Nothing Better About Better Care Act (Amy Dunn Johnson Commentary)

According to Congressional Budget Office estimates, 22 million would lose their insurance by 2026 under the Better Care Reconciliation Act, the Senate’s long-awaited repeal-and-replace of Obamacare. Here in Arkansas, a state that has seen some of the most impressive gains in coverage since passage of the Affordable Care Act, tens of thousands would lose their insurance. In short, it would be a fiscal and moral disaster for our country and state.

Unlike many states in the South, Arkansas was fortunate in 2013 to see expansion of Medicaid coverage through an innovative program that made marketplace plans available to newly eligible-Medicaid recipients. The Republican-authored private option, now known as “Arkansas Works,” has cut our state’s uninsured rate almost in half. Uncompensated care costs for hospitals have dropped by 55 percent, and more Arkansans are turning to community-based clinics rather than costly and unnecessary treatment in emergency rooms. All indications are that the increase in coverage has worked effectively to slow the growth of health care costs in Arkansas.

Under the BCRA, federal funding for Medicaid expansion programs like the Arkansas Works program would be phased out beginning in 2021 — after the next presidential election. A federal match decrease would trigger a state law terminating the program. State lawmakers would have to act to rescue the program — and then figure out how to shore up what would ultimately be a $526 million hole in our state budget.

Traditional Medicaid would be subject to per-person spending limits, forcing states to reckon with difficult decisions about which essential health services will no longer be covered. Lifetime caps will force Arkansans with serious or chronic illnesses to face the prospect foregoing treatment or bankrupting their families to pay out-of-pocket. Untenable choices such as these will hurt Arkansas families and put a strain on our economy.

Among those who stand to lose the most under the BCRA: seniors, children, the working poor, people with mental illness or disabilities and pregnant mothers. At a time when Arkansas has the third-highest maternal mortality rate in the country and when nearly one-third of our state’s children live in poverty, it is inconceivable that we would pursue a course of action that will only make this worse.

Rural Arkansans will also suffer. For those who rely on their local community hospitals for care, Medicaid cuts will shutter some of these hospitals, forcing residents of small towns to travel further for care and eliminating more hard-to-come-by jobs in those communities.

If Arkansas Works manages to survive the funding cuts, the bill will make our state’s Marshallese community ineligible for coverage that they previously were provided. Arkansas is home to the largest population of Marshall Islanders in the country; an estimated 12,000 live in the Springdale area. Eliminating coverage for a community in the United States that suffers lingering, chronic health problems as a direct result of Cold War-era nuclear tests that our country conducted in the Marshall Islands is unfathomable.

Even though the BCRA purports to retain protections for individuals with pre-existing conditions, it effectively eliminates those protections by permitting states to opt out of certain “essential health benefits,” including maternity care, mental health and prescription drugs. Employer plans could follow suit, meaning all of us have something to lose.

In the end, more people will end up in emergency rooms with catastrophic health events that could have been inexpensively prevented. Uncompensated care will go up, straining hospital budgets. These costs will get passed back to all of us in the form of higher insurance premiums and reduced benefits. We’ll be back at square one on health care reform.

Because states will be left to pick up the pieces once the provisions begin to take effect, our own state lawmakers stand also to lose when they are left to make the hard decisions about which essential Medicaid services must be cut in order to keep the state budget afloat.

We all fare better when Arkansas families have access to comprehensive, affordable health insurance coverage. The Better Care Reconciliation Act would be a decidedly harmful step backwards, not just for those who will lose access to health insurance, but for our entire state.

Amy Johnson is an attorney and co-founder of Harmony Health Clinic in Little Rock. In 2012, she received the Robert Wood Johnson Community Health Leaders Award. The views expressed here are the author’s and do not represent those of her employer or any other organization.