By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.
Next week – Dec. 15-17, to be precise – a legislative task force will try to reform health care in Arkansas while deciding what to do about the state’s most contentious issue in years. That’s all.
Here’s the background. After the passage of Obamacare and then a U.S. Supreme Court decision on the matter, states could choose whether or not to expand Medicaid, which provides health care to poor Americans and others. Blue states said yes to the expansion. Most red states like Arkansas said no.
Arkansas said, “Yes, but …” Instead of expanding Medicaid, it would use that money to buy private insurance for Arkansans with incomes up to 138 percent of the federal poverty level.
The program has insured 250,000 Arkansans at its height. In fact, Arkansas has led the nation in reducing its uninsured population. Several states have followed its lead and adopted or considered their own versions. However, some legislators are opposed because the state is scheduled to begin paying part of the cost in 2017, and because this is Obamacare, and because it contributes to the national debt.
The private option barely passed in 2013 and barely was reauthorized in 2014. Because money is being spent, passage requires a three-fourths majority, which means nine senators can block it.
Instead of having yet another political battle this year, Gov. Asa Hutchinson asked legislators to fund it through 2016 and, in the meantime, reform it along with the overall Medicaid program. To accomplish that task, a Health Reform Legislative Task Force has been meeting this year and will make its report by the end of this month. Their big meeting is scheduled for Dec. 15-17. Then there will be a special session next year where the full Legislature will vote.
The task force was composed of about half private option supporters and half opponents. It hired a national consultant, The Stephen Group, that offered suggestions for changes but certainly didn’t advocate scrapping it.
Hutchinson has offered his own reforms, similar to The Stephen Group’s, that he’s calling “Arkansas Works.” Speaking to a health care group this week, he insisted the private option would end on Dec. 31, 2016. But while Arkansas Works clearly changes the private option, it’s not radically different. The government still would pay for poor people’s private health insurance.
The changes instead would make it less of a welfare program. Beneficiaries who work would be required to be insured through their employer when available rather than through the private option, with the state chipping in to help with costs. Those who don’t work would be required to obtain work training. Recipients earning at least 100 percent of the federal poverty level – and maybe some making less – would be required to pay part of the costs for what is now free health care. Those who don’t pay would lose their health insurance and be locked out of the system for a period of time. Hutchinson also floated the idea of a lifetime cap, meaning a person can’t stay on the private option forever.
Hutchinson said the program must cut costs, explaining, “We have to have the savings if we’re going to do what I believe is our responsibility, and that is to cover that expanded population.”
Note that Hutchinson said covering those people “is our responsibility.” It’s been clear since his 2014 campaign that while he might want to change the private option, he doesn’t favor replacing it with nothing.
Nor do that many legislators. There are some, but even many of those who originally opposed it now would keep something in its place. Otherwise, many Arkansans would lose their health insurance and go back to waiting until they are really sick and then accessing the health care system without insurance – and their local doctors and hospitals would eat the cost. If that happens, hospitals will close. It’s happened in other states.
Actually, the private option isn’t the biggest controversy now. The big debate is about whether the state should adopt a managed care model where parts of the Medicaid system would be run by a private company and not the state. Supporters say it would create efficiencies. Opponents say managed care companies will take taxpayer dollars and skimp on care and on payments to providers. Several Republican legislators – generally they work in health care somehow – are among the opponents.
That debate is worth more space, but I only have 750 words to talk about health care. The task force, meanwhile, has one more week to reform it.