It makes no mathematical or philosophical sense. So it bears mentioning that our own Gov. Asa Hutchinson is the national spokesman for it.
He speaks eloquently to the epitome of the absurdity.
Republicans continue to insist on repealing Obamacare. Meanwhile, several of their governors and state legislatures — none more successfully or notably than those in Arkansas with the private option — choose to accept Obamacare’s federal money to expand Medicaid.
They do so even as their colleagues in Washington — even as they themselves — rail about the dire need to kill the host from which they leech.
The New York Times reported Sunday on this affront to math and consistency. It featured South Dakota, Arizona, Indiana, Iowa, Michigan, New Jersey, Nevada, Ohio … and Arkansas.
All of those are states where Republican governors have embraced and imposed Obamacare’s Medicaid expansion while their Republican delegates in Washington have persisted in trying to repeal Obamacare and thus pull billions out from under the governors’ budgets.
Other Republican governors have tried, or are still trying, to get Medicaid expanded under Obamacare in Tennessee, Wyoming and Utah.
Occasionally a Republican in Washington will make a concession to logic and consistency. John McCain, I mean. He has taken note that his Republican governor and legislature in Arizona have chosen to expand Medicaid, and said, “I am very reluctant to take positions that counter the decisions made by the governor.”
We haven’t heard anything like that from Tom Cotton or John Boozman in the Senate or whoever those guys are that we have dispatched to invisibility in the U.S. House. One of them has the first name of French, I think.
But the counterpoint to McCain—the money quote for illogic—came in the Times article from our man Asa.
The Times recounted that former Democratic Gov. Mike Beebe (and a few Republican legislators, I’d add vitally) concocted the private option. It’s the program by which a federal waiver permits the state to take the Medicaid expansion money and use it to buy private insurance for the expansion population.
Then the article recounted that Hutchinson has chosen to try to continue the program, albeit with a few cosmetic adornments suggesting conservatism if the federal government will allow them.
Then there was this quotation from our governor: “I opposed and continue to oppose the Affordable Care Act,” Hutchinson said, but, he added, “we’re a compassionate state and we’re not going to leave 220,000 people without some recourse.”
Thus Asa manages to internalize and personalize the contradiction. He puts it all inside himself. He owns it.
He is the walking contradiction, partly truth and partly fiction.
He is a governor embracing Obamacare money. And he is a governor saying we need to do away with Obamacare.
He is a governor saying we can’t jerk health insurance from 220,000 people. And he is a governor wanting to do away with the federal program that provides the money — 90 percent of it in the long term, but more than that now — that insures the 220,000 people.
The Arkansas contradictions are positively rich. You have former state Rep. John Burris, who was one of three progressive Republican architects of the private option. Then he went to work as political director for Cotton, who opposes Obamacare. Now Burris, a consultant to health-care clients, praises the private option, but only as a brilliant mitigation of the hellish nightmare of Obamacare.
It saves us, you see, from that on which it relies.
It also saves the state $438 million over five years by shoring up hospitals and generating health-insurance business and medical billings and saving the state budget directly by moving many on Medicaid from a 70-30 federal-to-state match to a 90-10 eventual match.
The only way the state could continue Asa’s declared compassion toward 220,000 people if Obamacare was repealed would be for the state, on its own, to move those 220,000 people to private premiums for which the state would pay hundreds of millions of additional dollars year after year.
And Republican critics say Medicaid expansion is unsustainable already, even with 90 percent of it federally borne.
That could only work if indeed the state found some actual way — beyond rhetoric and vague targets for reduced spending — to save hundreds of millions of dollars year after year after year in the overall Medicaid outgo.
Most of that money goes to hospital and nursing homes. And nursing homes have such strong lobbyists that Hutchinson has recommended exempting them from any managed-care reforms on their promise that they’ll reach their spending-reduction targets by their own free will and largesse.
One of Burris’ points is that, separate from Medicaid expansion, Obamacare has so many other costs and regulatory burdens that it amounts to a net loss to taxpayers.
Even if so, that doesn’t begin to address what we do for those 220,000 people, or hospitals, or insurance premiums, or the immediate state budget, if we simply repeal the totality of Obamacare.
The operative cliché is to “mend it, not end it.”
Any law, especially one as detailed and many-faceted as Obamacare, is an ever-fluid issue confronting an ever-assembling Congress. The debate should be ongoing about adjusting the temperature of the bath water, not throwing out all the bath water with the baby in it. Speaking of clichés.
The political dilemma for Republicans is that they can’t fix what they are strung out promising to destroy.
To make something work better you must acknowledge that there is value in salvaging it.
So you don’t mend it. But you do spend it. And you crow that you’re going to end it.
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 jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.