Category Archives: Health care

The debt, the private option, and the painter

Health care, Legislature, Politics, State government

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

If you’re helping a lot of people but contributing a few drops in the bucket to a big problem, should you stop helping those people? That’s one of the issues confronting legislators.

What’s helping people is the private option, which Gov. Asa Hutchinson is trying to rebrand as Arkansas Works.

Created in 2013, the program provides health insurance for Arkansans with incomes up to 138 percent of the federal poverty level, which is $11,880 for a single person. It uses Medicaid dollars – Medicaid being a federal-state program that serves lower-income people – that were made available by the Affordable Care Act (a.k.a. Obamacare). When the U.S. Supreme Court said states could choose whether or not to participate, many Republican states said no. Arkansas instead received federal permission to use the Medicaid money to buy private insurance.

It expires this year. On Thursday, legislators voted to extend it as Arkansas Works. But it lacked the 75 percent margins it will need to be funded in a fiscal session that begins next week. So we’ll see.

As of the end of January, 267,590 Arkansans were eligible. About 40 percent of recipients have no income. The others do, but many can’t get insurance. Speaking to legislators April 6, Hutchinson pointed to a pregnant mother employed at a West Memphis sandwich shop, and a 60-year-old painter and handyman from Jonesboro whose heart condition reduced his income so he couldn’t afford coverage. They’re both on the private option.

However, the program also is a few drops in the bucket of another problem. If it survives, Arkansas Works will bring about $9 billion in federal funds into Arkansas from 2017-21. During that time, the White House Office of Management and Budget projects another $3.766 trillion will be aded to the national debt, which is already more than $19 trillion. The math says Arkansas’ $9 billion would be one quarter of one percent of the new debt being created.

Opponents say Arkansas should do its part and say no to the money. The country already owes $19 trillion because too few will say no.

Sen. Terry Rice, R-Waldon, the lone no vote against Arkansas Works in a committee meeting Wednesday, made that point, saying, “I want to be as helpful to people as I can, but we are enslaving future generations, our children and grandchildren, to debt that we are irresponsibly putting on their credit card.”

But while the Affordable Care Act giveth, it also taketh away. The various taxes and changes to the law will take $5 billion out of Arkansas over that same time period. If Arkansas says no, it loses that money with nothing to offset it. Nineteen Arkansas hospitals are considered financially vulnerable, and without Arkansas Works, some will close. It’s happened in other states that rejected the money.

If Arkansas says no, there’s no guarantee the national debt will be $9 billion smaller. The federal budget is a huge, swirling pot of money. Meanwhile, the majority of other states – including those much richer than Arkansas – are taking the money. Louisiana, which first said no, recently elected a Democratic governor promising to say yes. So Californians and Louisianans will get health coverage, but the West Memphis working mom and the Jonesboro painter probably will lose theirs.

That’s why Rep. Charlie Collins, R-Fayetteville, a sponsor of the Arkansas Works bill, said in committee, with passion and emphasis, that he would support killing the program, but only on one condition: “Not only punishing our people.”

Perhaps the bigger issues are how the private option/Arkansas Works indirectly affects the national debt. You can say it grows government and contributes to a culture of dependency, which adds to the debt.

You also can say it’s a more honest way of paying for health care. The uninsured still seek care, but they wait until they are sicker, and then they can’t afford to pay for it. Then the costs are passed on to taxpayers, current and future, through government reimbursements to hospitals. At the same time, people who have insurance pay higher premiums. Local taxes are raised to save the hospital that’s been giving free care. The system shuffles money around like a streetside shell game scam artist. That process steals money from the future, too. It’s just not as obvious.

Lawmakers will need the wisdom of Solomon on this one. The bucket is filling up, but in this case, the drops are painters and sandwich shop employees.

Related:
Cynicism, watchfulness, the presidential campaign and Arkansas Works.

Arkansas Works and the private option: What’s all the fuss about?

Cynicism, watchfulness, the presidential campaign and Arkansas Works

Health care, Legislature, State government

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

Watchfulness is a cornerstone of a free society. Cynicism leads to the decay of it. There’s a huge difference between them, but not much distance.

What’s the difference? Watchfulness means being aware that people are sinful and selfish, that we seek our own glory and power and riches, and that we abuse and misuse other people and institutions. But it also takes into account that people make choices, and often the right ones. So it does the hard thing: It gathers facts about each individual situation and then makes a determination of what is happening, knowing that it’s probably neither all bad nor all good.

Cynicism sees bad qualities in others but often doesn’t see it in the mirror. Instead of gathering many facts to form a belief, it takes the lazy shortcut of forcing a few facts into a predetermined belief. It substitutes mockery for joy, and it builds its own worth on the shaky foundation of other people’s flaws.

