by Gwen Moritz
Posted 1/27/2014 12:00 am
Updated 6 months ago
A constituent named David emailed state Sen. Bart Hester, a Benton County Republican, to ask him to vote for continued funding of the “private option” Medicaid expansion when the Legislature meets in fiscal session next month. Hester’s response so shocked the young man that he immediately shared it on Facebook, and then it leapt to the blogosphere.
“David,” Hester replied, “I will vote to defund the PO. It is my opinion that it is not the governments [sic] role to provide for able bodied people. I believe the government should provide an environment so the free market can rule and jobs are plentiful so your family can work at a job where they can buy their own insurance.
“If you are depending on the government to provide for you I believe you should change your strategy ASAP.”
As it happens, David was concerned primarily for his 62-year-old father, who he said had been self-employed for about 20 years. His father isn’t old enough for Medicare, he couldn’t get health insurance before the Affordable Care Act because he has a pre-existing condition, and then he couldn’t afford it without the private option that took effect Jan. 1.
Hester, to his credit, continued exchanging emails with David — enough to prove that he didn’t understand the basics of the private option that he was dead-set against. He seemed to think the private option covers families of four earning up to $94,000 a year, when the cutoff for the private option is barely one-third of Hester’s figure. Obamacare does include federal tax subsidies for families earning between 138 and 400 percent of poverty, but Hester doesn’t get to vote on that.
Last year, I was so proud of Arkansas for bucking the trend among Southern states, the rest of which cut off their noses to spite their faces by rejecting the federal dollars to pay the vast majority of the cost of expanding Medicaid.
As originally enacted, the ACA — “Obamacare” — provided premium support for families earning up to 400 percent of the poverty level who don’t have affordable health insurance provided through their employers. Those at poverty (under a definition that hasn’t changed since the 1960s other than to be adjusted for inflation) and just above were to receive health insurance at no out-of-pocket cost under the expansion of government-run Medicaid, while those earning more were to get a sliding scale of tax credits that went to zero at 400 percent of poverty.
But the U.S. Supreme Court ruled that states could not be forced to accept the Medicaid expansion while leaving the tax credits for those earning 138 to 400 percent of poverty intact as part of the federal law.
Perversely, then, states that rejected Medicaid expansion left their most vulnerable working families — those hovering just below to just above the poverty level — with no help at all. If they don’t get affordable (and there’s a definition for that) health insurance from their employers, they aren’t poor enough to qualify for the existing Medicaid program, and they don’t qualify for tax credits because the ACA assumed that they would receive expanded Medicaid coverage.
Arkansas did not abandon its working poor. Aiming at a goal of helping them while appealing to the small-government ideals of conservative legislators, Arkansas’ Republican-controlled Legislature crafted a unique solution of using those available federal dollars to buy private insurance for households earning up to 138 percent of poverty — about $32,500 for a family of four. Surely Sen. Hester would agree with that definition of working poor.
Now our state is on the cusp of taking a giant step backward, taking away the private insurance that just began to provide a modicum of security for people living on the edge. Eventually, if Hester succeeds, the government will strike the perfect balance and create the perfect environment for the free market to produce so many high-paying jobs that no Arkansan willing to work will be too poor to buy health insurance — the price of which has inflated many times faster than wages, which the free market seems eager to keep as low as possible. But until that glorious day arrives, what?
The private option provides a long-overdue lifeline to working people who have not managed to break into the middle class. It also imports hundreds of millions of federal dollars, bringing with them all the usual benefits that new money brings. When the health — in some cases, the very lives — of our most vulnerable workers are at stake, hard-line ideology needs to take a back seat to human compassion and economic realism.
Gwen Moritz is editor of Arkansas Business. Email her at GMoritz@ABPG.com.