Asa’s state of the private option address

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Gov. Asa Hutchinson’s health care reform speech last Thursday was what the State of the Union address ought to be but rarely is – an accurate definition of a problem respecting both sides, followed by a solution that actually has a chance of being enacted.

Hutchinson spoke last week at UAMS before an auditorium full of legislators, health care policymakers, and other interested listeners. The atmosphere was serious and expectant.

Hutchinson started his speech with a history lesson. One of the provisions of the Affordable Care Act (Obamacare) expanded Medicaid in the states, but the Supreme Court had made that provision optional. Arkansas had created what Hutchinson called an “innovative” approach: using federal dollars to buy private health insurance instead of just pouring more money into Medicaid.

Hutchinson then accurately defined the two opposing viewpoints on the issue. Because of the private option, 200,000 Arkansans have health insurance, and hospitals are providing far less uncompensated care. However, the state will soon be responsible for up to 10 percent of the costs, which could equal $200 million by 2021. Opponents, he said, are “wise” to be concerned about this.

As he pointed out, the private option has paralyzed Arkansas politics. The votes in the two previous legislative sessions have been close enough that health care providers can’t completely rely on it. So many legislators campaigned this past election on ending the private option that its future is very much in doubt, but what about the 200,000 people?

Now for the solution. Hutchinson asked legislators to broaden the debate. Pointing to a single chart beside him, he said most Medicaid spending has nothing to do with the private option, so why argue over one slice of the pie? He asked legislators to approve the private option for two years, and to create a task force that will study health care reform in general for one year. The task force will produce recommendations based on principles such as minimizing the need for more revenues and increasing recipients’ accountability and work requirements.

It will be interesting where this goes. Arkansas is already involved in a promising health care reform process, the Arkansas Health Care Payment Improvement Initiative. Will the task force build on that, produce a different idea, or just tie a pretty ribbon on the private option and rename it so certain legislators can vote yes? We’ll know in a year, assuming the Legislature passes the bill that would create it.

At the end of the speech, Hutchinson remarked good-naturedly that he had not been interrupted by applause, so the audience clapped. The reason that had been the case was that audience members were listening intently – in order to learn important information, not for cues that would tell them to stand or sit in order to make a political point.

Contrast that with the State of the Union address, delivered two days earlier. President Obama’s speech had some good points in that it had a clear theme (middle-class economics) and a call for civil debate. But as is usually the case, it was marked by a list of proposals that had little chance of being enacted. Members of Congress played their expected parts. It was theater, not policymaking. Much of it will be ignored.

Not that there wasn’t some theater in the UAMS auditorium. Part of what Hutchinson was doing was buying time. He’s willing to change the private option, even significantly. But he wants neither to take health insurance from 200,000 people, nor to turn away the $1.3 billion in federal funds the private option will provide the state this fiscal year. After the speech, some legislators opposed to the private option expressed at least mild support because they said Hutchinson’s plan would end the private option in two years. That was not what he said.

But all that’s to be expected. This is politics. Hutchinson’s address changed the tone of the debate and offered a way forward. The legislation to create the task force has been filed, and there are good reasons for it to pass: Supporters don’t want the private option to fail, and Republicans opposed to the private option want their party’s governor to succeed.

Some still will oppose the plan, but what Hutchinson said won’t be ignored. Good speech.

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