception that the bill was “crammed” down people’s throat had muddied the water.
“It was so big, and lengthyand so controversial that it was easy for folks to distort or twist what it does,” he said. “We need to clean the slate and start over.”
In an update last week, the Congressional Budget Office revised its estimates on the effects of the law and raised its projections on how much the law will cost over 10 years. But Congress’ nonpartisan accounting arm also predicted that the law will not increase the budget deficit as much as previous projections.
According to the budget office, the law will cost a total of $1.49 trillion between 2012 and 2021, which is about $50 billion higher than previous estimates. The new estimate shows revenue from penalty payments and an excise tax on high-premium insurance plans adding $1.08 trillion to the federal budget during that time period, down from the previous estimate of $1.13trillion.
By 2016, the agency predicted the share of the non-elderly population with insurance will rise from 82 percent to 93 percent as a result of the law.
According to a draft report issued in January by the Arkansas Center for Health Improvement, the new law could stretch Arkansas’ already thin staff of health-care providers. Currently, 36 counties in the state are considered “health professional shortage areas.”
The report says the estimated 328,000 people who will participate in insurance plans as a result of the Affordable Care Act will place “additional strain” on the work force.
“People who are insured use the health system more frequently than the uninsured, and initial need may be higher due to pent-up demand from people who have been uninsured,” the draft states.
Lisa Sharp, owner of Nightbird Books in Fayetteville, hopes the health-care exchanges called for in the law result in lower premiums.
She and her husband dropped the insurance plan offered through his job as an architect in 2009. She said the plan’s out-of-pocket cost increased 250 percent over 10 years and became too expensive.
“Every year it would go up, just when it came time to renew,” she said. “I’m looking forward to the exchanges so we can find something that’s affordable.”
The new setup is too costly to the state, said Teresa Oelke, state director of Americans for Prosperity, a conservative advocacy group.
The state, already grappling with hundreds of millions of dollars in Medicaid funding shortfalls in the next few years, will see an additional 250,000 Medicaid enrollees as a result of the law. The federal government will pick up their tab for a while, but after 10 years, the state must start sharing the costs.
“It’s unaffordable, and it will bankrupt the state,” she said.
As the Supreme Court justices hear arguments this week, lawmakers on both sides of the aisle will be watching closely.
Whatever the outcome, Arkansas’ U.S. Rep. Rick Crawford, a Jonesboro Republican, said GOP lawmakers will continue efforts to turn back theoutcome no matter how the court rules.
“Conservatives are galvanized on this point, that we need to repeal and replace, and not to let the Supreme Court do our work for us,” Crawford said.
Front Section, Pages 1 on 03/26/2012