With all deliberate caution

— Discussions among state legislative insiders appear to be starting to coalesce on punting Medicaid expansion to a special session later in the year.

That’s what the Legislature chose on the epic Lake View school-funding case, which worked well enough. That process was contentious, arduous and lengthy, but perhaps that is the way of representative democracy.

This would not be a kick-the-can abdication of responsibility like we’ve seen in Washington.

Medicaid expansion is indeed of Lake View proportion. That is so in terms of sheer dollars, of course.

But it also is so in regard to the numbers of people affected, an estimated quarter-million working poor people, and vital institutions, mainly hospitals.

So the percolating idea is to find some combination of additional money, administrative efficiencies and spending cuts-though not for nursing-home residents-to put a Band-Aid on the shortfall in existing Medicaid during the regular session.

That is Problem One. It would pose challenge enough for a remade and novice Arkansas Legislature to deal with over 60 to 80 days.

Punting Medicaid expansion to single-issue focus later in the year actually would be a big improvement over the prevailing Republican idea just weeks ago, which was to reject it outright.

One thing that has happened is that the hospital lobby has begun to explain its dire need.

Many hospitals-big or small, rural or urban-are in trouble. That’s partly because they accepted Medicare reimbursement cuts in the Affordable Care Act as part of a deal to get Medicaid expansion later.

But then the U.S. Supreme Court made Medicaid expansion optional for states.

Another is that the two chambers, the Senate and House, have installed pragmatic, deal-making leadership that, while genuinely conservative, has begun to acknowledge at least some logical and credible need for Medicaid expansion.

This leadership has begun to grasp the arithmetic that the best way to shore up existing Medicaid more solidly is to expand it at full federal expense for three years and at 90 percent federal funding thereafter.

Some existing Medicaid expenditures would move from the current 71 percent federal match to the greater federal share, thus saving the state money.

If . . .

And these are not inconsequential ifs.

One is that the Republican legislative leadership remains dubious about state Human Services Department projections of state savings with Medicaid expansion. Legislators would like a second or third opinion, maybe via an independent consultant.

Another is that the Republican legislative leadership remains dubious that the federal government really means what it says in that states must take all or no Medicaid expansion and may not design any customized increment.

They’d like some period for discussion about that, maybe between Gov. Mike Beebe and fellow Democrats in Washington.

The third if-and by far the biggest: Can we really trust the long-term preservation of this federal commitment to pay 100 percent of expansion for three years and 90 percent indefinitely thereafter?

What if Congress ever gets serious about a budget deal?

What if Democrats continue to take cuts in Medicare and Social Security off the table?

Might someone then get the idea to revise those long-term federal commitments on Medicaid, perhaps to follow through on the hundred-percent funding for three years, but scale the long-term ratio back?

On one hand, the idea that Congress might ever get serious about real budget reform seems laughable.

On the other hand, the first place I’d look if I were in a generally serious Congress-well, the second, after defense spending-is that open-ended commitment to 90 percent Medicaid funding evermore.

Make no mistake: Medicaid expansion remains the smart and right thing to do in Arkansas. But fact-gathering never hurt anybody.

Assurances are always good to get. Caution is seldom a bad idea.

There is some urgency here, but not so much that a few months would make a difference.

A more deliberate and studied Medicaid expansion would be light years better than no Medicaid expansion at all.

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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.

Editorial, Pages 73 on 12/30/2012

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