The game of the name

Gov. Asa Hutchinson announced last week that he was saving the private option.

Well, let's be precise, because there is conflicting spin, perhaps by Hutchinson's design: He said he was proposing to save Medicaid expansion until 2017 and committing vaguely to protecting the interests of the expansion population amid broader health-care reform after that.

He doesn't like those two words, private and option, at least when put together that way, because they're toxic, like Arkansas and Democrat or Obama and care or income and tax or deflated and football.

Shortly after Hutchinson's declaration of a position and plan, Virginia political consultant Tim Griffin, holding the pointless office of Arkansas lieutenant governor, issued a statement celebrating that Hutchinson had killed the private option.

So did our new governor save or kill Medicaid expansion, aka the private option?


It might be instructive in the context of that question to distill what Hutchinson actually said, and then conduct a second sifting to apply reality.

The first distillation: Hutchinson said the private option had helped a lot of hospitals and people and that he was going to recommend continuing it until 2017, and that, in the meantime, he would appoint a task force to tackle health-care reform more broadly. He said the task force would come up with a design of a plan by 2016 for implementation by 2017 to remake the health-care system and serve those nearly quarter-million people by some new name and with new efficiency and some apparently changed mechanism.

Here's the second sifting: There is no way this task force could come up with the hundreds upon hundreds of millions of dollars in savings needed to continue providing private health insurance to those quarter-million people in the private option without accepting federal Medicaid expansion money after 2017.

We can and should do Medicaid more efficiently. We can and should do all of health care more efficiently. But we can't turn down federal money for expansion and still serve the quarter-million people newly insured, at least by conventional standards of arithmetic and logic.

It's important to know one big thing: Obamacare allows states to file for waivers to design their own health-care exchanges--the marketplaces of individual health plans for everybody--beginning in 2017. State Sen. David Sanders of Little Rock, who knows more about these issues than anyone in the Legislature, but who is being pushed a bit aside by the Hutchinson administration, has been talking about that for months.

So, yes, the task force can seek a waiver in 2017 for permission to build a new health-care exchange in a conservative image, and, yes, the private-option population could deal with those changes just like anyone else buying a policy on the exchange.

But the idea that the state could go back to basic Medicaid on a 70-30 federal-state match and serve more inexpensively over the long-term the poor population for which the federal government offers a long-term 90-10 match for Medicaid expansion ... well, that's somewhere between a pipe dream and a charade.

And it's one other thing: It's a way to produce nonsensically spun news releases like Tim Griffin's. It's a way to send a soothing signal to the right wing.

The political brilliance of what Hutchinson has done--why, it's positively Clinton-esque, I tell you.

At once he has me confident he will keep the private option, and his right-wing base saying he won't.

We'll know soon enough. The year 2017 will be here before we know it.

I hereby offer my conceptual support for some of the conservative principles that the new task force surely will seek to apply via requests for multiple federal waivers.

Public assistance shouldn't be more generous than privately paid insurance, since that provides a disincentive to take work. Co-pays and deductibles and no-frills coverage and even a job-training component for the able-bodied should be applied to some Medicaid.

The Medicaid payment reforms begun by Mike Beebe--those that don't offer straight payments for services, but instead reimburse bulk amounts for episodes of illness and care--are proving successful and should be broadened.

Other consumer-choice and provider-accountability reforms, not just for Medicaid, but also for all forms of health insurance, should be pursued.

The task force will prompt Arkansas to seek waivers to do much of the preceding. Waivers will be sought for basic Medicaid medical services, for the full state health-insurance exchange and, yes, for expanded Medicaid, or the private option, regardless of whether the new governor likes those two words abutting.

There is some support in the media for "Asacare" as a new name. I like "private option," because that's what it is, or maybe "private-option option."

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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 01/27/2015

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