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A Medicaid conversation

by John Brummett | May 7, 2015 at 2:54 a.m.

As advertised in this space Tuesday, I interviewed that afternoon the co-chairmen of Gov. Asa Hutchinson's task force assigned to do something with--or to--our state's nationally imitated private option form of Medicaid expansion.

Twelve minutes of our 21-minute discussion can be seen at 9 a.m. Sunday on the Talk Business and Politics program on television station KATV, Channel 7. The entire interchange will be posted on-line after that at talkbusiness.net.

But I want to go ahead and tell you now that Senator Jim Hendren, at least, talks like someone who is actually considering simply doing away with our state's acceptance of any continued federal funding after January 2017 for the private health insurance premiums of our Medicaid expansion population, mostly the working poor.

That's despite the fact that Hendren acknowledged the private option to be a success in holding down its own costs, bailing out hospitals and controlling or even lowering premiums for everyone.

Hendren said that pouring a billion dollars of federal money into any industry to alter it artificially will indeed reap benefits--in this case for hospitals and insurance companies and all buyers of insurance on the state's health-care exchange.

But an artificial market is never as true or as reliable in the long term or ultimately as desirable as a real one, Hendren said.

Perhaps he can move on to wean farmers and highway contractors from federal artificiality after he weans health insurance consumers and hospitals and poor people.

Before going further with a sounding of an alarm, I should make clear that Hendren was speaking speculatively or conceptually. He stressed from the start of the conversation that the job of the task force is to keep an open mind while collecting data in search of efficiencies throughout state government's vast health-care reimbursement system.

He said his one piece of advice to all task force members was not to do the one thing I am doing here, and which I managed to have him doing--jump to assume the end result of what will be a fluid process driven by data and studies.

And I should add that Charlie Collins, the House co-chairman, was more circumspect in his pronouncements. I thought I saw his eyes pop out along with mine on one or more of Hendren's speculations.

Still, Hendren is the majority leader of the Republican Senate caucus and the nephew of the governor. He also succeeded at times in the recent session in pragmatic leadership to bridge the Tea Party-ish element of the party with its establishment.

So when he corrects me to say there is no commitment by state policymakers to continue after 2017 providing health insurance to the Medicaid expansion population, but only to continue providing health services--and to acknowledge that returning to a system of providing uninsured care through hospitals is a possibility--then we should sit up and take notice.

Hendren told me after the taping about asking a hospital official what his facility's income had been from actual medical care for private option policy-holders. He said he also asked the official what his hospital's costs of uncompensated care had been since the advent of the private option.

He said he was trying to determine whether we might be buying insurance for poor people who don't use it for actual care, in which case it might be better simply to pay for the rare care directly or absorb the costs some other way.

He said the hospital official had no idea what the answer was.

His point is that we ought to find out before making definitive pronouncements.

You can't argue with that fact-gathering fluidity, but you can argue--and I vigorously argue--that we ought to encourage poor people to get their newly offered health insurance and use it for checkups and good health-care practices.

And I also vigorously argue that there are uncontroverted facts revealing the general and varied success of the private option and that the last thing we ought to do is even think about ending it.

Actually, when I suggested that the task force devote its efforts to finding savings elsewhere in the Medicaid system and applying those to the small state match that will begin to phase in for the private option in 2017, Hendren said that was always among the possibilities.

Collins also qualifies as a doctrinaire conservative, albeit one who has embraced the private option from the beginning as innovative conservatism.

He was most enthusiastic when talking about seeking a so-called "1332 waiver" for 2017 allowing the state to redesign our entire health-care exchange to add a work incentive, live within a finite block grant and add other unspecified "market reforms."

If the state indeed intends to seek such a federal waiver, it will need to have designed its proposed marketplace and begun the waiver-request process by the last quarter of this year.

So this task force may move not only with high stakes, but at lightning speed.

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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 05/07/2015

Print Headline: A Medicaid conversation

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