By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.
Arkansas is the land of the Hogs. When it comes to health care reform, it’s also offered itself up as a guinea pig.
Here’s why. The American health care system was a mess long before President Obama was elected. Costs were skyrocketing, and people were denied insurance based on pre-existing conditions, or they lost their insurance if they got sick. It’s long been unjust and unsustainable.
Along came the Affordable Care Act, which created Obamacare. Among its provisions was expanding Medicaid coverage for Americans with incomes up to 138 percent of the federal poverty level. Medicaid is a federal-state partnership that serves the poor, the aged and the disabled.
When the Supreme Court said states could choose if they participated in that expansion, many Republican-led states said no. In 2013, a group of Arkansas Republican legislators along with Gov. Mike Beebe’s administration instead said, “We’ll take that money, but instead of expanding Medicaid, we’ll purchase private health insurance.” The Obama administration agreed, and thus was created the “private option.”
It’s been a huge controversy that split Republicans between those who support it and those who see it as an unsustainable expansion of Obamacare.
Why would some Republicans support it? For one, a quarter of a million Arkansans now have health insurance because of it. Taking it away would be a state-changing event – for them, of course, but also for hospitals who would have to provide a lot of free care, and for the state, which would lose a lot of federal government money.
However, there’s another reason some Republicans support the idea: They’re trying to reform the entire health care system – which, as noted previously, has been messed up a long time.
Many Republicans have long advocated a “premium assistance” model for certain needy populations – basically, giving them money for insurance instead of putting them on a government program. But as state Sen. David Sanders, R-Little Rock, explained, the idea hasn’t been tried. If they could demonstrate in Arkansas that the idea could work, then they could change the entire national health care system starting in Arkansas.
What have been the results? There are more people on the program than were anticipated, and it hasn’t been managed well by the Department of Human Services. Coverage has been bought with taxpayer dollars for people without Arkansas addresses or, in some cases, a pulse. But a lot of poor people are covered, hospitals are saving money on uncompensated care, and costs per beneficiary have been lower than expected. The addition of a quarter of a million poor people to the insurance market has attracted providers to Arkansas, increasing competition and the choices available to us all.
As the experiment has continued, new elements have been included. Supporters hope to help people transition into self-sufficiency rather than trapping them in a big government program.
Hutchinson’s Arkansas Works program, which is the private option with a new name and some new wrinkles, includes work training referrals and a $19 per month contribution from better-off beneficiaries. He’d like to do more, but the Obama administration won’t let him. But next year, there will be a new administration.
So Arkansas has offered itself up as sort of the guinea pig in this experiment to see if the premium assistance model works. Since then, a number of other states have followed Arkansas’ lead and tried their own experiments. During hearings this past year, Arkansas legislators heard about some of those results, which could lead to changes here. States are the laboratories of democracy, and laboratories work best when they share what they learn.
Lawmakers hope the changes Arkansas has demonstrated could have other far-reaching effects. Sanders thinks the premium assistance model could be used effectively with the Veterans Administration – which, goodness knows, needs help. Rep. Charlie Collins, R-Fayetteville, thinks that, long-term, the model would work even for the biggest government health care program, Medicare.
There are those who say none of this will fix the health care system. Opponents from the right say government messes everything up. Opponents on the left say health care should not be a profit-earning enterprise, so the United States should do as other Western countries have done and just put the government in charge of paying the bills.
Sanders said something on which everyone should agree: This is an ongoing process. Health care isn’t going to be reformed. It’s going to be reforming, always. It must be.