Republican officeholders, in Arkansas and everywhere, have found themselves in an impossible catch-22 — caught between mutually conflicting political demands by their voters. I’m talking about the political dilemma of choosing between the widely hated Obamacare and the highly popular provisions of the Patient Protection and Affordable Care Act.

A recent Gallup poll shows that losing the protections of the Affordable Care Act like coverage of pre-existing conditions is an abiding worry of most Americans, including Republicans, although many if not most Republicans still hate Obamacare, if perhaps only the name.


Obamacare and the Affordable Care Act, of course, are one and the same, known statutorily as Public Law 111-148 of 2010. Most people began to catch up to that knowledge a couple of years ago, in time to sweep out of office in 2018 a bunch of Republican congressmen who had voted repeatedly to scuttle the law. Arkansas’s six members voted over and over to destroy those protections, but Arkansas voters tended to know only that they tried to kill the despised Obamacare. There is political safety in popular ignorance.

The Affordable Care Act/Obamacare sought to offer affordable medical insurance to everyone in the country by expanding Medicaid to cover more very poor adults and helping people whose incomes are between 138 and 400 percent of the poverty line buy first-rate health insurance. That had been the health plan of Republicans in the big battle over health reform in the 1990s, but the Affordable Care Act/Obamacare went further and also guaranteed that health plans would cover everyone’s medical issues, pre-existing or not, allowed young people to stay on their parents’ insurance until the age of 26, expanded Medicare coverage and blocked insurance companies from imposing annual or lifetime limits on anyone’s health benefits.


A massive ad campaign in 2010 labeled the new but complex law “Obamacare” and said it actually was a radical socialist plan to dictate what kind of medical care doctors had to provide each person, scrub Medicare and end health care for old people who seemed to be in the final stages. People would gradually learn that none of it was true but only false charges based on an opinion survey about which phrases really made people mad.

More than 20 million people gained health insurance after the law was passed, although about 15 Republican-governed states still have not yet implemented the Medicaid expansion. More than 400,000 Arkansans gained coverage. Obamacare also pumped nearly $2 billion a year of federal funds into the Arkansas economy, saved dying community hospitals and flooded the state treasury with premium and income taxes. It allowed the new Republican governor and legislature to start cutting taxes of corporations and the well-to-do (while raising them on ordinary consumers).


Last week, the catch-22 dilemma reached a new flashpoint. President Trump’s chief of staff persuaded him that his base was sore that he never fulfilled his 2016 promise to destroy Obamacare, so he ordered the Justice Department to join a Texas lawsuit and get the Supreme Court, which is staffed with fresh Trump loyalists, to scrap the law, take away insurance from the 20 million Americans and end all the protections that so many people of all political persuasions revered. Trump said a team headed by U.S. Sen. Rick Scott (R-Fla.) was going to write a health law for him that would replace Obamacare, cover nearly everyone with better insurance with tiny premiums and would cost the government next to nothing — a mathematical impossibility. He would get the plan before Congress in just a few months. As one Washington jester said, putting Scott in charge was like appointing Bernie Madoff to the Federal Reserve Board. Scott ran the giant hospital company Columbia/HCA until right before a federal investigation concluded that his company had looted Medicare of $1.7 billion, the biggest case of Medicare fraud in history. Scott scurried out of the business and got into politics.

Republicans in Congress panicked. Trump had dropped the health-care noose around their necks again as the 2020 elections were approaching. The Senate Republican leader went to the White House two days later and told Trump it wasn’t going to happen, so Trump said he and Scott would come up with the great health plan much later — say 2021. Meantime, Republicans just had to pray that the loyalist Supreme Court would rule against Trump on Obamacare or else stall the case and delay the catastrophe for 20 million or so voters until after next year’s election.

A wilier Republican than Trump was running the same show in Arkansas. Since taking office in 2015, Governor Hutchinson had walked a tightrope, giving lip service to attacks on Obamacare while also trying to preserve it, by another name, in Arkansas. For five years now, he has persuaded just enough Republican lawmakers who hated Obama and swore to eliminate every vestige of his presidency to vote for the appropriation to continue the biggest aspect of Obamacare in Arkansas. If he failed to get the three-fourths vote in each house every year it would wreck the state budget while throwing 250,000 people off health insurance.

Trump’s first announcement came just as the House of Representatives was about to vote on the appropriation and the same time that a federal court ruled that Hutchinson’s plan to lop off tens of thousands of jobless, infirm and technologically backward people from medical insurance was illegal — as it had always clearly been. The House promptly defeated the appropriation. The governor said he still intended to punish all those poor people but the legislature had to pass his appropriation so the Trump administration would have a reason to appeal the federal court order up to the Supreme Court. That made sense to about 25 recalcitrant Republican legislators, so they passed it.


I could never persuade myself whether Hutchinson believed the nonsense about helping poor people by denying them health insurance or whether it was a way to oblige enough of the angrier lawmakers to continue the Medicaid expansion. His argument in court was that by making proof of fairly steady work or other efforts a requirement for people to continue getting medical treatment and insurance he was forcing them to become better citizens who could afford insurance. That meant that he was meeting Obamacare’s requirement that any waiver had to either cover more people, not fewer, or else improve the delivery of medical care. Hutchinson maintained that since he imposed the requirement, thousands of Arkansans who had once had insurance had landed jobs.
Bureau of Labor Statistics belie that claim. When Medicaid dramatically expanded in 2014 and 2015, both the Arkansas labor force and employment increased sharply. After the work plan was implemented in 2018, both the labor force and employment flattened even while state officials were claiming a spurt of economic growth following the federal tax cut for corporations.

The deception didn’t work, at least with the federal judge, but it achieved its author’s purpose. More than 225,000 people will keep their insurance and others will regain it. Compare that success with Donald Trump’s.