Politics depends to an unfortunate extent on popular delusion, and those who practice it most effectively practice it best upon themselves.
Obamacare and Arkansas’s peculiar version of it, the “private option,” furnish a good case study.
Gallup released a survey last week that generated the best headlines for Arkansas in years. “Best state in America: Arkansas …” began the headline in the Washington Post’s political tipsheet. Gallup reported that Arkansas had reduced the number of its uninsured more than any other state since the last big element of Obamacare kicked in last fall.
No one could have been surprised because Arkansas had lagged every state but Texas in the proportion of its people who were uninsured and thus without sure access to medical care when they got sick, so any significant progress would be dramatic. Also, among the states with the highest share of poor, only Arkansas and Kentucky implemented the facet of Obamacare that insures the poorest of the poor.
A year ago, 22.5 percent of adults were uninsured, one of the highest rates in the country, but the share of uninsured had fallen to 12.4 percent early this summer. In other words, the uninsured were reduced by nearly half in nine months. Medicaid enrollment grows by the week, and by next spring, after the second enrollment period for the subsidized private insurance market, Arkansas should have one of the highest rates of medical coverage in the country, which will be dramatic for a state that has always been measured, by statistics and legend, as the unhealthiest place in the union.
The statistics only imply that this is a very good thing because libertarians say government-insured coverage accounts for nothing but bigger government. But progress is actually measurable in human terms. The Arkansas Hospital Association reported that emergency-room visits since the first of the year had dropped 25 percent and that hospital admissions were down even more. That was supposed to happen theoretically as insured people visited the doctor before their illness drove them to the ER and then to an extended charity stay at the hospital.
Back to the politics. Both Gov. Mike Beebe, a Democrat, and Rep. Davy Carter, the Republican Speaker of the House, quickly crafted statements touting the Gallup survey as proof that legislators and the governor did the right thing when they adopted the “private option” for covering Arkansas’s adult poor. Other Republican lawmakers who favored it were proud, and the Arkansas surgeon general, the state’s chief health advocate, said it was a banner day for Arkansas.
The bipartisan bragging was justifiable, but not unreservedly. The private option accounted for most of the gains in coverage but other factors were in play, too. And all of them — the private option, pure Medicaid for the frail, 38,000 adults and families privately insured through the new insurance market, coverage for young adults on their parents’ plans, renewed coverage for people with pre-existing conditions — are traceable to a single act: the Patient Protection and Affordable Care Act of 2010.
None of the statements from politicians even mentioned Obamacare or that the private option was even remotely related, although Beebe made passing mention of the Affordable Care Act. As far as I can tell, every Republican politician in Arkansas has condemned Obamacare to perdition and virtually every Republican candidate for office runs against President Obama and the law that opponents gave the sobriquet “Obamacare.” Beebe and most Democratic officials haven’t uttered a kind word for Obamacare since the tide of ads in 2009 and 2010 convinced Arkansans that it was a plot to take over the medical system, destroy people’s Medicare, empower government to make medical decisions instead of doctors, and ration medical care — none of which were borne out by the law.
The authors of the private option — the government buys insurance for the healthy poor in the Obamacare private market rather than enrolling them in ordinary Medicaid — insist that it is NOT Obamacare. They argue the point so earnestly that they must have deluded themselves into believing it. But it is the essence of Obamacare. Both Medicare and Medicaid have always provided options for private insurance, and a few states have used it for some Medicaid programs.
But even Rep. Tom Cotton, the Republican Senate candidate who has made Obamacare the bedrock of his campaign, acknowledged after the Gallup report that Obamacare had “no doubt helped some people” but that it was far outweighed by the enormous harm to the rest. The people it had hurt: people who had lost their jobs and “access to their doctor.” There is not a bit of evidence that those things have happened. Insurance companies canceled substandard policies of several hundred people last fall rather than give them the protections in Obamacare on Jan. 1, but most of them got better insurance in the market.
Obamacare helped only “some people” in Arkansas? Let’s tally them up:
Two hundred thirty thousand adults who didn’t have it have obtained insurance.
Since 2012 between 125,000 and 200,000 others have shared $17,740,412 in rebates from their insurers, as Obamacare requires when the insurance companies use more than 15 or 20 percent of people’s insurance premiums on overhead, promotion and profits. That’s a lot of spending money circulated in the Arkansas economy.
Arkansas seniors have pocketed some $125 million in drug savings since 2011 owing to Obamacare’s gradual closing of the donut hole in Medicare drug coverage — the threshold where the sick pick up the full cost of their drugs. And seniors can now get preventive screenings at no out-of-pocket cost.
Several thousand children have been added to the Medicaid and private rolls, many because of Obamacare’s directive that no child be denied coverage because of pre-existing conditions, many of them from birth.
Thousands of young adults up to the age of 26 were added to the plans of their parents in 2010-11.
Every Arkansan who has enjoyed health coverage has the peace of mind of knowing, should they ever become aware of Obamacare, that their insurance can never be canceled or their benefits suspended by lifetime or annual caps or be denied insurance for a medical condition.
Obamacare will continue to be an administrative nightmare for the government, as any universal system linking tax credits and private markets is bound to be, but helping only “some people”?