“Then he looked up at his disciples and said: Blessed are you who are poor, for yours is the kingdom of God. Blessed are you who are hungry now, for you will be filled. Blessed are you who weep now, for you will laugh.
“But when you give a feast, invite the poor, the maimed, the lame, the blind, and you will be blessed, because they cannot repay you. You will be repaid at resurrection of the just.”
— Gospel of Luke
Let this spirit of the season descend upon and surround the band of Republican legislators who want to prevent the state of Arkansas from offering medical and hospital insurance to more than 215,000 of Arkansas’ poorest.
There is evidence that a few of them have been moved, if not by the spirit or concern for the poor then at least by other groups that stand to be affected if Medicaid is not expanded to cover childless working poor men and women, but not enough lawmakers have been moved that we can be sure that Jesus’ commandments will be obeyed.
The Medicaid crisis is Arkansas’s own fiscal cliff, but the difference between it and the mindless standoff in Washington is that the remedy here is simple and the consequences of failure are known and documented.
A quarter of a million Arkansans, the poorest of the poor among able-bodied adults, will continue without the assurance of paid medical attention when they are sick; rural hospitals and even some big institutions will be in danger of closing; and thousands of desperately needy people who now depend on the state’s charity—those in nursing homes, institutions for disabled children, the mentally ill, or poor sick children—will be cut loose to care for themselves or to depend upon the charity and care of families or friends.
How Arkansas got into this predicament is a perverse story. Since Arkansas fared a little better than most states in the downturn that began in 2007, its per-capita-income ranking among the states improved a little, which meant that the state had to shoulder a slightly bigger share of the cost of medical assistance to the needy.
Because we were so poor, the federal government formerly paid a bigger share of those costs in Arkansas than in nearly every other state, but the state’s percentage has crept upward each year since 2007. It didn’t affect the state’s budget for five years because President Obama sent the state $825 million from his stimulus package to protect its Medicaid program.
All that money and the state’s Medicaid trust fund will be exhausted by the end of this fiscal year and the state will finally have to pick up the accumulated slack all at once, starting July 1.
State tax collections can’t make up the difference because over the past decade the state has steadily cut taxes that pay for those things. In the wake of the temporary shutdown of the federal estate tax a decade ago, the Arkansas legislature abolished the Arkansas estate tax permanently.
A tax on rich inheritances that had brought in $400 million the previous 10 years went to zero. The state slashed taxes on forms of investment income, virtually eliminated sales taxes on groceries, and excused manufacturers and other corporations from some taxes that others must pay.
Those tax cuts helped offset higher sales taxes to bring public schools up to a minimum funding level. Now Arkansas must find the money to continue the state’s Medicaid obligation or else decide who among the vulnerable it will no longer help. Restoring some taxes is off the table because it is considered political suicide in this climate.
That is where the much reviled Patient Protection and Affordable Care Act—“Obamacare”—comes in. One part of the law that kicks in a year from now expands Medicaid to cover poor childless adults, those with family incomes less than 135 percent of the federal poverty line.
Many states already cover them or most of them, but Arkansas and Alabama cover few destitute men and women unless they are severely disabled. The federal government will pay 100 percent of the cost of hospital and medical care for them until 2017, and then the state’s share goes up a little each year until it reaches 10 percent, where it will stay in perpetuity.
Arkansas is the biggest beneficiary of that program because it now serves so few. Hundreds of millions of dollars will flow into the state annually to pay hospitals, clinics, pharmacists and other practitioners for indigent care, which most of them now absorb and pass along to insured patients through higher fees.
But here is Obamacare’s big salvation, which bedevils Republican legislators who ran against it and promised to do everything they could to thwart it in Arkansas: The law provides that the federal government will take over the full cost of insuring tens of thousands of current Medicaid recipients, relieving the state of tens of millions of dollars annually and providing a windfall to protect all those services it would otherwise have to cut and the taxpayers from a tax increase. But if the state does not expand Medicaid as the law provides, the state would forfeit that subsidy.
That is the dilemma for the Republicans. The U.S. Supreme Court said states could opt out of the Medicaid expansion if they didn’t want to insure poor grownups or didn’t think the state could afford it, but they must take the consequences.
Since those roughly 250,000 people aren’t insured now, Jesus might not have meant that Republicans had to invite those lame and sick to the feast—maybe only those who were already being healed.
Every argument against insuring these people has been destroyed. The state budget far into the future will be helped, not hurt, by expanding the program and taking the federal help.Thousands will not have to be discharged from nursing homes. Hospitals and family doctors will finally get help with their charity care.
So Republicans are left with their pride. Obama-care was the focus of nearly every Republican campaign for public office, and they cannot be seen as cooperating on any part of it, no matter how much good it would do or the harm that would befall the state with its repudiation.
Jesus had something to say about pride, too.
Ernie Dumas, a longtime editorial writer for the Arkansas Gazette, is the dean of Arkansas journalists.
