COMMENTARY

Logical considerations

Let’s get logical, shall we?

Gov. Asa Hutchinson has announced that he will go to the University of Arkansas for Medical Sciences to announce at 10 a.m. Thursday his plan for health-care reform. That presumably will include his declaration of a position on the private-option form of Medicaid expansion.

The private option has provided a fiscal elixir for UAMS by replacing indigent-care losses with the real dollars of insurance payments.

One of the private option’s leading advocates in meetings with Hutchinson has been Dr. Dan Rahn, chancellor at UAMS.

So there is no way Hutchinson would go to UAMS to announce that UAMS would have to start eating those costs again.

You would announce something like that at your conference room with a quick getaway to your office, if not in a news release late on a Friday afternoon. Or maybe at a Tea Party meeting, which is about the only place it might be applauded.

And consider logically: Hutchinson and an entourage flew on Friday to Washington to meet with Health and Human Services Secretary Sylvia Burwell. They sought to extract her assurance that her department would work cooperatively with the new conservative regime in Arkansas as it endeavors, probably through waiver requests, to add requirements such as that private-option recipients seek or train for work.

State Sen. Jim Hendren of Sulphur Springs, nephew of Hutchinson and arch-conservative majority leader of the Senate, reported a productive discussion.

There is no way, logically speaking, that Hutchinson would go to Burwell’s office to seek moot assurances for a course of action he was not intending.

To continue our logic: Hendren probably wouldn’t have described the meeting as productive if Burwell had told the Arkansas entourage to stick it.

And to stay with our logic: There’s no way the Obama administration is not going to bend nearly backward to keep in place the Arkansas model for palatably conservative Medicaid expansion, one being steadily imitated or near-replicated in other red states.

That’s not to say the specifics of waivers will be easy. Health and Human Services has historically held that Medicaid coverage cannot be withheld on account of a work requirement. A poor man suffering a heart attack is not going to be turned away from an emergency room because he can’t prove active participation in a job-training program.

The best way to go might be the way Utah has discussed, which is to forget the idea of a federal waiver for a work requirement. It is to impose the requirement through state government’s back door, maybe by denying a driver’s license to a Medicaid enrollee who is neither working nor training for work.

The man would still get emergency-room treatment for a heart attack. But he couldn’t drive himself to the unemployment office or community college or a doctor’s office for a precautionary checkup.

Thus we’re now moving away from logic, not to mention compassion or decency. Or even equal protection under the law. But we’re trying to keep the private option afloat amid a red-state tidal wave, and you do what you have to do.

Harder still will be re-achieving the three-fourths legislative votes required to appropriate the federal money. The conservative quotient in the General Assembly was substantially raised by the recent election.

No high-profile legislative race pitting a private-option supporter and foe has been won by the supporter. In fact, a Democratic legislative supporter was saying the other day that no Democrat had been rewarded for voting for it, but that several Republicans had survived voting against it; therefore the minority Democratic caucus conceivably could oppose renewal if Hutchinson’s proposed restrictions were considered too draconian.

As for complications with the right-wing Republican base: There is talk that Hutchinson may want to emphasize new conservative restrictions to take effect only after 2017. That’s when full federal funding ends and the state must pick up a small share. And it’s when a broader waiver may be sought.

Any stated idea to renew the private option pretty much as is for now and repackage it in fine conservative style after two years might be met with suspicion and hostility at the Tea Party town-hall meeting.

Logic would suggest that, anyway.

But the prevailing logic of the private option must not be political logic. It must be the ultimate logic of arithmetic.

The private option saves state government’s budget enough money to make Hutchinson’s tax cut mathematically conceivable. And it balances hospitals’ bottom lines.

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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