COMMENTARY

Yum … pretzels of progress

We have discovered the mother lode of irony. It runs under the Arkansas state Capitol.

Our state’s legislative Republicans, who hated the Affordable Care Act as much as anyone, are now in the national vanguard of advancing its very essence.

Our state’s legislative Republicans, who resisted Medicaid expansion on the argument that the federal government couldn’t afford it, are now marching boldly into that vanguard with a plan that could well cost the federal government more.

It all suits me splendidly. And the governor likes it fine. And Arkansas hospitals love it. The state’s health insurers are looking at new business. And state Human Services officials are thinking, gosh, this is strange, but maybe it’s fine, even swell.

By the way, poor people could well get better medical service.

The only negative factor is that the deficit-riddled federal government may have to borrow more money, especially if other states start demanding the same deal little ol’ Arkansas is getting.

How supremely strange. Here in Arkansas we have surely the most inexperienced Legislature in the country. Yet now it gets visited by national journalists wanting to study this Arkansas innovation.

The key to sustaining these new Republican legislative majorities in Arkansas is a demonstrated ability to govern effectively. Nonsense over abortion and guns imperiled that objective. But leading the rest of the nation into the health-reform vanguard might help.

Just to refresh: The central point of what is often called Obamacare is the notion that our health-care system can begin to settle down if everyone gets insured.

The pathway was three-laned: Americans would be mandated to buy insurance in the private sector. Exchanges would be set up to provide arrays of private plans that the government would subsidize for low-income people. For the very poorest, Medicaid, which is a federal-state partnership, would be expanded from the bottom upward to 138 percent of the federal poverty level. That would be done at full federal expense for three years and mostly federal expense thereafter.

Republicans opposed it on all counts, but now they’ve essentially lost or relented on all counts:

  1. They said the individual mandate was unconstitutional. But the U.S. Supreme Court said it was constitutional.

  2. They resisted state-run insurance exchanges. But now they are glad to have one in Arkansas, at least one in partnership with federal exchanges, because of the forthcoming No. 3.

  3. They said Medicaid expansion would bankrupt the already debt-riddled federal government and burden Arkansas with steep new expenses after three years in a program that already has exploding costs.

But now they cheer new permissions to use that same amount of federal money, or likely more, though not to expand Medicaid. It is to run all these poorest people out of Medicaid and into this new state-federal exchange. It is to use that federal money to buy all the poor folks’ private health insurance outright, in full, for three years.

Republicans want to sunset all of that after three years to let a new legislature take stock and decide whether to keep going.

In other words, Arkansas Republicans have successfully prevailed on Gov. Mike Beebe to prevail on U.S. Health and Human Services Secretary Kathy Sebelius to let Arkansas use that federal money and perhaps more to embrace the original essence of Obamacare.

Remember that original essence: It’s getting everybody private health insurance.

Sebelius told Beebe that would be fine. I figure she wanted to get poor people in Arkansas covered, whatever it took.

For the record: Republicans negotiated on the sticker price and likely dickered it up.

Why do I say that? Let me answer by asking a question.

Take an able-bodied, middle-aged person. He’s the primary person to be covered by this plan since kids and senior citizens, who go to the doctor more often, are covered otherwise by ARKids First and Medicare. Which is likely to be higher for him—his health-insurance premiums over a year or what he actually incurs in direct medical costs for going to the doctor a time or two a year for an antibiotic for his sinus infection?

The insurance would cost more, usually. That’s the very idea of health insurance. It needs to rack up on healthy people so it can afford the actual costs of really sick people.

Why would Arkansas Republicans—led by such young conservative eminences as Sen. David Sanders and Rep. John Burris—embrace this notion, which they call “premium support?”

It’s because they are slaves to their rhetoric. They promised the Tea Party rally back home that they would never expand government. Oh, no. But it turns out they’ll use the same amount of federal deficit money or more to expand the semi-socialized private sector.

The Republicans’ argument is that they have simultaneous plans to tighten up basic Medicaid. It’s also that competition, which they say is better, conceivably could produce new and low-cost kinds of private health insurance for able-bodied poor people.

It turns out their objections to Medicaid expansion weren’t matters of cost, but concept. Putting a poor man on Medicaid is bad, they say. Paying his private-sector premium is good, they say.

It’s fine by me.

Poor folks are going to get covered. Health care will become more efficient, with fewer uncompensated costs eaten by all of us. The Arkansas economy will be awash in new federal money. Our struggling hospitals likely will get reimbursed more generously by private insurance than by Medicaid. And private health insurance might get some of these poor folks in for covered wellness checkups every year whereas Medicaid would merely wait to pay when they got sick.

So what’s happened is that our legislative Republicans have let their rhetoric tie them into pretzels of progress.

I stand back in curious wonder and applaud.

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.

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