COMMENTARY

Stuff and nonsense

Gov. Asa Hutchinson said something nonsensical and alarming the other day.

It was that continuing the private-option form of Medicaid expansion after 2016 is “off the table.” It was that changing the program only in a cosmetic way and then continuing it more or less in status quo form also is “off the table.” It was that anything less than ending the program is “not going to fly” with Arkansas voters.

That is to say we need to stomp the sucker flat before it continues to work so effectively.

Our governor thus is committing in no uncertain terms merely to destroying the most innovative, nationally acclaimed, widely imitated and demonstrably successful Arkansas government program in a generation or more.

Hutchinson intends to do away with a program that has come in under cost estimates in providing health insurance to a quarter-million Arkansans, holding down rates on our general health-insurance exchange, relieving the pressure of basic Medicaid on the state government budget and availing itself of federal government money to fortify the financial condition of our hospitals that previously were absorbing unsustainably mounting sums of uncompensated care.

Our governor thinks the voters of Arkansas won’t stand for that kind of success.

I used the words “nonsensical” and “alarming” rather than “insane” and “tragic,” which were on the tips of my typing fingers, for two reasons.

One is that—actually—the original law creating the private option called for its discontinuation (and presumed renewal, I would assert) when a small state share of the costs began to kick in for 2017. So we were faced with a cliff anyway. We just hadn’t previously vowed to go over it on purpose.

The other reason is that Hutchinson insists his task force now starting its daunting work will come up by the end of the year with ideas for an innovative “Arkansas way” to cover all those people and those hospitals and this state budget in some other fashion, presumably more conservative in precept and practice and less costly—mostly by taking a little skin off the hides of the poor people.

Around the country they are applauding the vanguard of innovation that the private option has made of Arkansas. Meanwhile, back at home, our new Republican governor, elected by Obama hatred that entailed resentment of health-care reform and its signs of success, says we need to scrap the innovation and come up with some … well, innovation.

The first thing that’s going to happen is that this task force—headed by Republican Sen. Jim Hendren and Republican Rep. Charlie Collins, the latter a consistent private-option supporter from the beginning—will hire a consultant to help it come up with some way to destroy the successful private option.

Help us hurt ourselves—that should have been the heading on the request for proposals.

We could keep the private option and apply these consulting fees to the small beginning state match-taking effect in 2017. But that … don’t tell me … is “off the table.” For voters, that idea … don’t tell me … is “not going to fly.”

The people demand their consultants, apparently.

I could save the state the consulting fee and tell you for free right now what this task force is going to come up with. In fact, I think I’ll do just that.

The task force is going to end up recommending that the state seek two waivers, one for the Medicaid expansion pool and the other for our health-care exchange overall.

In combined form, these waivers will ask that Arkansas be allowed to:

• Require working-poor recipients whose coverage is paid through Medicaid expansion to pay some sliding scale of personal charges in forms of co-payments or deductibles.

• Design insurance plans for these working-poor recipients that will not be more generous than the average private-pay plans, on the conservative theory that welfare shouldn’t be such a sweet deal that it acts as a disincentive to seeking work.

• Speaking of the working poor, the state will seek permission to require them to take job-training programs—not to qualify for expanded Medicaid coverage specifically, because that’s against federal law, but to do as Utah is thinking of doing and withholding driver’s license renewals to any Medicaid recipients not actively engaged in job training or verifiable job searching.

• After all that, the state will ask that the federal government send it a Paul Ryan-type block grant for its expansion pool and vow to use the aforementioned waivers efficiently to keep annual expenditures within that amount or eat any overage itself.

I would not be terribly surprised to see the Obama administration, and then the Clinton administration, grant these waivers. It could be the only way to keep Medicaid expansion alive as an element of universal coverage in a state that was the vanguard but has gone mad red.

Meantime, this task force is charged with looking at all aspects of Medicaid payments, including, for example, care for the infirm and asset-depleted elderly in nursing homes.

It would be much more cost-effective to pay families a stipend for keeping their elderly loved ones at home if at all possible, or to pay smaller community-based centers providing day care.

But that would alarm the nursing homes, the smart ones of which ought to quit spending money to buy judges or lobby the Legislature to cap damages or build more old-people warehouses, and instead spend that money to open home-health and community-based programs as components of a modern full-service company.

Everyone else is adapting these days. So should the nursing homes.

It would be about like the current political ruling class in Arkansas to save Medicaid money, mostly for the federal government, by penalizing poor and old people but not nursing homes.

If this task force must hire a consultant, may I recommend Andy Allison, the former state Medicaid director who educated me and others on all of these kinds of things in the first place?

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.

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