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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 Read his @johnbrummett Twitter feed.

Editorial on 10/17/2017

Print Headline: Up on the high-wire

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  • Rightside
    October 17, 2017 at 7:31 a.m.

    Money to pay subsidies was never appropriated by Congress. Under the Constitution, Congress must appropriate money in order for the executive branch to spend it.
    Federal district court judge Rosemary Collyer ruled that the Obama administration’s payments were unlawful.
    If democrats want to fix that law now, they can either make a deal or win elections. It isn't the Republicans that caused the mess known as Obamacare.
    Maybe it was a demagogic and megalomaniacal clown that came up with Obamacare..Obamacare doesn't work. Democrats knew Obamacare would collapse.

  • RobertBolt
    October 17, 2017 at 8:02 a.m.

    America falls further behind the many civilized nations that provide healthcare as a basic right, but as American Jesus said to the leper, "If you can't afford a doctor, heal thyself."

  • mozarky2
    October 17, 2017 at 8:30 a.m.

    "If democrats want to fix that law now, they can either make a deal or win elections".
    Well, they've proven that they can't win elections, so they'd better start dealing.

  • hah406
    October 17, 2017 at 8:35 a.m.

    The people in Arkansas are about to get what they voted for and deserve when it comes to healthcare. Some will likely die as a result.

  • WhododueDiligence
    October 17, 2017 at 9:07 a.m.

    davidscherrey, as Brummett said, Republicans "could have and should have chosen to authorize the subsidies by law" after they failed to repeal and replace Obamacare.
    "Obamacare doesn't work."
    Not anymore. Not after Trump trashed it.
    "Democrats knew Obamacare would collapse."
    How could they possibly know that? The Supreme Court ruled that states could opt out of Medicaid expansion. How could they know that would happen? Then, more than one-third of the states which were in Republican control DID opt out. How could Democrats know that would happen? Arkansas didn't opt out. Arkansas worked within and even wisely improvised within the system, but many other Republicans across the country worked to destroy Obamacare despite the fact that they had nothing to replace it with and despite the fact that American health care costs had been rising at unsustainable levels for decades prior to Obamacare which was passed in 2010. THAT is what Democrats knew.
    And now Trump trashed Obamacare with nothing to replace it. He broke it; he owns it. The do-nothing Republican congress didn't destroy Obamacare except in typical do-nothing fashion by doing nothing to authorize the subsidies. Trump simply dumped Obamacare. So now instead of Obamacare we've got Trumpdump. Trump voters must be so proud. Meanwhile, insurance companies are forced to raise rates. Trumpdump flows downhill.

  • Slak
    October 17, 2017 at 9:19 a.m.

    Little hit on care's cost seen by state; Trump step has Medicaid offset

  • drs01
    October 17, 2017 at 9:35 a.m.

    Kudos to Trump for "forcing" some action on this disaster called Obamacare. America needs some leadership with least Trump has a pair. Americans need to get off this government sugar tit and start taking care of their responsibilities. Trump is forcing that to happen. Yes, this is ugly, but it also is necessary. Here are some truths:
    Health insurance, free or substantially reduced, is not a RIGHT.
    Those of us who understand that should not be burdened with paying for those who think it is.
    Hospitals are one of the most ineffectively managed institutions in this country.
    They have been "subsidized" for years, even before Obamacare
    Insurance providers would never complain about Obamacare because they were getting their own government sugar tit.
    America has 535 worthless bastards in Congress who care more about the "party" than the people they are suppose to represent.
    John Brummett is an elitist hypocrite who is selectively discrediting this president because he can't accept the fact that Hillary and Bill didn't win.

  • hah406
    October 17, 2017 at 10:18 a.m.

    drs01, virtually everything you said, with the exception of the 535 bastards in congress, is not true. Healthcare is a right in every westernized country except the United States. You seem to espouse the idea that if a working man who makes $12.00 an hour and can't afford health insurance has a heart attack and needs open heart surgery, it's his tough luck and he should just go ahead and die because you don't want to "pay" for it.
    Well, that is not how a civilized society works. Maybe if your house is on fire, the fire department will need your credit card, insurance policy, or cash before they start putting it out. Not how it works. We all contribute to the common good. Healthcare is a common good. It makes for more productive citizens and a better society. More important, caring for one another makes us human. But I suspect you are so greedy you only care about you, much like Trump only cares about Trump.

  • TimberTopper
    October 17, 2017 at 10:25 a.m.

    John, you have the haters foaming at the mouth over this one. I expect many more will join in, and it may be your most commented column yet. John, you have to give Putin his due. He didn't want to deal with a Hillary Clinton, as she is smarter than he is, so knowing the general public of America and their weaknesses, and attitudes, he choses to back the person he knows he can control, and out smart. So he buys fake news for those lazy minded Americans to roll in and think they are such great Americans if they vote for Trump. He spends hundreds of thousands of dollars buying their loyalty to the Russian Party candidate,
    and by golly it works. For now the American people are stuck with a person that doesn't have the capability to be POTUS and the leader of the free world. Here we are in the 10th month of the Trump experiment and the biggest winner is Russia's Putin. And as for those lazy minded Americans, they haven't a clue what has happened yet. They just mostly still whine about Obama and the Clintons. Ignorance for them is bliss.

  • Rightside
    October 17, 2017 at 10:40 a.m.

    The number of Americans insured under Obamacare fell by nearly 2 million people between Jan. 31 and mid-March. High costs and lack of affordability were the most common factors individuals cited when asked why they didn't keep their coverage. Ones who aren't getting health care subsidies are dropping out as premiumns keep rising. Barack Obama promised that his health reform plan would "lower premiums by up to $2,500 for a typical family." So it's not surprising that many people are dismayed by the rising costs.