Category Archives: U.S. Congress

Health insurers want to raise prices. What now?

Health care, Legislature, Politics, U.S. Congress

By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

The big news in health care this week was that most of the state’s insurers are asking for rate increases for policies purchased individually or through the state’s Arkansas Works program.

The bigger issue – rising health care costs, and the political system’s inability to address them – is not new.

The two Blue Cross providers are asking for 14.7 percent increases, while QualChoice Life and Health and QCA Health Plan are asking for increases of just under 24 percent. The state’s fifth insurance company, Ambetter, is asking for less than 10 percent and is not required to publicly disclose or justify that amount. The sixth insurance company, UnitedHealthcare, unable to make a profit, is leaving the market.

The Arkansas Insurance Department still must approve the requests. Commissioner Allen Kerr sounded skeptical in a statement released by his office.

There are many reasons for the requested hikes. I’ll summarize those given by Arkansas Blue Cross spokesperson Max Greenwood. Patients are using more health care than expected. Costs are rising, particularly for prescription drugs and catastrophic claims of more than $50,000. The Affordable Care Act’s transitional reinsurance fee, which offset higher cost enrollees, is going away.

One other factor pertains to Arkansas Works, the program formerly known as the private option that uses federal funds to purchase private insurance for lower-income Arkansans. Remember last year when we learned many people living out of state, or not living at all, were being covered? When that was more or less fixed, Blue Cross lost a population of 25,000 members whose premiums were being paid but who didn’t use much health care, especially the dead ones. So now the insurer says it has to adjust.

Of course this all happens in the context of Obamacare. Sen. Tom Cotton, Rep. French Hill and Rep. Bruce Westerman released statements calling once again for the Affordable Care Act to be repealed and replaced with patient-centered reforms.

That’s easier to say than do. Since the Affordable Care Act was signed into law more than six years ago, congressional Republicans have voted dozens of times to repeal it. Replacing it? Not so much. True, Rep. Tom Price, R-Ga., a physician, has been offering alternative bills since 2009, and Donald Trump’s website lists a framework of reforms. But the party has never coalesced behind a detailed, specific plan and then spent political capital selling it to the American people. Instead, it’s mostly just voted to repeal Obamacare knowing that, ultimately, President Obama would veto the repeal anyway.

Health care is by far the most difficult issue facing policymakers. There are many reasons, including that it’s a service Americans believe should be unlimited and cheap, which is a high standard. We need health care like we need groceries, but with food, most of us want steak but will buy canned tuna if that’s all we can afford. With health care, we all want nothing less than steak, but at canned tuna prices.

Like any other service, someone has to pay for a health care provider’s costs, and there are only three imperfect ways to do that. One is the free market approach where the consumer pays, which offers more freedom but less security and doesn’t have a clean answer when the consumer can’t afford the care. Another way is for the government to pay, which offers more security, at least initially, but less freedom. In that case, the government is deciding how life and death resources are allocated. Then there’s the third approach: Someone else pays, typically an insurance company. That method tries to strike a balance between freedom and security but gives a lot of power to a private corporation and in recent history has not effectively controlled costs.

The American health care system was a convoluted concoction of those three payment methods before Obamacare, and it still is. Prices were rising before Obamacare, and they still are. Undoubtedly, more Americans have insurance now than they did, and that’s a positive that shouldn’t be ignored. But many still are uninsured, and the big problem – cost – has not nearly been solved.

Republicans at the national level would do well to follow the example set by Republicans in Arkansas, who have done most of the creating, amending, defending and opposing of the aforementioned private option/Arkansas Works.

We can debate whether Arkansas Works is a good idea. But at least it’s a new one, with specific details that are clearly communicated and fought for.

Related: The real goal of the private option: Changing U.S. health care

Return of the Democrats?

Elections, Legislature, Politics, State government, U.S. Congress

Conner Eldridge is running as a Democrat for the U.S. Senate seat held by Republican Sen. John Boozman.
Conner Eldridge is running as a Democrat for the U.S. Senate seat held by Republican Sen. John Boozman.
By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

The last eight years have been really bad for Arkansas Democrats. The last few months have been a little better.

Democrats controlled Arkansas politics for 140 years. As late as 2008, the party controlled five of the state’s six congressional offices, all seven statewide constitutional offices, 27 of the 35 state Senate seats, and 75 of the 100 state House seats.

But they have fallen far, fast. After President Obama’s election, Arkansas did what much of the rest of the South had already done and became a Republican state.

Now, Republicans occupy all the state’s congressional offices, all seven statewide constitutional offices, 64 state House seats and 24 state Senate seats. In the last two U.S. Senate races, Democratic incumbents won only 37 percent of the vote in 2010 and 39 percent in 2014. Almost twice as many Arkansans voted in the March 1 Republican presidential primary (410,920) as voted in the Democratic primary (221,010). Democrats could not field a candidate in three of the four congressional races and do not have enough candidates in state legislative races to win back a majority, even if they win every race they are contesting.

