The private option — the state’s unique plan using Medicaid funds to purchase health insurance for low-income Arkansans — has provided coverage to 150,000 Arkansans (and counting). The funding mechanism for the private option is Obamacare, and repealing Obamacare is at the top of Rep. Tom Cotton‘s agenda. Repeal Obamacare, and the private option dies with it.
At today’s presser, I asked Cotton about this.
“We would repeal Obamacare and replace it entirely with many reforms for our health care program,” Cotton said. I asked whether he had a specific replacement plan which would cover all the folks who would lose their coverage if Cotton succeeded in repealing the law. He trotted out some tried-and-true Republican talking points which would do no such thing, such as allowing insurance to be sold across state lines. “We want every Arkansan, we want every American, to have quality, affordable access to health care,” Cotton said.
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Okay, but the thing is, Cotton offered no details on a plan that would cover the people that the private option does. Similarly, Cotton’s platform offers repeal Obamacare + hand-waving.
As lots of folks have pointed out over the last month, Republican candidates are coming to terms with the fact that repealing Obamacare means that millions of people would lose their coverage — so they vaguely say they’ll sweep in some replacement. Every American should have access to quality, affordable health care, says Cotton! But the details never come, in part because, as one GOP aid put it, “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act.” Once you start dismantling Obamacare’s pay-fors and policy mechanisms, you start diminishing coverage. At least Rep. Paul Ryan was honest enough to admit that repealing Obamacare means repealing the popular parts (and most of the provisions in the law are very popular), not just the unpopular stuff. That means a lot of people who have gained health insurance under the law would lose it.
In short, unless and until Cotton offers a detailed plan to cover the 150,000+ Arkansans who have gained coverage under the private option, the impact of his policy stance would be that those folks would lose that coverage.
Of course, many Republicans in the state would prefer to repeal Obamacare, but given the state’s options with the law in place, concluded that the private option was the best approach. I asked Cotton: under the circumstances, does he think that the state made the right decision? Much like Asa Hutchinson, he declined to take a position.
“The private option is a state-based issue,” he said. “Once we repeal Obamacare, Arkansas, like every state, will address its own needs, hopefully with a Medicaid system that has been returned to them and lets them address their needs for the entire state.”
As Max has pointed out in this space many times, Cotton’s political director Rep. John Burris (now on leave from the campaign as he runs for state Senate) was one of the key Republican architects of the private option. But I think a simpler explanation for Cotton’s bobbing and weaving and refusal to take a position on the issue is that, like Hutchinson, he wants to straddle the fence. The last thing Cotton and Hutchinson want to do is piss off the Tea Partiers in their base who loathe the private option — but they also have to appeal to moderates and independents who might view the policy favorably. Thus Cotton says it’s a “state-based issue” and Hutchinson says it’s up to the legislature, and who knows what they actually think on one of the biggest policy questions in the state of Arkansas.