Cynicism leads to inaction. Because cynicism says that nothing can be fixed, then there’s no reason to try. That’s why everyone who ever did anything great was optimistic about something. Worse, cynicism can lead to scorn, and scorn can lead to blaming, and blaming can lead to dehumanizing, and dehumanizing can lead to a lot of terrible things.

The challenge with watchfulness, on the other hand, is that it requires a delicate and difficult balance. Tip too far in one direction, and it falls into naivete. Tip too far in the other direction, and it leads to cynicism. There’s a huge difference between the two, but not much distance.

So let’s try to look, not on the bright side, but on the true side. It is true that the presidential race includes four candidates who for many people elicit strong negative emotions: Donald Trump, Sen. Ted Cruz, Secretary Hillary Clinton, and Sen. Bernie Sanders. (I wish Gov. John Kasich would elicit some negative emotions, too, but alas.) It would be easy to watch what has happened in this campaign and become cynical. Very easy.

But remember that watchfulness doesn’t take that easy route. It looks at the whole picture. So while it can be dismayed that the system isn’t working as well it should, it doesn’t ignore that the system is working much better than it could. For all the system’s flaws, we can be virtually certain there will be an orderly transfer of power come next January, and that’s a pretty uncommon thing in world history. The next president of the United States, far from seizing power with a sword, is traversing the country begging little ole’ you and me to vote for him or her and, to some degree, listening to our concerns. Yes, the watchful person says, money has far too much influence. On the other hand, Jeb Bush had a lot of it.

Closer to home, legislators during the next month will be engaged in a fierce debate about extending the private option, the program that uses federal dollars through Obamacare to purchase private health insurance for Arkansans with incomes up to 138 percent of the federal poverty line. It serves about a quarter of a million Arkansans. It expires at the end of this year, but Gov. Asa Hutchinson is trying to save it by making some changes and calling it “Arkansas Works.”

It’s a very divisive issue. Democrats unanimously support it; Republicans are split. Cynicism from one direction says it’s all part of a movement to nationalize the health care system. Cynicism from the other direction says some people don’t care enough about the poor or simply oppose whatever President Obama supports. There are elements of truth to all those charges, and they should not be ignored.

But the rest of the truth is that a legitimate debate is occurring about the role of government in imperfectly addressing a problem that can’t be perfectly solved. Health care is hard. It’s a product we naturally think should be cheap and limitless, and that’s just not possible. So we try to find that delicate balance between spending enough and spending too little, and doing it the right way.

Where is that balance? No one knows. But we’ll come a lot closer to finding it by being watchful than we will by being cynical.

Related: What exactly is Arkansas Works?

Arkansas Works and the private option: What’s all the fuss about?

Health care, Politics, State government

Gov. Asa Hutchinson
Gov. Asa Hutchinson
By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

This next month, legislators will debate whether or not the private option should continue as Gov. Asa Hutchinson’s version, Arkansas Works.

What’s all the fuss about? I’ll try to answer your questions.

What exactly is the private option?

Let’s start with the background. The Affordable Care Act, which created Obamacare, expanded the number of Americans eligible for Medicaid, the program that pays for medical care for poor people. Americans with incomes up to 138 percent of the federal poverty level became eligible. Meanwhile, the act cut the federal government’s reimbursements to hospitals that serve a high number of uninsured patients, who often don’t pay for their own care. The assumption was those people would be on Medicaid.

But then the Supreme Court ruled that states could choose whether or not to participate in the Medicaid part. Most Republican-leaning states said no, but their hospitals’ reimbursements are still to be cut. Arkansas in 2013 said “Yes, but.” Instead of putting people on Medicaid, a government program, it used those dollars to purchase private insurance. Republican legislators and Gov. Mike Beebe’s administration created it, and the federal government approved it.

What have been the results?

As of the end of January, 267,590 Arkansans had qualified. A Gallup poll last year found Arkansas’ adult uninsured rate had dropped from 22.5 percent in 2013 to 9.1 percent in 2015 – the country’s biggest improvement. Hospitals are treating fewer patients who don’t pay.

Other states that turned down the Medicaid money have faced consequences. Rural hospitals have closed. Oklahoma this week proposed cutting what Medicaid pays doctors and hospitals by 25 percent. That’s huge because Medicaid already doesn’t pay much, which is why many doctors won’t treat Medicaid patients. Louisiana, which first said no to Medicaid expansion under a Republican governor, recently elected a Democrat who promised to take the money.

What do opponents say?

The private option as it currently exists would cost $1.63 billion in 2017. Currently, the federal government pays for almost all of it, but next year the state starts picking up 5 percent, which increases to 10 percent by 2020 – assuming Congress doesn’t change the rules and make the state pay more. So the state will have to find that money.

Some legislators have a major philosophical problem with the private option. They say it’s a health care entitlement with roots in Obamacare that increases government dependency and adds to the national debt. Those federal dollars aren’t a gift; they come from American taxpayers, current and future.

So what’s Arkansas Works?

