No fighting here, fellas

— The federal government derives its power over states from the authority to regulate interstate commerce and, more thoroughly, the authority to tax and in turn spend-and thus conceivably withhold-money.

Conservatives hate that last part.

They assuredly will remind you that the federal government extracts its power from the pocketbooks of the people. They will point out that this leveraged dollar is now heavily borrowed.

I understand how conservatives feel. Their instincts are territorial, chemical, visceral.

I object only when they profess instinctive distrust of the motives of the federal government.

There probably are occasions to distrust those motives. But those are not universal or even pervasive. If they were, then we’d need a revolution. And we don’t need a revolution.

Mostly, people profess to distrust the federal government only according to their own biases.

Conservatives profess to distrust the federal government on taxing and domestic spending. They actually only disagree. Liberals profess to distrust it on war and privacy. They actually only disagree.

So the federal government plods on with a functioning balance, never angering all the people all the time.

In this context, the federal government declared last week that states may not self-style some localized increment, but instead must take or leave in totality the hundred-percent federal funding to expand Medicaid to 138 percent of the federal poverty level.

I immediately thought of state Sen. Michael Lamoureux of Russellville, incoming president pro tem of the Senate. While a thoroughly conservative Republican, he also is a deal-pursuing pragmatist.

He had told me several days before that he hoped our new Republican legislative majorities in Arkansas would be able to work well enough with Gov. Mike Beebe to fashion something in Arkansas falling between outright acceptance and outright rejection of Medicaid expansion.

Now comes the federal government to say forget that.

The federal government’s position is essentially as follows: We’re sending all the money, so we’re setting all the rules.

This is a simple disagreement. There is no reason to distrust motives.

The Obama administration believes that the nation can best attend to the otherwise unsustainable long term budgetary drain of health care, as well as to the medical needs of our people, only if it comes as close as possible to having everyone insured.

To get to that point, it believes the best way to plug the gap between the poorest and the middle class is to raise Medicaid’s application to more of the working poor who can’t much afford medical care or health-insurance premiums on their own.

So I asked Lamoureux if this development means the end of his idea for a specialized Arkansas solution.

“It depends on whether you think they really mean what they say,” he said.

He’s wondering if, when we get right down to it, the federal government wouldn’t let Arkansas help at least some of its people.

Lamoureux has a pretty high opinion of Beebe, actually.

He says the veteran Democratic governor ought to be the one negotiating with Republicans on this issue because he’s good at it, and people such as state Medicaid Director Andy Allison and Surgeon General Joe Thompson . . . well, aren’t, so much.

He says legislators and Beebe ought to keep working first toward shoring up our existing shortfall in Medicaid, and then, and only then, on whether and how to expand it. And if we come up with something at odds with federal dictates, then Lamoureux, for one, is content to rely on Beebe to talk his party’s federal government into acceding.

The governor already seeks a so called global waiver to let Arkansas manage existing Medicaid dollars with greater flexibility.

So let’s redesign what we’re doing with Medicaid now and then talk about applying that redesigned template to expansion, Lamoureux suggests.

It’s not the worst idea in the world. The worst idea in the world is simply to turn down this money.

Meantime, Lamoureux elaborated on two percolating Republican ideas.

Drug tests for people receiving Medicaid would be intended not for investigative or prosecutorial purposes or to deny medical care, but to identify users and refer them to treatment programs.

He likens it to a simple drug test that discovers cancer, and results in referral of the patient to treatment.

Co-payments, as Lamoureux sees them, would be designed to guide recipients to smarter use for themselves as well as for the state. His idea is that someone going to a hospital emergency room for a cold, for example, would be charged a co-pay that would be forgiven if he went to a clinic or doctor’s office instead.

Personally, if I was trying to live on 138 percent of the poverty level, I’d take a drug test and an optional co-pay in exchange for government health insurance.

That’s not an endorsement. It’s a negotiation.

———◊———

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.

Editorial, Pages 83 on 12/16/2012

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