Arkansas state government continues to act as if the problem with Medicaid is that too many people get it on account of being poor, old, sick and disabled.
Scant blame is placed on fraudulent providers lathered laxly with hundreds of millions of dollars based on an association with a criminal lobbyist chummy with corrupt legislators.
Federal prosecutors have homed in on the corruption. Meantime, state bureaucrats have been wringing their hands about the literally hundreds of dollars that all these poor, sick, old and disabled people require by needing help all the danged time.
I call it Meanness Part II.
Meanness Part I has been the requirement, relaxed only Wednesday, in this, the nation's least computer-savvy state, that Medicaid expansion clients, the least among us, click a series of computer icons each month to attest that they are working or looking for work or volunteering. And it's taking Medicaid away from thousands ostensibly because they're not working, but actually because they're not computer-clicking.
Part II is the meanness reported on this newspaper's front-page Sunday.
It's that the governor, Asa Hutchinson, is worried that Medicaid costs so much, which could imperil his budget-balancing as he aims in the looming session to cut income-tax rates for the highest-income group.
I'm not saying the governor is mean in his heart. I'm saying he's mean in his math.
He has directed that Medicaid savings be achieved. His human services officials have obliged in part by arbitrarily cutting payments for home care and now proposing new caps for the ARChoices program, which keeps sick old people and disabled people in their homes.
The notion of in-home care under Medicaid by a visiting aide--paid by a management company sanctioned by Medicaid and passing through those dollars--is both humane and financially wise.
The humaneness is helping people stay at home as long as possible and sustain a quality of life. The fiscal soundness is that reimbursing for home care--usually for a number of hours each week determined by a state nurse's in-home evaluation--is cheaper than the round-the-clock care provided in nursing homes, which, for poor people, Medicaid pays in full.
Over the last few years the state has been cutting the hours of approved in-home care based on algorithms drawn up after the governor set his savings goals. An ailing grandma with an annually degenerative condition has been getting approved for annually declining hours of home care.
Her family members thus had to try to fill new gaps amid their own pressures of work and child care.
Or they could make the hard decision to put their loved one in a nursing home where Medicaid picks up the much more expensive tab.
In-home care for poor people makes Medicaid a partner with the family, not an automated teller machine for nursing homes.
Nursing homes are vital. Some are excellent. Sometimes, as family after family learns, an aging loved one declines to a point at which no other viable option remains.
But why the state would want to chintz on alternative services before that sad and expensive day is a policy mystery and outrage.
Once the home-care option was a conservative notion to value people more and save taxpayer money at the same time.
If the concern is waste and fraud, then the answer is to monitor better--certainly better than the state-monitored large-scale criminal conduct--rather than serve less.
These cuts make no sense except in the most superficial mathematical context. The state saves a few Medicaid dollars for one side of the equation so that it can give income-tax cuts at the highest income levels on the other side of the equation.
But it makes no sense in the longer term or in mildly more advanced mathematics.
With abundant baby boomers edging into old age, a wiser and less-mean state would be expanding cheaper and more sensitive long-term-care alternatives, not begrudging and reducing them.
The way to cut Medicaid is to invest in educational and economic opportunity as well as a healthier population, then to get serious at the national level about cutting costs of medical care, long-term care and prescription drugs.
It's not to throw people off health insurance for not having command of computers they don't own.
And it's not to order up arbitrary cuts year-to-year in the hours of authorized home care for disabled people and impaired seniors.
And it's never to resent and blame poor and old and sick and disabled people for their needs and the costs associated with their needs.
Meanness Part I, meaning the work requirement, at least sounds good to the naked ear.
But Meanness Part II, cutting money for granny's home care to expedite her life sentence in a more taxpayer-costly nursing home ... that may not resonate quite so richly in the coffee shops and echo chambers. It certainly shouldn't.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.
Editorial on 12/13/2018