Friday, May 05, 2017

EDITORIAL >> What repeal would mean

If you are one of the 25 million Americans, including 800,000 Arkansans, who must worry almost daily about getting medical care and paying for it, this has been a bummer of a week, because your health insurance has been jeopardized. If you need to assign blame, you can start with President Trump and Governor Hutchinson, but there is plenty of censure to go around.

Hutchinson summoned the legislature into town for three days to adopt measures that he hopes will allow him, with Donald Trump’s approval, to kick 60,000 poor people off the state health insurance rolls and assign the cost of taking care of them from state and federal taxpayers (that’s you) to just U.S. taxpayers (that’s still you) and to your struggling local hospital, which will inherit a new burden of charity care.

Desperate to claim victory on something in his first 110 days, President Trump begged his party in Congress to capitulate to two dozen members of its far-right-wing caucus so that the House of Representatives could pass a bill that claims to repeal the once despised Obamacare, although the bill violates every principle for reforming health care that Trump ever espoused.

The bill will never become law, at least in anything like its present form, but the House passed it Thursday with one vote to spare so the president could celebrate.

Now they all count on the nearly evenly split U.S. Senate to come up with something far better and convert it into law before November 2018, when they have to face voters. Trumpcare, as the American Health Care Act and whatever mutation the Senate might produce will be called, claimed only 17 percent approval with voters before Thursday’s vote, half the popularity of Obamacare at even its lowest point.

Our own congressman, French Hill, voted for the bill and praised it lamely and inaccurately. But we should cut him some slack. He hopes to land a big Treasury Department job, if Trump ever gets around to filling all those subcabinet jobs, and a vote against Trumpcare would have killed his chances.

For six years, Republicans were blessed by wide public ignorance of the Affordable Care Act of 2010. It was complicated and poorly defended by the president and Democrats, so people were easily persuaded by the barrage of commercials and flyers that said it was going to destroy Medicare, prevent people from choosing their own doctors and have the government prescribe the care, if any, that people could get. “Socialized medicine,” Republican PR guru Frank Luntz told Republicans to label it.

Those slogans evaporated as people slowly grasped what the big insurance overhaul actually did and what its real problems were—federal subsidies were not big enough to enable millions of low- and middle-income people to pay the insurance premiums. But when Republicans this year had to finally prepare a replacement for the law they wanted to scrap, people saw clearly what they were doing, and they didn’t like it.

Trumpcare does two things Republicans felt they had to do to satisfy their donors and their base: It repeals two taxes on wealthy people (couples earning more than $250,000 a year)—the 0.9 percent payroll tax to shore up Medicare and the 3.8 percent tax on big investment income—and it also ends the mandate that people who can afford it enroll in an insurance plan and that large employers provide employee plans.

Without the mandate, the only customers an insurance company would have are those who are aging and/or sick, and the market would collapse. That is what Republicans want to happen: a collapsing insurance system they can blame on Barack Obama and Democrats. The mere prospect of that happening is undermining the market.

In addition to ending the wealth taxes, a few minor corporate taxes and the mandates, the House version of Trumpcare clears the way for states to end community ratings and allow insurance companies to charge much higher premiums, deductibles and copays to women, aging customers and people with acute and chronic illnesses, which will price most of them out of the market.

Yes, young and healthy people may get lower premiums, if they care to buy insurance at all. The nonpartisan Congressional Budget Office calculated that 24 million would lose insurance over the first 10 years.

The bill would abolish the Medicaid expansion in 2020. That provision added 10 million people to government and private insurance rolls in 31 states, including Arkansas. In its place is House Speaker Paul Ryan’s career-long goal of turning all of Medicaid—for the mentally and physically disabled, aged nursing-home patients, children, nursing mothers and other categories of indigents—into block grants to the states, with the goal of gradually phasing out the program. That potentially could affect more than 800,000 Arkansans who get some help every year from Medicaid.

That is the part that seems to make Governor Hutchinson’s little session futile. Obamacare helps families earning between 138 and 400 percent of the poverty line pay for their insurance through fundable tax credits. Adults making below 138 percent of poverty are eligible for Medicaid, where the federal government pays 95 percent of medical costs and the state 5 percent.

Hutchinson, who faces terrible problems funding existing state services after a long string of tax cuts cut flattened revenue growth, figured that he could shift lots of the state’s Medicaid costs onto the federal government. The legislature gave him authority to seek a waiver from Trump to kick people off Medicaid if they don’t have a steady job or if they earn more than $11,800 a year. They then will have to buy an insurance plan in the market with whatever assistance, if any, the Trump administration agrees to give them. It will not be enough to enable them to keep insurance. They’ll be on their own or else rest on the charity of hospitals.

If Trumpcare goes through in anything like the form passed Thursday, all 320,000 Arkansans on the current plan, not just those earning between $11,800 and $16,284, will eventually be out in the cold.

—Ernie Dumas