You get what you vote for. That's how it supposedly works.
Arkansas voted for a demagogic and megalomaniacal clown to become an absurd excuse for a president.
Arkansas thus voted to take health insurance from poor and low-middle-income working people. And it voted to force closures of small rural hospitals to make emergency treatment less likely for heart attacks, strokes and car-crash injuries--common among an overweight population driving on bad rural roads.
We've been tooling along with the artificiality of a smart and progressive policy that, from the beginning, belied our shallow and ill-informed rhetoric.
We passed and re-passed this unlikely policy by finesse, hook, crook and the sheer luck of having a couple of competent governors, Mike Beebe and Asa Hutchinson. They worked with a small group of reasonable and smart Republican legislators, who, somehow, forged grudging and altogether unnatural legislative super-majorities from the prevailing right-wing extremists of their caucus.
I refer to acceptance of Obamacare's Medicaid expansion money--even as we railed against this very Obamacare. I refer to our creative use of the money to purchase private health insurance from the Obamacare exchange for persons up to 138 percent of poverty level, meaning they work, but not for much. The program gave rural hospitals paying customers in place of nonreimbursed care. And it plopped more than 300,000 publicly funded customers into the state's private health-insurance market to hold down premiums for the rest of us.
So, on Friday, President Donald Trump decided that, since he and his party couldn't repeal or construct a passable replacement for Obamacare, he would sabotage it. He would do that by ending cost-sharing subsidies paid to insurance companies to defray their costs for premium-subsidized coverage for low-income and low-middle-income people. The subsidies offset out-of-pocket costs--deductibles, co-pays--otherwise due from lower-income participants buying individual plans on the exchanges.
Trump calls these subsidies payoffs to big insurance companies. They weren't. They were, instead, payments to cover lower-income people's out-of-pocket costs so that they might better afford health insurance.
Without these subsidies, health-insurance carriers will be forced to spike their premiums. State government's cost of buying private insurance for the working poor will rise to the point of financial unsustainability, since the state must gradually assume up to 10 percent of the costs. Political will that was tenuous in the first place will be lost.
A death spiral for an insurance pool occurs when people drop out of it because of rising costs, thus further raising those costs to the point of unaffordability for people trying to stay in the pool.
Trump will call Obamacare a failure after causing it to fail.
Republicans will tell you these cost-sharing subsidies had no specific authorization by law and that Trump had no legal choice but to end them. That's not so. The matter is in litigation and under a stay on appeal.
Republicans, after they were unable to replace Obamacare, could and should have chosen to authorize the subsidies by law to shore up a health-insurance system they didn't like but which, in their ineptitude, they'd left as law for the American people.
Instead, Trump governs by petulance and the Republican Congress governs not at all.
Hutchinson, who has done his level best to keep Medicaid expansion going, will tell you that I am overstating. He and the sane Republican legislative caucus--people like Sen. David Sanders and Rep. Charlie Collins (except on guns)--are saying not to rush to despair.
They're saying we'll be OK for a year at least and that we need to study how it'll go after that. They say we'll still be better off than non-expansion states, which means only that non-expansion states will experience imploding health-care exchanges a little earlier than we will, since, for a while, we'll keep plugging 300,000 or so working poor people into ours.
Hutchinson, bless his heart, is left to the high-wire act of Clinton-speak. He is afraid to oppose Trump, so he says wholly falsely that Trump had no choice but to stop these illegal subsidies. But he says these subsidies are needed and that a bipartisan Congress ought to enact them--although he, a couple of weeks ago, told me that, while he supported the goal of bipartisan Obamacare fixes, I shouldn't hold my breath in the current political climate.
The National Governors Association, of which he is a member, put out a clear statement opposing Trump's intentional imposition of further instability on the health-insurance market.
But Asa must negotiate Trump's wasteland, that being what his state voted to become.
So, he teeters on a shaky high-wire. He's not alone up there. He's joined by 300,000 poor people and a bevy of small country hospitals.
The chance of all of them keeping their balance ... that seems far less than the chance of all of them plunging at once.
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 firstname.lastname@example.org. Read his @johnbrummett Twitter feed.
Editorial on 10/17/2017
Print Headline: Up on the high-wire