Despite voting to expand Medicaid last year under a modified proposal referred to as the 'private option,' Arkansas lawmakers are having a tough time renewing it, preferring to see over 100,000 poor people closed out of access to health care. Worse yet, the actual expansion has only been in effect for two months.
Two factors are in play right now. First, the state has a requirement for a75 percent supermajority to renew the expansion. Second, and more importantly, Americans for Prosperity has been aggressively operating in the state to end the expansion and defund the so-called "private option".
But the outcome of their preferred policy — ending the private option — is precisely to kick 100,000 people off of the coverage they've gained this year through the private option, and to ensure that around 100,000 more eligible people never gain that coverage at all. It's time for opponents to own that. The press conference introducing the Ballinger amendment last week was a bizarre spectacle. Lawmakers deeply committed to ending the private option offered a "compromise" which explicitly ends the private option, and then stood up there saying they weren't ending the private option. But the really silly part was their insistence that they weren't kicking people off of coverage, as if kicking folks off in December, or in March, doesn't count.
I think it's helpful to think through this in the context of the full debate over the past year. Ballinger and Hendren and others in the hardcore opposition are on the record vociferously arguing that the state never should have enacted the private option to give coverage to low-income Arkansans, that it should be defunded as soon as possible and indeed that they are willing to block the entire Medicaid budget if it includes the appropriation to cover low-income Arkansans under the private option. They do not believe that this policy should be in place to cover 100,000+ Arkansans. They want it to end, and for coverage for 100,000+ Arkansans to end with it. Again, they have sincerely held reasons for that belief but their specific policy goal is to take that coverage away. Every "compromise" they have offered explicitly does exactly that. Taking people's coverage away at a later date than July 1 or hand-waving about some unnamed alternative plan does not provide political cover or change this fundamental fact.
In full-throated cynical Republican fashion, opponents of renewal claim it's somehow cruel to give people access to health insurance under last year's expansion and then take it away, so they simply want to end it altogether, so they don't suffer the political fallout of granting a benefit and then yanking it away.
I think this is the tell about what’s really going on here. It’s not that private option opponents are worried about hurting the people who would be denied coverage – again, they do not believe they should have this publicly funded coverage and ending it is precisely the goal. They’re worried about the political optics of folks losing coverage. That's the only sense in which the distinction they're making makes any sense. Of course a person who needs health insurance would rather have it even for a year than never have it at all. But from the perspective of a politician, taking something away, well, looks worse.
And of course, they all sing the old tune about "replacement" even though they have no intention of replacing anything. After all, these people aren't actually human to them. They're just a drain on the treasury, a reason for them to have to pay some taxes. Let them die, and decrease the surplus population!
The other bit of political cover that Ballinger and co. like to trot out is that they oppose the private option but maybe there is some other magical policy that would cover these people that they would support, if only we end the private option first. "If we have an end to the program, what kind of ideas can be brought in?" Ballinger asked last week. "What can be done to help these people?" But here's the thing: they never, ever, ever offer specific, affordable plans to offer coverage after they take it away. That's despite the fact that the private option has been vigorously debated for a year. The simplest reason for that is likely that they actually have a philosophical opposition to publicly funded safety-net programs for low-income people. They are not offering a plan to provide health insurance for these folks because they do not want Arkansas or the feds to do so.
If they keep this up, they may not like the outcome, because we will get to a point where a publicly-funded insurance plan like, say, Medicare, will have to be implemented on the federal level to pick up the slack states like Arkansas leave behind.
Meanwhile, these tea snorters are perfectly satisfied to see hospitals go bankrupt, people die, and children starve. Because freedom.