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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.

------------v------------

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

Print Headline: Why ya gotta be so mean

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  • BLUEWATERMAN
    December 13, 2018 at 7:39 a.m.

    Brummett continues to ignore those who abuse the social services because of indolence, drug abuse, alcohol abuse and plain laziness. What many used to describe as the "lay-abouts." Self sufficiency is a concept that too many never learned because of irresponsible parenting and dependence on state services and subsidies. They never have to face the harsh realities of life on your own, where rent, food and shelter are not provided by someone else. Single motherhood, and the crime and mayhem it spawns continues to be a plague upon our land. Yes, help those truly in need, but not those who subsist on the government teet because of personal irresponsibility and indolence.

  • Dontsufferfools
    December 13, 2018 at 9:24 a.m.

    Bluewater, because some people abuse a service is no reason to abolish the service. Your reasoning is akin to closing all banks because they are targets of bank robbers. Here's what Asa and his abettors are up to: Raising the cost of healthcare for everyone. How are they doing this? By lopping people off Obamacare policies, hospitals and doctors will treat more patients who can't pay, which will lead these providers to raise their prices to cover the lost revenue. When Obamacare was being developed, Obama persuaded hospitals and other providers to accept lower Medicare reimbursements under the assumption that the lost revenue would be made by treating more patients who were insured. Republicans immediately went about undermining this arrangement by attacking the ways Obamacare boosted the insured population — mainly expanded Medicaid and the penalty for going uninsured.

  • NWAGrandma
    December 13, 2018 at 10:05 a.m.

    The thing that infuriates me the most about these dreadful "cost-saving" tactics is that they are heartily approved by our supposedly Very Holy, Godly Christians of our government. Shame on them all. I have not found anywhere in the Bible that says "thou shalt take away from the poor and give lavishly to the very richest."

  • condoleezza
    December 13, 2018 at 10:24 a.m.

    Bluewater. Name me a service that isn't abused by someone.You throw out aspersions with no evidence. What percentage of people on social services are abusing it vs what percentage do such services help? I prefer that my tax money help a fellow American, even if she is imperfect. Much better than wasting it over frivolous lawsuits involving Jason Rapert's efforts to force his religion on the rest of us.

  • Packman
    December 13, 2018 at 10:46 a.m.

    Conservatives believe America is better when people are more dependent on self and less dependent on government. Libs believe America is better when people depend more on government (Don't take my word for it, just as any socialist Democrat, like Bernie Sanders or Alexandria Occasional Cortex).
    .
    Believing in self-reliance has nothing to do with being mean.
    .
    Hey Condelezza - "Name me a service that isn't abused by someone." So, we need more "services" we know people are going to abuse? Sure, Connie, that makes LOTS of sense.

  • Dontsufferfools
    December 13, 2018 at 11:29 a.m.

    Scintilating assessment there, Russkypack. Come up with it all on your own? Now, some people might argue that reliable health care actually frees people to be better members of society, whereas uninsured people with untreated ailment or who are forced into bankruptcy because of huge medical bills are hindered, as are the unpaid hospitals and doctors. One could argue that children fed via food stamps and school lunch programs are better equipped to succeed in school are more likely to become productive members of society down the road. Dependency is a condition. Babies and old folks in nursing homes are dependent on others. So are some handicapped and disabled people. You're chronically dependent on others to explain all the flaws in your thinking. Nothing is stopping you from buying a hilltop in Montana, building a wall around it and declaring it the free state of Russkypack. You can, if you wish, deny entrance to your children and your disabled kin. Don't fret about it. Nancy, Chuck, Bernie and Alex will pick up the slack for you.

  • Illinoisroy
    December 13, 2018 at 1:31 p.m.

    not christians, capitalist!

  • ecs
    December 13, 2018 at 1:38 p.m.

    If it's a question of money, we can measure the cost of home care vs nursing home care. We can measure the cost of prisons vs the cost of decent public education. If what matters is the money, why can't the cheaper alternative prevail? Could it be because that benefits only the poor, young, aged, infirm? The money saved seems to be directed at the population who already have plenty.

  • mozarky2
    December 13, 2018 at 2:19 p.m.

    Everybody loves Santa until it becomes apparent Santa isn't real...

  • GeneralMac
    December 13, 2018 at 4:12 p.m.

    I have yet to read where Jesus mentions GOVERNMENT taking care of people.

    Yet, "usual suspects" seem to throw the "UN-Christian " label at anyone who doesn't believe Jesus though GOVERNMENT should take care of people.

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