Gov. Mike Beebe met with reporters Monday and said no one had been doing a good enough job explaining the Medicaid issue.
So he commenced explaining it and took a breath maybe a quarter-hour later.
He was mildly Clintonian in his professorial instruction and in his contextual connecting of the dots.
If everyone could hear this explanation, then public opinion would change. If all legislators could hear it — and he said that he and his staff would share it with them anytime — then a three-fourths majority to appropriate the money for expansion might not seem so implausibly daunting.
So I’m going to take a shot at explaining it as he explained it, availing myself, for that purpose, of this online column so that I might blow through newsprint’s space limitations.
First, the governor said, existing Medicaid (and our deficit thereon) is an entirely separate issue from proposed Medicaid expansion.
While it’s true that Medicaid expansion would solve some of the existing deficit problems, the two issues do not overlap much in terms of service, and not at all in regard to essence.
Existing Medicaid goes overwhelmingly to asset-depleted folks housed in nursing homes — mostly helpless senior citizens — and to children’s health insurance through the ARKids First program. So we need to plug our existing shortfall to keep from having to reduce vital aid to those two needy groups.
Expansion has little to nothing to do with serving more nursing-home residents or children. Instead, it’s about extending Medicaid’s basic health-insurance coverage to a greater number of recipients — about a quarter-million adults who now work and don’t quality for Medicaid but who make so little that they can’t easily afford health insurance.
Their children probably are covered under ARKids First, but they are likely uninsured.
If they get sick now, particularly in some kind of high-dollar emergency, they probably wind up getting treated at the local hospital and are sent bills they never pay, at least in full, because they can’t.
So their costs get written off as uncompensated care, or indigent care, and the hospitals build those costs into their price structures in a way that raises health-insurance rates for all of us.
Beebe will be happy to explain to you that he formerly was on the hospital board at Searcy and knows firsthand what he’s talking about.
The essential point of so-called Obamacare, he said, was to reap long-term efficiencies for the health-care system, and eventually for all of us, by getting those kinds of patients insured.
That would mean the rest of us wouldn’t have to keep paying those costs in ever-rising medical bills and health-insurance rates.
To try to hold down the immediate explosion in the federal budget deficit, President Barack Obama and Democrats included in the Affordable Care Act a reduction in reimbursements to hospitals for Medicare — not Medicaid, but Medicare.
And to compensate hospitals for that lost revenue, the law provided for this expansion of Medicaid at hundred-percent federal funding for three years, and 90 percent federal funding thereafter.
But then the U.S. Supreme Court said states could opt of the Medicaid expansion. Then it all hit the fan.
If we opt out in Arkansas, vital hospitals — from UAMS to your nearest local one — will be in big trouble.
And if we opt out, there will be a lingering and unjust gap in health insurance in this state.
The poorest people will have health insurance on basic Medicaid. Most middle-class and upper-class people will have private insurance. Some in the lower range of middle class will be able to buy insurance through new health-care exchanges and receive some form of subsidy in their premiums. Seniors will have Medicare.
Alone without insurance would be people working and making too much to get basic Medicare, but earning less than 138 percent of poverty and thus ill-equipped to afford even subsidized care through the new exchanges.
So, as Beebe laid it out, we can expand Medicaid at federal expense and help our hospitals and our working poor people.
And we can seek to construct a new health-care culture in which costs might stop rising so much because of uncompensated care.
Beebe acknowledged that some people, understandably, believe the federal government simply can’t afford to be throwing this kind of borrowed money at states.
But, as he said, that money is going to be borrowed and spent regardless of whether Arkansas takes its relative pittance.
For us to decline the expansion would be to close some of our hospitals, conspicuously deny insurance to our working poor people and perpetuate an unsustainable system of uncompensated care.
And it would accomplish diddly in regard to the federal deficit.
If you’re still opposed, then you’re simply stubborn or I need to go back and shorten some of these words and sentences.
It’s not a matter of ideology, which, in this case, only gets in the way of profound logic.
If we in Arkansas could solve the federal deficit by sacrificing our hospitals and working poor people, then maybe there’d be some argument.
But to sacrifice them to nothing at all — that’s just wrong.
John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. E-mail him at firstname.lastname@example.org. Read his blog at brummett.arkansasonline.com.