At Gov. Asa Hutchinson's insistence, the state Legislature met in special session last week to slap around working poor people.
It was thus an expeditious three-day exercise, devoid of controversy, and well in line spiritually with near-simultaneous federal action in Washington.
A new law produced in the special session says that the state, if granted a waiver that seems certain from the similarly anti-poor Trump administration, will throw up to 60,000 people off Medicaid expansion's health-insurance coverage.
The state will boot these people--individuals with incomes between $12,000 and $16,000, give or take--over into the private health-care exchanges with currently generous federal subsidies for premiums. But those subsidies would decline precipitously under the bill Republicans passed Thursday in the U.S. House.
At the Capitol in Little Rock, there was, in fact, concern expressed about transferring from Medicaid expansion to personally purchased insurance policies these thousands of people falling between 100 and 138 percent of the federal poverty definition. The concern was that the action might hurt ... rural hospitals, not the people dropped, though closing the hospital closest to them surely wouldn't do them any good.
It is expected that some of these people won't have the wherewithal or gumption to buy health insurance, or even an awareness that they need to do it. Some of them will get seriously ill and be taken urgently to the hospital. They will incur bills they can't pay because they have no insurance. That will amount to uncompensated care that will put some of these rural hospitals on the track to bankruptcy that they were on until Medicaid expansion saved them.
Perhaps you wonder, then, why the state is undertaking this policy. It's for two reasons.
One is that our private-option form of Medicaid expansion has been too successful. It has enrolled more than 300,000 poor Arkansas people. The program is now starting to cost state government a small match of federal funds, currently 5 percent, headed eventually to 10. If we don't get this enrollment down, please understand, then the state won't be able to keep cutting income taxes.
The other is that the governor and legislators think that these people--not quite so poor as to be called impoverished by a federal guideline--need to show personal responsibility.
Personal responsibility is something one tends to show more of as one has more cash.
A fellow venturing out to a job to make $1,250 a month would, by this new state initiative, lose his Medicaid health plan. He would be expected to exercise the personal responsibility of his $1,250 a month to pay his rent, car note and utility bills as well as ante up for his gasoline and groceries. Then, with the personal responsibility he would have left over, he would be expected to get on his computer and find a suitable health-insurance plan. He would then be expected to buy it with the help of a federal tax credit that the House bill that was passed Thursday would reduce substantially, to $2,000 annually.
The math doesn't look all that draconian to someone making, say, $75,000 a year or more. The poor working man, if young and not beset by a pre-existing condition, might find a policy for $250 a month, since the Republican bill in Congress also would allow states to permit low-benefit econo-policies.
The federal tax credits as reduced by this pending Republican legislation would amount to $166 a month. The state would be asking the man to pay from his pocket $84 a month, give or take, along with co-pays and other cost-sharing.
What's the big deal about $84 to $100 a month? The fellow ought to be able to do that much--shouldn't he?--at least in those months when he doesn't need new tires or a new refrigerator.
Bald tires roll just fine. What's he going to use that refrigerator for, anyway--beer?
He should have thought about those kinds of things back when his folks gave him no education ethic and he didn't have enough money to go to college.
Perhaps a more basic question is whether the poor fellow would ever know what happened to him.
At a recent news conference, I asked Hutchinson if the affected people would be automatically moved to private plans about which they'd be notified, or whether they'd have to take personal affirmative action. He deferred and called up his human services director, Cindy Gillespie. She answered that they'd need to take personal affirmative action.
The state has some experience in that regard. Even as it passed Medicaid expansion, the Legislature refused to accept millions in federal money to hire facilitators to help people sign up for it. They wanted the Medicaid money for the state budget, but not so much for poor people.
But there is some talk now about guiding these dumped people through the transition. It's out of concern ... for rural hospitals.
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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 05/07/2017