Gov. Asa Hutchinson announced with seeming pride and satisfaction Monday that he intends with federal permission to throw tens of thousands of people off the state's popular and successful Medicaid expansion program.
Hutchinson said that the affected people--those with incomes higher than the federal poverty line but less than 138 percent of it, meaning generally an annual income between $13,000 and $17,000 for an individual--could go into the health-care marketplace and buy health-insurance plans that are heavily subsidized federally.
But, in Washington, the House Republican leadership was announcing about the same time that its Obamacare replacement plan would do away with those subsidies. It would replace them with much-lower tax credits, the size of which would hinge not on income level, meaning ability to pay, but age, meaning likelihood to need costlier health care.
Let's take a real-life example. Let's use a situation I'm familiar with--mine.
I'll be 64 next year, a year from Medicare. I am self-employed and I purchase wholly nonsubsidized individual health insurance. I'm on my own.
The Republicans' proposed age-based tax credit, from $2,000 for young folks to $4,000 for old folks--in some cases half the size of the subsidy low-income recipients get now--begins to phase down at an individual income level of $75,000, or a family income of $150,000, but not vanish until an individual income level of $215,000.
Because of my age, and because I earn less than $215,000, I appear to be set up under the House Republican plan to take at least some of that federal help that Asa says will exist for the tens of thousands of younger people with individual annual incomes in the $15,000 range that he'll throw off Medicaid expansion.
Somebody give me a high-five. I just ripped off a poor person, aided and abetted by congressional Republicans.
The only viable argument is that, indeed, health problems rise with age, as do, I can attest, premiums for individually purchased plans. But it's hardly fair in the broader policy sense to give me a bigger tax break than the one for a younger man making $15,000 a year and just kicked off Medicaid.
The proposed credits in the Republican plan would make a decent dent, but only that, in annual premiums currently charged in Arkansas. But, in some states, they would get you through only a few months.
The only provision in the Republican plan to address that predicament is authority for customers to buy cheaper plans that cover much less than the minimum standards in Obamacare.
More cost for spottier coverage--that's kind of what the Republicans are offering. Or exactly what the Republicans are offering.
Hutchinson asserted that moving people off Medicaid expansion would better serve his goal of making Medicaid "a transition to work," not a permanent condition.
But it is not clear why a man below the poverty level would take a job paying him a scant couple of thousand dollars more a year than he's getting, only to be rewarded by losing Medicaid in exchange for health-care premiums he can't afford and the subsidy for which is going away.
Meantime, the House Republican plan also caps federal money for Medicaid expansion by 2020, thus punishing the 31 states including Arkansas that chose to accept the expansion.
Four Republican senators from expansion states--Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowsi of Alaska--sent a letter Monday to Senate Majority Leader Mitch McConnell objecting to the House Republican treatment of expansion states.
But not a peep was heard from the Republican senators representing the expansion state of Arkansas. That's probably because John Boozman never makes a peep, period, and Tom Cotton tends to reserve most of his noisemaking for more testosterone-driven issues like war.
It also no doubt reflected that the Republican governor back home was assuring his senators that he was already laying the groundwork to kick enough people off to make the thing work.
Right-wingers are calling the House Republican plan Obamacare-Lite because it doesn't undo the Affordable Care Act entirely. Left-wingers are calling it Obamacare-Mean for reasons outlined here.
After Hutchinson's announcement Monday, I asked state Sen. Bryan King of Green Forest, an arch-conservative Republican and ardent opponent of Medicaid expansion at all, if Hutchinson's announced plan was mean enough for him.
He declined to accept the question in that form.
But he did say he believed everyone ought to be personally responsible for their health insurance.
I replied that everyone ought to get elected to the state Senate.
Legislators may go onto the state employee health plan, which is relatively affordable and generous, and, by the way, funded in part by an employer contribution, meaning taxpayer money, meaning ... a subsidy.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at [email protected]. Read his @johnbrummett Twitter feed.
Editorial on 03/09/2017