Medicaid put in new light by U.S. deal

Expansion easier to accept for some GOP lawmakers

— A day after Arkansas made national headlines for wrangling a unique option for Medicaid expansion from the federal government, lawmakers, advocates and providers at the state Capitol on Wednesday tried to absorb the details of providing health coverage to 250,000 poor Arkansans through the state’s insurance exchange.

Some Republicans said Gov. Mike Beebe’s announcement that expansion could proceed without directly expanding the state’s $5 billion Medicaid program that already covers about 780,000 Arkansans helped mollify their concerns about skimpy payments, overburdened doctors and an expanding state bureaucracy.

Others in the GOP ranks worried about the state’s price tag when the federal government stops picking up the entire tab. They wondered if the exchange could handle the extra quarter-million people. And they speculated whether it would be politically feasible to scuttle the state’s expansion if a three-year “sunset” clause is part of a final deal on expansion.

Meanwhile, a Republican senator who has been critical of the state’s partnership exchange model said he was increasingly interested in pursuing a state-run exchange. Beebe has said that the current deal with U.S. Health and Human Services Secretary Kathleen Sebelius is contingent on the state continuing its partnership arrangement with the federal government.

The U.S. Department of Health and Human Services has said states that missed earlier deadlines for a staterun exchange can’t switch to that model before 2015.

But Jason Rapert, R-Bigelow, said Beebe’s deal with Sebelius shows that the federal government might be willing to bend the rules on exchanges, too.

“Nobody said that Arkansas could put all of our people in the exchanges until this week either. So I think that if there is a state that is plunging forward here into making some decisions, I think they would just as soon have us take on that responsibility sooner than later,” Rapert said after a hearing on the future of the state’s exchange.

Rapert has been in favor of ceding control of the state’s exchange to the federal government, but recently hehas said he will keep an open mind. On Wednesday, Rapert spoke positively of New Mexico and Idaho’s exchanges, both of which are led by GOP governors who support state-run models. He said he has discussed similar ideas for Arkansas with Beebe.

“I’m not saying I want a federal exchange or a state exchange or a nonprofit or a partnership. Right now, I’m saying we’re still gathering information,” he said.

Rapert has scheduled another hearing for Monday. He hopes to bring a New Mexico official to explain that state’s exchange.

The new option of Medicaid expansion through the exchange, which would allow poor, uninsured Arkansans to buy private insurance with the federal government paying their premiums, has shifted the debate, but many Republicans remain wary.

Sen. Missy Irvin, R-Mountain View, said she is encouraged that expansion through the exchanges would help increase access to doctors, who would likely get higherreimbursements from private carriers than from Medicaid. Leaving the existing Medicaid program alone so it can be fixed also appeals to her, she said.

“Things are changing so fast,” Irvin said. “Everybody needs the weekend to process all of this.”

House Democrats rallied at the Capitol to voice their support for expansion. Democratic leaders said expansion would benefit the state’s economy and strengthen its heath-care system.

“I do think you’re going to see action on Medicaid in the next few weeks,” said House Minority Leader Greg Leding of Fayetteville. “I think there will be a much larger amount of bipartisan support with thislatest announcement.”

Some Republicans said they were still leaning against expansion even with the greater role for private insurance and the possibility of copayments for some of thehigher-income Medicaidfunded population.

“My biggest heartburn about it at this point is that it’s still an expansion of government,” said Rep. Nate Bell, R-Mena. Bell said he also preferred a federally run exchange, which wasn’t part of the deal.

Any federal promises on expansion need to be in writing, he said.

Rep. David Meeks, R-Conway, said he worried about giving health coverage to 250,000 Arkansans if the state were to remove their coverage in three years after the full federal funding ends. By 2020, the state is responsible for 10 percent of expansion dollars.

“I’m hesitant to do that,” Meeks said.

Some providers are worried that any copayments wouldn’t be paid by recipients, leaving the providers to pick up the bill. Beebe’s spokesman Matt DeCample said the governor is aware of their concerns and promised to work with them on any deal.

Widespread support exists for requiring those earning between $11,170 and $15,415 to have some financial “skin in the game,” DeCample said.But the governor appreciates that providers could be put in a “difficult position” if they have to swallow unpaid copay charges.

“We’ll listen to providers and lawmakers will, too,” De-Cample said.

State Medicaid officials will recalculate the estimated saving that expansion might bring. Previously, they predicted about $630 million in saving through 2021. Expansion through the exchange rather than through the Medicaid program likely wouldn’t have a “huge impact” on those numbers, said spokesman Amy Webb.

At the exchange hearing, Insurance Commissioner Jay Bradford said that expansion through the exchange would be the smoothest way to extend health coverage to the poor. Such a plan eliminates the “churn” of people switching between Medicaid and private coverage as their income fluctuates, he said.

“Having one system to address all the needs of people in Arkansas on the private system, with private insurance companies, which at this stage we regulate, is absolutely best for the public,” Bradford said.

Arkansas, Pages 9 on 02/28/2013

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