Gov. Asa Hutchinson will consider the immediately ensuing paragraph an absurd outrage. But it's instead a rich irony. It sounds inherently contradictory but is true.
Here it is: The greatest stain on Hutchinson's otherwise solid governorship--partisanship and ideology aside--is the decline of health insurance for the neediest Arkansans.
For the governor and his intimates, the situation seems totally to the contrary: Hutchinson took office as a Republican dealing with a Republican Legislature intensely averse to the Affordable Care Act and its Medicaid expansion, and, against those odds, managed bravely and deftly to save Medicaid expansion for somewhere in the vicinity of a quarter-million of the state's poorest residents.
The recent eviction of 18,000 persons from those rolls, the governor and his people will argue, resulted from a work requirement that was essential to securing the aforementioned Republican legislative acquiescence. They will explain that those 18,000 were removed only after arduous efforts to locate them by the state Human Services Department and independent service agencies on which the department prevailed for help.
Hutchinson and his administration want absolution for throwing 18,000 people off health insurance because they managed to save health insurance for more than 10 times that many.
But human services for the needy are not designed on a basis by which you can take credit for broader compassion as an offset for narrower meanness.
The fact remains that this administration is throwing people off Medicaid expansion in a way that has been declared illegal by a federal court in Washington, D.C., and which has emerged as the national example of how not to do a work requirement, if indeed a state must do one at all, which several of the red ones in the Trump Meanness Era seem to think they do.
In Indiana, officials are touting their new work requirement as nothing like the vanguard disaster in Arkansas, though detractors think it looks all too similar.
Hutchinson defends his work-requirement program as (1) necessary politically to save Medicaid expansion, and (2) a process that was steadily improved from the initial computer-click complexity, and (3) a worthy inventory by discovering 18,000 people who can't be accounted for, thus saving the state the monthly private premiums for those persons under the innovative "private option" form of Medicaid expansion that buys private insurance for enrollees.
Alas, there is a simple and compelling counter to each: (1) Health insurance for poor people is entirely too vital to be subjected to use as a political tool. (2) While the state did endeavor to make its work-reporting requirement less of an obstacle course for poor people, the repeated changes in reporting methods served mainly to enhance the confusion. (3) A true inventory of recipients--and a cessation of premium payments for recipients who can't be found--would be wise. But it should not be disguised as a punitive work requirement. And it should not kick people off and require re-application but simply suspend payment of premiums subject to restarting premiums and paying them retroactively for missing persons showing up, at, say, an emergency room.
Meantime, Arkansas Advocates for Children and Families issued a report last week showing a recent enrollment decline, after years of growth, in probably the state's finest program--ARKids First, meaning health insurance for needy children, whether abjectly poor or in the low-income working class.
The report blames the state less than federal anti-immigrant policies under the Trump administration. But it does make two recommendations that would reduce the onerous restrictiveness of existing state policies and practices.
It asked the state to stop the absurdly mean-spirited practice of refusing to pay for outreach programs to spread the news to the poor of the availability of health insurance.
Just think about that: It is the policy of state government--in language written into the appropriation--not to tell poor people about how they might get health insurance.
And Arkansas Advocates asked the state to stop reassessing ARKids Part A insurance for the poorest kids randomly at any point, and to do so once annually, as is the case in Part B for higher-income families.
The working poor's income is typically volatile--by season, month or even week.
Yet the state reserves the right to come along in, say, July, and say, "Too bad, little guy, your daddy shouldn't have mowed that extra yard last month."
One check, once a year, on annualized income--that's the way to go if your objective is service, not punishment.
Those policies pre-date Hutchinson's governorship. Arkansas has been mean-spirited to its poor for far longer than Hutchinson has been governor.
But now an opportunity presents itself to the Hutchinson administration to repair some of the health-care meanness for which rich irony is specifically and not inappropriately besmirching it.
Outreach programs and annualized income-eligibility checks--those would make Hutchinson's legacy even better.
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.
Web only on 07/03/2019