Gov. Asa Hutchinson was tooling along Wednesday outlining his key recommendations to yet another of his task forces.
All of a sudden it was as if Bernie Sanders had possessed him.
This was the task force Hutchinson created to put cosmetic conservative touches on the private-option form of Medicaid expansion. That is so that he can more easily cajole his right flank into going along with his saving it--because it's smart and right for everybody, from the state budget to hospitals to poor people to all those who now shop or might ever shop on the Obamacare exchange.
But Hutchinson made one head-scratching recommendation that wasn't a cosmetic conservative touch, but a substantive old-style liberal touch.
Hutchinson said he wanted to use the private option--by which the state avails itself of a federal waiver to take Obamacare money for Medicaid expansion and buy private insurance for persons up to 138 percent of poverty--only for people with jobs. He said he wanted those without jobs who are now on the private option to go into regular Medicaid.
Say what?
Let me explain: Obamacare called for states to expand Medicaid to 138 percent of poverty. Arkansas Republicans objected. The smarter among them designed an alternative--the private option--and secured a federal waiver to do it. So now Asa is recommending, amid an array of conservative window-dressing, to abandon some of the private option and replace it with straight Obamacare.
I was told that the governor believes straight Medicaid would be cheaper in that we'd reimburse only actual medical expenses, not pay monthly premiums to private carriers to cover those expenses.
There is much that is wrong with that.
First, it seeks a financial advantage for the state from banking that poor people won't go to the doctor.
Second, it gambles that poor people won't get really sick.
Third, it is belied by the unfolding experience, which is that the private option offers a cheaper trend line in the long run than general Medicaid. The private option is coming in under estimates. Basic Medicaid is not.
Fourth, it threatens to take tens of thousands of people off the private option, and thus off the health-care exchange where their private policies get bought. That would have the effect of running up premiums on that exchange for everybody.
So what we saw Wednesday had the richly ironic effect of sending state Sen. Joyce Elliott of Little Rock, proudly viewed as the most liberal member of the Arkansas Legislature, to social media to question the wisdom of what the governor was doing.
And here I am, supposedly center-left, criticizing the Republican governor for going left.
But I've long written that I think the private option is brilliant--better than the old liberal notion of straight Medicaid, at least as long as we have a mixed public-private system. It uses public money not for wholly isolated services, but to invest in the private market in a way that helps private consumers.
Hutchinson's pronouncement also wholly confused legislative politics.
You had right-wing legislators who oppose the private option as too much like Obamacare. They were confused and chagrined that the Republican governor was partially choosing straight Obamacare. If they weren't going to vote for the private option, then they surely won't vote for that.
You had moderate Republican legislators who are committed to the private option who were aghast that the governor was wanting to weaken it and do so from left field on old thinking.
And you had the Democratic caucus saying ... what the heck?
Hutchinson subsequently got a little support from Sen. Jonathan Dismang of Beebe, president pro tem of the Senate and one of the three architects of the private option. Dismang told me Hutchinson's idea was worth looking at if exchange premiums weren't adversely affected and if the Medicaid coverage could be done in some way, perhaps with managed care, that teaches recipients how to practice preventive care rather than merely use emergency rooms and await serious diseases.
Big ifs. Mainly, I think, Dismang was just trying to help his governor.
There was one other odd thing: Hutchinson spoke to his task force one day after public release of a preliminary report from the task force's consultant that the private option would save the state $438 million through 2021.
And Hutchinson acted as if that had never occurred. He simply declared the private option in need of fixing.
The governor has had better days than these lately.
And by the way: He's probably going to get the state named in an imminent class-action lawsuit. That would be for violating the due-process rights of private-option clients who got purged on a vague letter and because they couldn't get through as instructed to their local Human Services office to challenge that purge.
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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.
Editorial on 08/23/2015