The state's leading legislative advocate of the private option says he wouldn't favor the ballyhooed Arkansas Medicaid expansion plan unless it was an ever-changing piece of broader conservative reforms.
But it is, and so he does, says state Sen. David Sanders, Republican of Little Rock.
He makes the assertion in an interview that will air in part at 9 a.m. Sunday on the Talk Business and Politics show on KATV, Channel 7.
Sanders thus shares what may be--may be--the retooled selling point by which a newly Republicanized state Legislature presumably will be asked by Gov.-elect Asa Hutchinson to reauthorize by a formidable three-fourths vote the use of Medicaid expansion dollars under Obamacare to buy private health insurance for poor people.
A voracious student of policy, Sanders tends to be wonkish and verbose in his discussion of this issue. What follows is the columnist's attempt at a fair synopsis of what the bright young senator contends in the interview, and has long argued in conversations:
The American health-care marketplace is sick in an unsustainable way that harms businesses, consumers and the economy.
That marketplace must be subjected to substantial reforms that would help small businesses and large employers find savings in their providing of health insurance to employees. Sanders likes the Wal-Mart self-insurance system that emphasizes care at designated "centers of excellence," which have demonstrated records of effective and efficient treatment.
The marketplace also needs to be subjected to consumer-oriented reforms by which data about quality of care by providers--their performance therein--would be publicly disclosed. Consumers need to be able to shop as knowledgeably for a medical provider as for a car or a roofer or a lawn-maintenance specialist.
And Medicaid itself--the private option itself--needs to be ever-changing to introduce elements of individual responsibility. That perhaps would include requirements tying eligibility to participation in better job-training programs as advocated by state Sen. Jane English of North Little Rock, the vital 27th vote for the private option in the Senate last year.
Without these conservative market reforms, the ailing health-care system will be addressed inevitably with decidedly non-conservative fixes, such as a single-payer government system.
We must hang on to the private option--and keep reauthorizing it with those three-fourths majority votes--to be able to implement conservative reforms and demonstrate their effectiveness. That is why conservative governors in Utah, Tennessee and Alabama have moved toward their versions of the Arkansas model.
Merely "rebranding" the private option to call it something else--something more conservatively engaging--would be transparently tactical and hollow.
Simply taking federal Medicaid expansion money to put enrollees into private health plans--the essence of the private option--would not in itself qualify as a conservative notion, Sanders acknowledges. But doing so in a way that introduces individual responsibility and cost-savings and represents only an element of broader market reforms--that's plenty conservative, says this state senator who once was a Stephens Media columnist providing a supposed conservative counter to me.
Sanders says he can envision genuinely conservative legislators deciding to vote for the private option, perhaps albeit grudgingly, as a means to a greater and much broader conservative end.
Hutchinson, the Republican governor-elect, has said he won't talk about the private option until later this month.
Meanwhile, Sanders says he has discussed these matters in lesser detail with Hutchinson, but that Hutchinson is noncommittal.
He did say that he knows Hutchinson from his congressional career to be thoughtful, reform-oriented and counter-intuitive, such as on his support for campaign-finance reform.
But Sanders is close to Hutchinson's chief of staff, former Senate president pro tem Michael Lamoureux, a key private-option supporter as a legislator, as well as to other Hutchinson aides known to share his interest in conservative health-care marketplace reforms.
And Hutchinson himself has been said, from private meetings, to understand the benefit to the state budget of the private option and to be processing these ideas for broader health-care reforms.
Finally, there is this matter: Sanders has the advantage of actually having read the Affordable Care Act and of having long understood that the law contains a provision allowing states to seek waivers in 2017 to do their Obamacare health-insurance exchanges entirely differently from the way those exchanges are set up in the federal act.
He has long advocated using the private option to build a case for an Arkansas waiver.
The point seems to be that Arkansas needs to embrace for now an element of Obamacare--the private-option form of Medicare expansion--in order to build a case for undoing Obamacare pretty much altogether later.
Now that would be a conservative selling point.
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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 01/01/2015