That darned math again

This afternoon I will interview state Sen. Jim Hendren of Gravette and state Rep. Charlie Collins of Fayetteville, co-chairmen of Gov. Asa Hutchinson's task force to replace the private-option form of Medicaid expansion, thus to ruin everything.

The conversation or portions thereof will air at 9 a.m. Sunday on the Talk Business and Politics program on KATV, Channel 7.

Because the point of the interview is to engage in instructive dialogue, not a contest, I will now give Hendren and Collins the first question in advance. I do so in hopes that they will take these few hours to prepare their best answer.


Here is the question: What is it about the private-option form of Medicaid expansion that needs fixing?

Why we would want to undo the rarest of government programs that comes in under cost estimates and works for poor people and hospitals and to hold down everyone's health-insurance premiums by delivering a quarter-million mostly healthy customers to the health-insurance companies ... well, there is but one explanation. And that is the utter irrationality of blind partisanship.

Gov. Asa Hutchinson, addressing his Medicaid advisory council the other day, put it this way: "Everybody comes to this council with firm ideas as to what we need to do, and sometimes you need to have your determined point of view and your convictions tempered with political reality."

What Hutchinson was saying was that the private option has come to be irreversibly enmeshed in Obamacare in the Arkansas consciousness. And Arkansas has become a Republican state for the very plain reason that people in Arkansas abhor Obama and his Obamacare--or think they do.

So Asa was saying we must abandon good policy and sound math for political convenience. His, mainly.

I also assert my view that the governor, whom I invite to explain otherwise should he choose, knows the private option to be a sound policy, but believes that sometimes you have to listen to the people and obey them even when wrong rather than try to explain what's right to them.

I also suspect that I know what Hendren and Collins will say in answer to my simple question.

It is that they are studying all of Medicaid and health care in Arkansas, not only the private option, and that the long-term costs of all that to both the federal and state government are unsustainable unless we find efficiencies and transfer some of the costly untenable federal mandates of health-care service to the greater flexibility of states.

They'll point out that, absent some sort of change, the state would begin in 2017 to assume a share of the private-option costs, one eventually phasing to 10 percent. They'll say Arkansas cannot afford that (because we are Republicans now and we will cut taxes every time the Legislature assembles). They'll say we can't trust the federal government, which is debt-choked, to keep funneling that 90 percent to us ad infinitum.

And if the federal government bails, they will say, then that will leave Arkansas holding the bill for private health insurance for a quarter-million people. It is better then, they will argue, to find some different way to handle all of that at the state level.

That means, they will say, that we must reform the entirety of the health-insurance exchange in Arkansas to add conservative principles and efficiencies through the granting to us by the federal government of what will be known, effective in 2017, as a "1332 waiver."

The Affordable Care Act, you must understand, contained a section saying that states, beginning in '17, could seek a federal waiver to proceed with their self-styled health-insurance marketplace.

You might wonder why I would bother interviewing these fellows if I think I already know their answers. It's a prediction, like a sportswriter presuming to foretell a game's outcome. It's just that political partisans are easier to predict than sports contests.

So we had an alarming statement from Hutchinson to that advisory council. He said, "You might have to swallow hard here, but I think it is important that we look at options" that don't involve the enhanced Medicaid funding.

That's well more than a billion dollars. So if Hutchinson is truly committed as he has said to continue to provide in some different mechanism the basic coverage now provided to private-option recipients, then he was saying that we may need to come up with more than a billion dollars in state money because we can't possibly afford a tenth of that.

Beyond the arithmetic and rhetorical absurdity, that is akin to saying we need to look at paying for all our highways ourselves instead of taking all that federal highway money.

"But you can see roads," a conservative told me on the radio Sunday.

You also can see poor people. And you can see the smiles on hospital officials' faces when the poor people present insurance cards.

You say you don't want to pay for that care? Too bad. You're going to pay for it either way.

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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 05/05/2015

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