In 1960, New York transplant Winthrop Rockefeller hosted a “Party for Two Parties” at Winrock Farms in hopes of building the almost nonexistent Republican Party into a viable contender. At times these past eight years, I’ve wondered if we’re going to need another one of those parties.

But Arkansas Democrats have had at least three bright spots lately.

One, they’ve got a young, energetic U.S. Senate candidate, former U.S. Attorney Conner Eldridge. He’ll have a tough time unseating the Republican, Sen. John Boozman. But he’s running an aggressive campaign.

Second, the presidential race is shaping up about as well as Democrats could hope: former Arkansas first lady Hillary Clinton versus Donald Trump. He’s brought new people to the Republicans but also split the party, which will not completely unite behind him. President Obama won 37 percent of the vote in Arkansas in 2012. That’s consistent with the percentages those incumbent senators won in 2010 and 2014, so it’s not certain Clinton will do better. But at least Trump gives Democrats a target.

Finally, Democrats at the state level, who sometimes have been behaving as if they hope things will just get back to “normal,” have been acting a little more like a vigorous minority lately.

I’ll try to make this brief. In the fiscal session that just ended at the State Capitol, the big issue was Arkansas Works, the program that uses federal Medicaid dollars to purchase private health insurance for a quarter of a million Arkansans. It had passed by large majorities in a recent special session, but it fell just short of the three-fourths needed in both the House and Senate for funding during the fiscal session. Under the Arkansas Constitution, nine senators can kill funding for any program, and this time, 10 Republicans were determined to stop Arkansas Works.

However, the Arkansas Constitution also contains a provision requiring that the first item that must be passed in a session is the general appropriations, which funds expenditures such as legislators’ reimbursements. Democrats in the House decided to hold that up until Arkansas Works was passed.

After much maneuvering by Gov. Asa Hutchinson, Arkansas Works was funded. Because he practically staked his governorship on it, it’s debatable how much of an effect the Democrats’ effort had. But at the very least, it was a reminder that 35 House Democrats can throw as much of a monkey wrench in the proceedings as 10 Republican senators can.

As a party, Democrats tend to support more government activity to help lower income people, so Arkansas Works would seem to be an appropriate issue for them to fight for, or at least stand with the big guy doing the fighting. Now they are coalescing behind another issue they think is a good fit, more funding for pre-K education.

That’s a better strategy than waiting for their majority to return, which isn’t going to happen any time soon. Two parties are better than one, and if you’re going to be a minority, you might as well be a vigorous one, Rockefeller would say.

Related: How Conner Eldridge thinks he can win.

Cuba: trade embargo, or free trade?

Business and economics, Politics, State government, U.S. Congress

Rick Crawford
Rick Crawford
By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

U.S. Rep. Rick Crawford’s 1st District in eastern Arkansas is home to half the nation’s rice acres. Cuba imports 400,000 tons of rice a year, mostly from Vietnam. So yeah, he’s for opening up trade to Cuba.

Speaking by Skype last week to a pro-trade-with-Cuba gathering at the Winthrop Rockefeller Institute on Petit Jean Mountain, Crawford said the trade embargo, in place since Oct. 19, 1960, has punished American producers instead of the Castro regime. Shipping rice from Vietnam take 36 days, versus the 36 hours it would take to ship Arkansas’ better, fresher rice, but the market is closed. Crawford, a member of a pro-Cuba trade congressional working group, has sponsored legislation that, among other provisions, would let Cuba buy rice on credit rather than requiring it to pay cash, which it doesn’t have. He’s traveling April 5-9.

Crawford isn’t the only Arkansas policymaker favoring a new approach to the communist country 90 miles off Florida’s shore. Sen. John Boozman also supports a change. He says the 55-year embargo hasn’t removed the Castro brothers from power, so it’s time to try something else – trading goods and ideas. The United States does business with worse regimes, he says, including Saudi Arabia and China. Last year, Gov. Asa Hutchinson – who helped enforce the embargo as undersecretary of the Department of Homeland Security, led a delegation of about 50 Arkansas business and government leaders to Cuba. He favors more trade without completely lifting the embargo.

Naturally, these policymakers have allies in the business community, including Arkansas Farm Bureau and Riceland Foods, both of whom see Cuba as a huge market.

Two Arkansas policymakers disagree. U.S. Senator Tom Cotton criticized President Obama as he traveled to Cuba last week, pointing out that the Castro regime arrested a human rights activist shortly before the trip. Rep. Bruce Westerman, who represents the 4th District, says opening up trade with Cuba rewards a regime that is still in power and still guilty of human rights abuses.

The state’s two other congressmen are still on the fence, sort of. Rep. French Hill, who represents the 2nd District, told KARN radio the other day that Arkansas will benefit from opening up the Cuban rice market, but he needs to see a path toward democracy and a market economy, and he’s concerned that there doesn’t appear to be a plan to make reparations to those who lost their businesses to the Castro regime. Rep. Steve Womack, from the state’s 3rd District, is still weighing the benefits and pitfalls of opening up trade, his office said.

