LITTLE ROCK — Republican state legislators urged the Beebe administration last week to go slowly and methodically on deciding whether to expand Medicaid under federal health-care reform.
They also called for figuring out how to run Medicaid more efficiently before we consider making it larger.
They made these pronouncements in a publicly released letter for which they could have saved the stamp.
For all the obvious and common sense their missive seemed to invoke, what they offered was more a matter of tactical politics than tangible policy. It was more vapid than valid.
Go slow? Be methodical? What do they think Gov. Mike Beebe has been doing for months now?
The governor says he is inclined, but only that, to have the state participate in Medicaid expansion. But he says he first needs the federal government’s answer to a question: If the state participates and accepts full federal funding for three years and 90 percent federal funding thereafter, can it pull out of the expansion later if it runs into a budget crisis?
It is such a good question-and such a fiscally responsible one with implications for all states-that U.S. Health and Health Services Secretary Kathleen Sebelius is going very slowly and being very methodical in answering it.
Meantime, the Beebe administration has been working for two years on efficiencies in existing Medicaid, doing so without so much as a lifted pinky of cooperation from state Republicans.
The Beebe administration has received a conditional federal waiver for a pilot Medicaid project to pay for a few selected medical treatments with bundled payments covering various elements of treatment for health conditions. In other words, Medicaid would pay a kind of lump sum for a condition rather than the usual separate fee for every separate doctor’s visit, referral, test or procedure.
Generally, Republicans believe services or recipients, not providers, ought to provide these vaunted efficiencies. They say the pilot project won’t work. One way to know whether it will work is, you know, to try it.
The Republicans’ missive outlined a few hollow ideas that were barely substantive enough to meet the objective of tiding Republicans over until the November elections.
One was to join other states in seeking a “global waiver.” That means open-ended federal permission to spend federal Medicaid money any darned way we please.
Far preferable is the established, substantive, strategic and credible method for a waiver. That would be the kind pursued by the Beebe administration. It is to design a specific cost-saving plan and seek federal permission to proceed on its particulars in a limited trial.
The Republicans’ letter calls for co-payments by Medicaid recipients. A man living at the starvation-risking federal poverty level could use his few precious dollars for groceries or to replace the radiator hose on the clunker so he can get to work. But if it makes Republicans feel better to charge him a buck or two to take his ear-infected child to the doctor . . . well, it’s a priority.
And, of course, Republicans want to ferret out waste, fraud and abuse in Medicaid. Don’t we all? Attorney General Dustin McDaniel, though a Democrat, must. He just announced the state had piggybacked on some big Medicaid fraud suit and won more than a million dollars.
The real ace up the Republican rhetorical sleeve is the bulleted item in the letter to require Medicaid recipients to submit to random drug testing.
Drug abuse is one thing, a bad one. Expanded health insurance for the working poor is an entirely different thing, a good one.
Medical care shouldn’t be made contingent on a drug screening. Are we going to turn away a trauma case from the emergency room because the poor guy shows up on a meth user list? Rush Limbaugh deserved treatment for any illness no matter how many painkillers he’d stockpiled.
If the notion is merely to use Medicaid’s rolls to take an inventory of drug abusers in need of treatment and then require treatment in exchange for insurance-as state Sen. Michael Lamoureux tells me-then that’s better in principle. But it’s probably only slightly improved in practice.
The likely effect would be less a matter of identifying and treating drug abusers than of deterring poor folks with a drug habit from daring to sign up for medical care.
To be clear, though: Taxpayers will treat these people one way or another, regardless of whether they’re on crank or crack.
It is classic conservative boilerplate to invoke bad or destructive personal behavior as an excuse to assail public policy designed for the broader common good. The welfare Cadillac is invoked to oppose the whole of welfare, not as an attack on the specific cheater driving it.
That’s like shutting down highways because some people speed. It’s like the Razorbacks forfeiting the game because they had several offsides penalties.
But those are things we value, right? Roads and Razorbacks, I mean. Health insurance for poor people-maybe not so much.
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John Brummett is a regular columnist for the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.
Editorial, Pages 13 on 07/31/2012