Congressional critics, some of them, of the Affordable Care Act (“Obamacare”) were prescient. The most candid of them, in their most candid moments, got it right: a government program that proves popular with the people is almost impossible to dismantle. Call it a new entitlement, call it “government overreach,” call it a life-saver or call it a “job-killer,” call it what you will, Obamacare has survived.
Yes, multitudes of Americans still recoil at the very mention of Obamacare. But, as survey after survey confirms, they like what it does. They like having health insurance for the first time. They like having it despite pre-existing medical conditions that previously disqualified them. And a few other components of Obama’s “signature domestic achievement.”
The “repeal and replace” movement in Washington died at 9:47 Monday night when Senate Majority Leader Mitch McConnell of Kentucky, who can count, counted too few members of his chamber in support of his effort to scuttle Obamacare. It was the second such attempt in less than a month. There were the obligatory gripes about Democrats “refusing to cooperate” but if McConnell can count, so can a lot of other people, and they know the failure owed not to the opposition party but to the deep division within the GOP on Capitol Hill, the Senate especially.
How deep? Consider that Arkansas’s two senators, John Boozman and Tom Cotton, campaigned for their seats with a relentless advocacy for Obamacare’s repeal. Yet by the moment their leader threw in the towel, neither Arkansan had declared for or against either of the repeal bills. In Cotton’s case, his silence was especially notable given than he was among the 13 members of a select ad hoc committee McConnell empaneled to draft repeal-and-replace. Cotton and Boozman each had expressed “reservations” or “concerns” about McConnell’s initial attempt.
All four U.S. Representatives from Arkansas had supported the House version, which was dispatched to the Senate on a party line vote and with the certainty that it would prove un-digestible. Thus they could argue, hey, we did our part; we passed [begin ital] something [end ital].
If Boozman and Cotton preferred to be counted only as “undecided,” they were doing some counting of their own: 300,000 or so Arkansans enjoying the security of health insurance, many through the expanded Medicaid program. They were assisted in their tabulations by their fellow Republican, Governor Asa Hutchinson, horrified by the prospect of a proposed $800 billion reduction in Washington’s contribution to Medicaid. Arkansas’s share of the cut would compel either new taxes at the state level or a serious pruning of services, either destined to arouse political or clinical constituencies. Too, it was Obamacare’s hundreds of millions of dollars, Mr. Hutchinson surely reminded the senators, that helped bankroll his package of income tax cuts. So there are a fair number of Republican officeholders who like Obamacare even if they dare not speak its name, except with disdain.
Consider that Obamacare’s Medicaid expansion in Arkansas, almost a decade ago now, was reconfigured into the “Private Option,” by which Medicaid funds were deployed to purchase insurance for the low-income. It was devised by Republican state legislators (with then Gov. Mike Beebe, a Democrat) and enacted against near-unanimous Republican opposition in the House and Senate.
Upon succeeding Beebe, Mr. Hutchinson declared that the Private Option’s time had passed (it had barely begun). Mr. Hutchinson tweaked it, renamed it “Arkansas Works” and kept it. And wants to keep the essentials of it. Which is to say, the money of it. The McConnell agenda spelled fiscal chaos for Arkansas and the other states which expanded Medicaid.
The governor had some lingering complaints, sure. He wanted more “flexibility” in administering Medicaid; already he has been granted some. And his Human Services Department has resolutely followed his directive to pare the Medicaid rolls to the extent that federal statutes and administrative regulations permit. But: “We can’t just have a significant cost shift to the states because that’s something we cannot shoulder,” Mr. Hutchinson told a national TV news audience.
McConnell now speaks of offering a simple repeal measure, basically the House approach. A non-starter.
So it appears Mr. Hutchinson and the like-minded can breathe easy, and Senators Boozman and Cotton are off the hook.
Three-hundred thousand Arkansans previously without medical coverage have since acquired it because of the Affordable Care Act, a reduction in the number of uninsured not seen in any other state except Kentucky.
And which state would probably be the hardest hit should somehow repeal succeed? Mitch McConnell’s Kentucky. A close second? The Arkansas of Boozman and Cotton — and Asa Hutchinson.