Did state government now under full Republican control set out to throw a bunch of people off Medicaid whether rightly or wrongly?
Pretty much.
That sounds harsh. So what’s your point?
The most conservative Republicans — of which the Arkansas General Assembly has a substantial and influential contingent — tend to think Medicaid is either dubious or rampantly abused or both.
They think we squander too much taxpayer money taking care of too many people who need to be weaned from the trough.
Asset-depleted old people with dementia or terminal illness who can’t take care of themselves or pay for long-term care? Well, that’s different. Disabled people, too. Rare is the conservative who wouldn’t help them.
But conservatives say that able-bodied people in their vibrant years who are simply poor — and who have been enrolled in droves in this new private-option form of health-insurance expansion — are perhaps that way by their own fault and need to be weeded out.
Maybe they’re not trying to do better. Maybe it’s their sinister scheme to be slothful.
Or maybe they’re not slothful, but so industrious as to be cheating. Maybe they’re staying on the dole while they’re not entitled. Maybe they sneak around and make an amount of money that would lift them above the eligibility limit if they got caught making it.
And if we don’t stop them, these most conservative of the Republicans insist, then our government will keep costing us prohibitive sums. Our culture will become one of dependence rather than responsibility.
So now the most conservative of the Republicans exercise this sudden urge to purge about 50,000 or so private-option participants.
Gov. Asa Hutchinson, no longer on the far-right wing himself, if he ever was, must oblige from time to time these significant forces in his party. If he is to keep Common Core, then he must at least give the right wing a different standardized test. If he has any hope of continuing into 2017 an adapted version of the private option, he must make the private option lean and mean.
So we behold this great purge of the summer of 2015, which began with 35,000 poor people having health insurance they do not now have. We’re on our way to 50,000.
Most of these people aren’t purged because they certifiably bettered their economic condition, which would be cause for celebration. They are purged because they didn’t respond to a piece of mail.
And state regulators admit they’ve probably purged some people who are, in fact, eligible — some, even, with no incomes at all, or so the Arkansas Times blog was told by a state official, because a software program used to “ping” questionable cases had issues.
One other thing the most conservative Republicans always like to say is that government can’t be trusted to do anything. And here the government is proving them right. And yet here they cheer the government. Because now it’s their government, doing what they want.
The federal government has always required — and should require — annual income-verification reviews for all Medicaid cases. And Arkansas has always thrown people off in 10 days of their notice of suspected ineligibility, which is the minimum notice required by the federal government.
What’s different here goes back to the conception of the private option mainly by three regularly conservative and mildly pragmatic Republican legislators — Sens. Jonathan Dismang and David Sanders and former Rep. John Burris.
It was their idea to tell the federal government we’d take that bad old Obamacare money for Medicaid expansion if — and only if — we could spend it our way for premium support for private insurance, impose our own restrictions and show the world how such programs could be reformed in Paul Ryan’s glorious image.
The federal government said go ahead, knock yourselves out. They needed at least one Southern state that would play ball.
But these innovative Republicans had to attend to political pressure from their right flank. So they — Dismang, primarily — insisted that, in exchange for creating the private option, the state would conduct a full “redetermination” of Medicaid eligibility. That would be an audit, an inventory-taking, something beyond the usual income-verification cycle.
So finally the state Human Services Department designed the method for this “redetermination,” and began the process, and applied the standard 10-day rule, and so now we have this purge and a spectacular and heartless mess.
State agency officials can tell you with seeming blitheness how it came to be that some people clearly eligible got notices and didn’t respond and now have no coverage. And these state agency officials act as if that’s simply collateral damage.
They say, hey, the federal government gives 90 days to appeal, so we’ll probably end up putting a lot of these people back on.
Swell. You can break a lot of legs and contract a lot of diseases in 90 days.
Let’s take state legislators off the state health-insurance system for 90 days and then put them back on.
And the governor’s office can tell you with a straight face that it doesn’t get what the big deal is — that we’ve always had a 10-day notice and that we’ve always been required to verify incomes, and ought to do that, and that we have this new state law requiring this “redetermination,” and that, OK, maybe there has been some anecdotal evidence of people unfairly purged, but the problem is information overload at the state agency.
So Hutchinson has called a two-week moratorium to catch on the paperwork, not reconsider the process, after which the mad purge will start again.
State officials also did one other thing: They asked private insurers, the ones getting the money, to help them figure out whom they were purging, and whether they were right or wrong, and instruct potentially wronged people in how to respond.
I often think in terms of newspaper headlines, such as this one: State government asks Blue Cross to figure out what state government is doing.
The more compassionate and reasonable among us stand accused of opposing integrity in the program, although that’s precisely what we want to protect.
And there is widely shared thought on the right wing that sob stories and liberal hand-wringing are simply tired and predictable prices to pay if we are to have any hope of tightening these wasteful programs.
Those on the hard right will tell you that 50,000 disqualifications just go to show that the program was inept and wasteful.
The program may indeed be inept and wasteful. But you surely couldn’t prove it from the inept and wasteful manner in which state government is setting about ostensibly to prove it.
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.