By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.
Want the private option to go away? Maybe you should root for the candidate for governor who seems most supportive of it. Want it to survive? Maybe you should root for the candidate who seems most on the fence.
Let’s review the backstory before explaining.
The private option came about because of two provisions in the Affordable Care Act, otherwise known as Obamacare. First, it required states to expand their Medicaid rolls to serve more poor people. Second, because it was doing that, it cut government reimbursements to medical providers for giving uncompensated care to people who don’t have insurance and don’t pay. The thinking was there would be less uncompensated care because more people would have Medicaid.
When the Supreme Court ruled Obamacare constitutional, it also said states didn’t have to expand Medicaid, and many Republican-led states did not. Arkansas legislators – Republicans, actually – along with Gov. Mike Beebe’s administration instead created the private option, which serves the same population by using government dollars to buy private insurance instead of enrolling them in Medicaid.
As a result, about 200,000 Arkansans are benefitting – most through the private option, and the rest because they were routed into Medicaid while trying to enroll in the private option. The federal government is paying for almost all of the private option now; the state will begin kicking in a small share in 2017, eventually paying 10 percent under the program’s current terms.
Supporters say it’s is a rational mechanism for funding health care for 200,000 people. We’ll end up paying for health care for them anyway – often in the emergency room if they don’t have insurance. Smaller hospitals have closed in states that turned down the money. The private option’s mechanisms encourage recipients to behave like health care consumers and be more picky and choosy with their decisions, in theory reducing the cost. So far, it seems to be doing much of what it was intended to do.
Opponents say it’s just Obamacare by another name, inevitably resulting in more government and more debt. Doing business with the federal government is a risky deal, they say. That 10 percent will amount to real money, and at this point, we don’t even know how much it will cost.
The funding mechanism must pass the Legislature with a three-fourths majority every year. Democrats are all for it; Republicans, who likely again will have majorities in both the House and the Senate next year, are split between “yeses,” “no’s,” and “heck no’s.” It barely passed earlier this year, and there will be even more legislative opponents after this year’s elections.
Which brings us to this year’s campaign for governor. Democrat Mike Ross is totally for it. Republican Asa Hutchinson, knowing his party is split, has hedged throughout the campaign. In Tuesday’s televised debate, he referred to its successes but says Arkansas must know the costs before deciding whether or how it should continue.
If he’s really against it, he’d say so.
Let’s not ignore the other candidates: Green Party nominee Joshua Drake supports the private option, while Libertarian Frank Gilbert is opposed.
When the Legislature convenes in January, the new governor will have an agenda (along with all 135 legislators), but everything will hinge on the private option. It’s that big and that controversial, and Hutchinson probably gives it a better chance of continuing in some form.
That’s because Hutchinson, the Republican, would have much more pull with the Republican “no’s” than Ross. (No one will flip the “heck no’s.”) Every legislator in Ross’ minority party is already for it. He could use his veto if the Legislature left out the private option, but the Legislature could override that with a simple majority – the same percentage that passed the bill in the first place.
So Ross perhaps would be more eager to fight for the private option, but Hutchinson, the outwardly more reluctant warrior, would have more weapons.
Hutchinson would have his own motivations for saving it. He has plans, including cutting taxes by $100 million during his first year in office – a difficult prospect anyway and an impossible one without the private option’s federal dollars. He does not want to spend his first term reneging on his campaign promise, plugging budget holes, and trying to save endangered hospitals.
The private option may survive, albeit with changes, regardless of who wins. It may die either way. But it probably has a better chance of surviving with help from the candidate for governor who won’t say he supports it.