Last year, Hutchinson convinced legislators to approve the private option through the end of 2016 while the state figured out what to do next. In the meantime, he’s proposed Arkansas Works, which changes the program in a few ways. Beneficiaries with incomes from 100 to 138 percent of the federal poverty level would pay up to 2 percent of their income for insurance premiums – about $19 a month. Private option recipients would be referred to work and work training opportunities, though they wouldn’t be required to take advantage of them. Hutchinson would like to do more in that area, but the Obama administration won’t let him.

Is it really that different from the private option?

No.

Why does the Republican governor support government-funded health care?

He says he opposed and still opposes Obamacare, but he inherited this situation. If Arkansas does nothing, the private option would go away at the end of this year, and then all those people would lose their health insurance, and hospitals would have to go back to providing all that uncompensated care. Also, losing those federal dollars would blow a $100 million hole in the state budget.

What does the next month look like?

Legislators are meeting starting April 6 in a special session to vote on Arkansas Works. Then starting April 13, legislators meet in the fiscal session that occurs every even-numbered year. Because Arkansas Works will cost money, it requires a three-fourths vote in both the House and Senate. In other words, 26 representatives or nine senators could kill it.

What’s the vote count look like?

Hutchinson doesn’t have a three-fourths majority yet in either the House or the Senate. But he’s trying.

What will the outcome be?

I don’t know.

Related: The private option ink blot.

Less government, not no government

Health care, Politics, State government

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

At the State Capitol this week, a high-profile Republican talked about reforming an important but imperfect government service, rather than complain about it being there.

Lt. Governor Tim Griffin recently completed an extensive review for Gov. Asa Hutchinson of the Department of Human Services, the sprawling state agency that handles human needs such as health care for Arkansans with low incomes or disabilities, paying for nursing home residents, and serving foster children.

Meeting with reporters in his office, Griffin said he found an agency that’s poorly organized into divisions that don’t communicate with each other, leading to waste, inefficiency and less effective services. An Arkansan served by more than one division must talk to each separately, with little help.

Griffin, who previously served four years as Arkansas’ 2nd District congressman, said this kind of organization exists in other agencies. Addressing it in DHS is most critical because it serves what he said are “vulnerable” Arkansans.

The presentation was completely constructive. He offered solutions. He was genuine in wanting better services for DHS clients. He didn’t dismiss the department as another example of hapless government. He didn’t blame anybody.

Griffin’s presentation was not the only example this week of Arkansas Republicans trying to make government work better and smarter, when it would be easier to just criticize it. On Monday, the Republican-dominated Health Reform Legislative Task Force voted to endorse Republican Gov. Asa Hutchinson’s Arkansas Works program, which is a continuation of the private option, which was created largely by Republican legislators.

The private option uses federal Medicaid dollars to purchase private health insurance for Arkansans with incomes up to 138 percent of the federal poverty line. It now provides insurance for 200,000 people.

It unquestionably is a government expansion, so many Republicans understandably don’t support it. Republicans who do are trying to make government work at the state level to address problems not being fixed at the federal level or through the private sector. It’s a tough call, and the Legislature may yet choose to end it. However, Louisiana at first said no to the Medicaid money, and now it’s changing its mind.

Republicans have long been more comfortable with government at the state and local levels than at the federal level. State and local governments are closer to the people. In Little Rock, constructive work does get done.

But the party’s rhetoric often doesn’t reflect that, at any level. While it’s the party of less government, it often sounds like it’s the party of no government.

Unfortunately, it’s painting itself in a box. The GOP says it wants to cut or end government programs it can’t cut or end. That means it breaks a lot of promises and disappoints a lot of people. Meanwhile, its base includes a lot of people age 60-plus who depend on government or soon will. So what does the GOP do with that?

So here’s where we are. One party says it wants to cut government unrealistically. The other party too often wants to grow government. What’s not being said enough is that government is sometimes the best bad answer we have, but that it should be smaller and that it should work better. Instead of ending government, or growing it, there should be more talk about reforming it. What Griffin did at DHS should be done everywhere.

In the presidential race, you know who’s sort of filling that niche now? Donald Trump. He doesn’t seem to have a well developed political philosophy, but he’s talking about bringing his supposed business competence to government. He certainly doesn’t talk much about cutting government, aside from repealing Obamacare. He doesn’t want to cut Social Security or Medicare. He wants to build up the military and enact tariffs on Chinese goods. He wants to build a wall along the border funded by Mexico, which can’t afford it, so American taxpayers would pick up the tab.

This election may have been an eye-opener for the GOP. It opposes government, but its voters are nominating a candidate who doesn’t.

Maybe, somewhere in our political discourse, there’s room for responsible candidates to talk knowledgeably about smaller, cheaper, smarter government – reforming it, in other words, because sometimes that’s the best an imperfect society can do.

That’s not pro-government. It’s pro-honesty, and it can happen, even in politics.