The delusion of repealing Obamacare


The current travails of Obamacare have heartened Republicans who still think they have a shot at repealing the Affordable Care Act.

But to understand how delusional that thinking is, look no further than Scott Walker’s Wisconsin.

The Republican governor has no use for Obamacare. He’s rejected an expansion of Medicaid. But Walker sees in the law an opportunity.

Because Wisconsin has very generous Medicaid eligibility limits, a lot of citizens currently on the state-run health care plan are eligible to purchase private insurance policies through the subsidized health care exchange. Walker has announced that 77,000 people will be removed from Medicaid and pointed to the new marketplace. These are people with incomes between 100 percent and 200 percent of the federal poverty level.

In turn, about 83,000 low-income Wisconsinites who have been locked out of Medicaid coverage will be added to the rolls, according to this NPR report.

The change initially was to take effect Jan. 1. But because of the technical difficulties plaguing, the federal exchange, the plan is to delay the move for three months.

Walker is taking flack from Democrats and many in the health care community for cutting back on Medicaid eligibility when about half the states so far have taken advantage of opportunities to expand it.

But it’s hard to knock the governor’s plan too much. Everyone will have a means to obtain health care. Many of the people who will transfer from Medicaid to the exchanges are expected to pay premiums of less than $20 a month.

And here’s the point I’m getting at: Throughout America, even in some GOP-controlled statehouses, health care reform is taking shape under the parameters of the Affordable Care Act. It’s not happening as quickly, or as smoothly, as people had hoped. But it is happening.

That’s the great D.C. disconnect. Republicans in Congress huff and hold hearings and shut down the government as part of some vague plan to eventually repeal the health care law. But come the first of April, 83,000 persons in Wisconsin will be receiving Medicaid for the first time, and an additional 77,000 persons should have new policies purchased on the exchange.

Given all the uproar about people not being able to keep their plans, how on earth do Republicans expect to undo everything that’s currently been done?

For sure, they won’t be popular in states like Washington, Kentucky and Connecticut. Based on this essay, governors in those states are right pleased about the rollout of Obamacare, and so are many of their constituents.

If you’re wondering whether Missouri or Kansas could do something like the Wisconsin plan, the answer is a big no.

The Affordable Care Act begins subsidizing policies in the insurance exchanges at 100 percent of the poverty level. The law’s intent was that people with incomes below that line would receive Medicaid. But a U.S. Supreme Court ruling made that optional.

Walker’s plan works because his state’s current Medicaid limit is already above the federal poverty mark. It can actually be rolled back without leaving anyone in an insurance vacuum.

Missouri’s upper limit for adults with children is 19 percent of the poverty level. In Kansas, it’s 32 percent. Since neither state has accepted the Medicaid expansion, hundreds of thousands of citizens with incomes between those ridiculously low thresholds and the 100 percent poverty level mark will be left out of insurance coverage.

Barbara Shelly is a columnist for the Kansas City Star.

©2013 The Kansas City Star

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