Health Care and the GOP Dilemma (Blake Rutherford On Politics)

by Blake Rutherford  on Wednesday, Apr. 9, 2014 1:00 pm  

Blake Rutherford

Last week the Obama administration announced that the initial targets established by the Congressional Budget Office (PDF) for enrollment in Obamacare had been met. What does it mean? Quite a great deal, actually, when you consider it in the context of other developments in the politically-charged arena of health care reform in Arkansas and elsewhere.

Millions of people formerly without insurance now have it.

One of the early myths promulgated by health care reform opponents was that the new systems – insurance exchanges and Medicaid expansion – would largely cater to people who already had obtained some form of health insurance in the past. In other words, all the exchanges and Medicaid programs would do is recycle existing customers.  

That has not been the case. According to Rand, 2 million previously uninsured people have enrolled in health insurance through the insurance exchanges; 4.5 million previously uninsured have obtained insurance through state Medicaid expansion programs; and 3 million young people now have health insurance because they are permitted to remain on their parents' health plans until they turn 26.

Add that up and 9.5 million people who didn't have insurance before the passage of the Affordable Care Act now do, which benefits the system as a whole, but particularly for hospitals that had to subsidize care for the uninsured.[1]

Gov. Mike Beebe was right to pursue the private option.

Before the U.S. Supreme Court's determination that state Medicaid expansion must be optional, the Congressional Budget Office projected that 17 million low-income Americans would benefit from the program. After the court's decision, it reduced that number to 8 million.

While the debate over the private option, Arkansas' alternative program to Medicaid expansion, will continue into the next gubernatorial administration, today more than 100,000 Arkansans have health insurance because of the innovative solution crafted by Beebe, House Speaker Davy Carter, and state Sen. Jonathan Dismang.  

The benefits it will have on Arkansas health system are well-stated to the point that even presumed GOP gubernatorial nominee Asa Hutchinson has said he will monitor the program in the near term rather than advocate for its repeal.[2]

The insurance cancellation problem was overstated.

Last year the Associated Press reported that 4.7 million people would have their existing insurance plans cancelled without any affordable alternative. That report amped up the opposition's rhetoric. Sen. Ted Cruz of Texas, a frontrunner for the GOP presidential nomination in 2016, said, "The bulk of the people who are signing up had insurance to begin with, and they probably had their insurance canceled because of Obamacare … It is abundantly clear this thing isn’t working."[3]

Of course, that's hardly accurate. An analysis conducted by the Minority Staff of the U.S. House of Representatives Committee on Energy and Commerce illustrates that fewer than 10,000 people nationwide would find themselves in a health insurance no man's land: a cancelled policy without an immediate and affordable replacement.

Support for repeal of the Affordable Care Act is fading.

In January, U.S. Chamber of Commerce president Tom Donahue Sr. remarked, "We're not going to get rid of that bill, and so we're going to have to devise ways to make it work." One month later, at a meeting of the National Governors Association, Republican Rick Snyder of Michigan said, "The whole dialogue on the Affordable Care Act is about people fighting, causing gridlock and a mess, instead of working on something important like wellness."

Repeal becomes less potent as many more people realize the breadth of benefits the Affordable Care Act provides.

For example, according to a story published in The Wall Street Journal in March, health care reform is responsible for an increase in consumer spending and personal incomes. "The Commerce Department reported Monday that consumer spending rose a better-than-expected 0.4 percent and personal incomes climbed 0.3 percent in January. The new health-care law accounted for a big chunk of the increase on both fronts," the story read. So there's good news beyond the millions of people purchasing health insurance.

That, and public opinion is not on the side of repeal. According to a Kaiser Family Foundation poll released in March, only 18 percent of Americans support repeal outright (and with no alternative), while 49 percent want to keep and improve it.[4]

Relentless partisan attacks are having mixed results.

Despite all of this, Republicans have continued their relentless attacks on incumbent Democrats who supported the Affordable Care Act.

Nationally, Americans for Prosperity alone spent more than $20 million in national television ads during the last six months of 2013. In Arkansas where some of that money was spent, GOP Rep. Tom Cotton has made repeal of the Affordable Care Act a centerpiece of his strategy to unseat incumbent Democrat Sen. Mark Pryor.

But it has been met with mixed results, and a new Talk Business-Hendrix College poll released this week showed Pryor leading Cotton 45.5 percent to 42.5 percent.[5] That poll, it is worth mentioning, was conducted three weeks after AFP launched a $700,000 anti-Affordable Care Act ad campaign aimed exclusively at Pryor in Arkansas.


[1] The cost of uncompensated care is unsustainable. The extreme remedy is that hospitals begin to turn away those that do not have health insurance and cannot demonstrate an ability to pay. Republicans in the Arkansas General Assembly may not yet see this as a realistic consequence if they repeal the private option in the upcoming general session that begins in January. They should.    

[2] Since Arkansas unveiled its plan, Iowa also pursued a similarly structured alternative. At the end of February, the governor of Utah unveiled his Healthy Utah Plan based in pertinent part on the work that was done in Arkansas. It is expected to provide coverage for more than 100,000 Utahns. As an aside, the last time a Democrat won the state of Utah in a presidential election was 1964.

[3] In Texas 1 in 4 persons are uninsured, the largest percentage of population in America. By mid-March more than 300,000 previously uninsured people had purchased health insurance. Consider also that Republican-led states of Tennessee, Florida, Idaho, Maine, Michigan, North Carolina, and Wisconsin, to name just six examples, are states seeing a rise in new health insurance enrollees that exceed estimates. In Philadelphia, Independence Blue Cross has more than doubled its customer base since last year. Its New Jersey subsidiary, AmeriHealth New Jersey, experienced a seven-fold increase, according to information compiled by the Los Angeles Times.      

[4] From a policy perspective, is it possible the Republican leadership in the House of Representatives is quietly trending this way? On Monday, it passed a measure that did away with caps on deductibles for small businesses within the exchanges, a measure supported by Democrats and urged by the US Chamber of Commerce, among other influential pro-business groups.

[5] This poll is more good news for Pryor. In February Rasmussen found Cotton leading Pryor 45 percent to 40 percent. One week later, Impact Management Group had Cotton ahead 46 percent to 42 percent.


(Blake Rutherford is vice president of The McLarty Companies and previously was chief of staff to the Arkansas attorney general. You can follow him on Twitter at BlakeRutherford. His column appears every other Wednesday in the weekly Government & Politics e-newsletter. You can subscribe for free here.)



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