By Tom Baxter
How do you spell Obamacare sideways? Maybe Insure Tennessee, the name of the new program announced Monday by Gov. Bill Haslam, the third Republican governor to accept the Medicaid expansion since the midterm elections, and one of the most creative in figuring out what to call it.
Haslem has worked for more than a year to forge a deal both the feds and his Republican legislature could accept. In Alabama, Gov. Robert Bentley, like his counterparts in Georgia, struck a more defiant tone, declaring that “the anything but Affordable Care Act has done nothing to gain our trust.”
That was January. Last week Bentley took a more tactical approach, telling legislators he could support the expansion in the form of a block grant, with a lot of strings attached.
We won’t have to worry about such back-sliding here in Georgia, no matter how bad things get, because with the hearty endorsement of Gov. Nathan Deal, our legislature took a burn-your-bridges approach and relieved him from the responsibility to make decisions about Medicaid. This is now the General Assembly’s province, and that’s the end of it.
People cuss Obamacare just as loudly in Alabama and Tennessee as they do in Georgia, but the governors there have left themselves more wiggle room to accept what amounts to a huge revenue advantage over the states that refuse the expansion.
That economic division, between the states that have embraced the Affordable Care Act and those that have rejected it, could sharpen very quickly, depending on what the U.S. Supreme Court decides in the latest challenge to the bill. In this case, opponents of the law have challenged the subsidies being made available in states, like Georgia, that didn’t set up their own health care exchanges.
If the court rules with the plaintiffs, the results for Obamacare would be catastrophic, but all those catastrophes would be concentrated in the 36 states that refused to set up their own exchanges. In those states, an estimated 4.5 million people will lose the subsidies they have used to get health insurance. With that money off the roles, the insurance market for everyday consumers in these states — again, including Georgia — is likely to soar. The collateral economic impact could be severe.
If Obamacare had been a dismal failure up to now, calculating the political consequences of this might not be hard for Republicans. But in fact, millions of uninsured — and with them billions in uninsured expenses weighing on the health care system — have been eliminated. The benefits of this massive savings have been notably slow in trickling down,
but hospitals and insurance companies have seen the impact. And while some consumers have seen sharply higher prices for health insurance, overall health care costs are rising at the slowest rate in years.
National Journal put the GOP’s dilemma neatly in a headline: “If the Supreme Court Breaks Obamacare, Will Republicans Fix It?” The biggest increases in health insurance coverage have come in the counties around the country that vote most solidly Republican.
So if the court invalidates the subsidies as they are being applied now, there will be growing pressure on Congress to put them back, perhaps with the artful help of Gov. Haslam, an expert in rebranding.
Any chance Georgia would change course on the Medicaid expansion part of the ACA went by with the last election, and it never seriously considered setting up its own health care insurance exchanges. But this doesn’t mean Georgia won’t be dramatically affected by the fate of the law. More so, in fact, than otherwise.