The trade embargo began more than 55 years ago under President Eisenhower. In that time, all that’s been accomplished is that an ailing Fidel Castro was replaced by his brother, Raul. During that time, the United States has had 11 presidents. Meanwhile, the Soviet Union has gone from world superpower to historical artifact (for the moment); China has gone from closed communist country to manufacturing powerhouse; Europe’s economic borders have largely been erased; and the two Germanies have become one.

So the world has changed a lot – all except Cuba, where the Castros are still in charge.

And yet even Cuba’s past doesn’t necessarily limit its future. At the Winthrop Rockefeller Institute, Ruben Ramos Arrieta, Cuba’s minister counselor at its Economic and Trade Office in Washington, said the country has been undergoing a “transformation” since 2008. He said 80 percent of its agricultural land is state-owned, but 70 percent of that is now being used by private farmers and cooperatives. Whether or not that’s accurate, it’s notable that he described the private sector positively and that he spoke of “transformation” rather than “revolution.” Michael Bustamante, a Yale University professor with family in Cuba, said Cubans have an entrepreneurial spirit that helps them maintain an “a-legal economy” that is often ignored by the government authorities. Who knows what they could accomplish given freedom and a free market?

It’s said in sports that Father Time is undefeated. The same is true in politics. Raul Castro has said he’s leaving office in 2018, and even if he doesn’t, he’s 84 years old. Fidel Castro is 89. In the near future, somebody else is going to be Cuba’s leader.

The question for policymakers is, would that person be more influenced by a trade embargo, or by free trade?

Related: Make Cuba thirsty.

GOP shows Obama its cards, helps Hillary Clinton

Politics, U.S. Congress

By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

Generals don’t tell the enemy where they are going to attack. Boxers don’t tell their opponents where they are going to punch. But Republicans told President Obama and the Democrats exactly what they were going to do about the U.S. Supreme Court vacancy, and because of that, they may have increased the chances Hillary Clinton will be the next president.

After Justice Antonin Scalia passed away, Republicans quickly declared that Obama might as well not nominate a successor because the Senate won’t confirm him or her anyway. Senate Majority Leader Mitch McConnell, R-Ken., said the seat “should not be filled” until the next president takes office. Most of the party’s presidential candidates made similar statements.

That was a political mistake. Now, Obama has the high ground. He can make this a contest between himself and McConnell, who’s not exactly an electrifying figure. The “executive order president” can paint himself as the defender of the Constitution. He’ll do his constitutional duty in nominating a successor; now will Republican senators do theirs and give a fair hearing to the nominee?

Moreover, now he knows the Republicans’ strategy, but they don’t know his, so he can plan his next move accordingly.

For example, he can nominate a female with a long list of accomplishments, maybe even a military record. If Republican senators refuse to give her a fair shot, or even treat her poorly, then Clinton can spend the rest of this election talking about those obstructionist Republicans keeping glass ceilings above women’s heads. That message will resonate in an electorate where Obama won women by 12 points in 2012, according to Gallup. In that same election, Republicans won men by only eight points, and more women vote than men.

In addition to the vacancy, three justices – Ruth Bader Ginsburg, Anthony Kennedy and Stephen Breyer – are at least 80 years old or getting close. So the irony is that to keep Obama from nominating one justice, Republicans likely have given Clinton an issue she can use to win and have the chance to nominate four.

What Republicans should do is praise Scalia as a strict constructionist who believed the Constitution means what it says it means, and that they will honor him by insisting that Obama’s nominee follows his example. If Obama nominates someone too liberal, they can expose that person’s record and make voters more uncomfortable with Clinton’s potential nominees. By then it will be late spring, and then Republicans can plausibly make the case that, at that point, we might as well wait for the next president.

On the other hand, Obama wants to appoint a Supreme Court justice at least as much as he wants Clinton to win, so maybe he will nominate someone Republicans can live with. Some senators might decide they’d rather confirm his nominee in his last year, rather than take their chances on Clinton winning and nominating someone in her first. Republicans, after all, control the Senate now. Next year, they might not.

I can think of three reasons Republicans tipped their hand so clumsily. One, many of them viscerally, emotionally dislike Obama, and people in that state of mind make mistakes. Two, it’s a presidential year, so the party’s focus naturally turns to candidates trying to get elected by appealing to the party base, and away from those trying to run a government. And three, they did it because they had no choice. A beast has been created these past eight years that must be fed anti-Obama red meat at all times. Had Republican leaders played their cards a little closer to their vests, that beast would have been angry.

Let’s not overstate this. Republicans made a bad move, but not a fatal one. It’s a long way until November, when the election will be decided mostly by the actual nominees. Since Obama was elected, Republicans have gained or solidified control of both houses of Congress, a majority of state Legislatures, and a large majority of governor’s mansions. They must be doing something right, politically.

But now, for the first time in a long time, they do not have control of the Supreme Court. It’s now 4-4, which means we’re looking at a lot of deadlocked votes. Let’s hope Republicans walk back their previous statements. The president should fulfill his constitutional duty, and they should fulfill theirs.