Category Archives: Health care

Hutchinson’s ham and egg election

Elections, Health care, Legislature, Politics, State government

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

You know that old saying about the difference between ham and eggs? The chicken is involved but the pig is committed. Gov. Asa Hutchinson was both during this year’s primary elections.

With the presidential race, he was merely involved. He endorsed Sen. Marco Rubio for president eight days before the vote. He made a couple of appearances and a TV commercial. Donald Trump won Arkansas. Rubio was third, which he was going to be anyway.

Hutchinson, however, was committed in the state legislative races, where his political action committee, ASA PAC, donated money to eight Republican candidates who had Republican opponents.

This happened because the eight he supported also support, or at least would consider supporting, Hutchinson’s Arkansas Works. That’s the continuation of the private option, the state program that uses federal Medicaid dollars through Obamacare to purchase private insurance for adults with incomes up to 138 percent of the federal poverty level.

Created in 2013 by Republican legislators and Gov. Mike Beebe’s administration, it now covers 200,000 Arkansans. It brings a billion dollars in federal money to the state’s economy annually and has saved hospitals from providing millions of dollars in uncompensated care. But some Republicans are opposed because of its association with Obamacare, because it’s another government entitlement, and because they say neither the state nor the country can afford it.

Because it involves spending money, it requires a three-fourths vote for passage every year, which means nine senators can kill it. It barely reached three-fourths in 2013 and in 2014.

In 2015, Hutchinson persuaded legislators to accept a truce: Fund the private option through 2016, when it would end, and he and a task force would look into creating something else. That alternative is Arkansas Works, which is like the private option except that it requires a bit more personal responsibility on the part of beneficiaries. He says it’s a real change. Opponents say it’s cosmetic.

Hutchinson says Arkansas needs it. His budget depends on it. He doesn’t want to take insurance from 200,000 people. He needs $50 million in extra money for highways so the state will be eligible for $200 million in matching federal dollars. Take away the private option, or Arkansas Works, and that money’s hard to find without a tax increase, which isn’t happening.

On April 6, legislators will meet in special session to vote on Arkansas Works, or something. It can pass with a simple majority, which isn’t that high a bar. Then they’ll meet in the fiscal session, which occurs every even-numbered year, to vote on funding. And because a three-fourths majority will be needed, that session could be a doozy.

Arkansas Works was a central issue in those eight Republican primaries, which left Hutchinson a choice: Do nothing so as not to offend the potential winners; get involved like the chicken; or be committed like the pig. He was committed. He openly supported candidates. He held a press conference defending them. His political action committee gave each of them $5,400.

His job would have become much harder had those candidates lost. While the winning candidates would not take office before the special session, the current legislators would see Arkansas Works as a losing bet. Then Hutchinson next year would be dealing with as many as eight new legislators he’d worked to defeat.

Instead, six of the eight won, including all three in the Senate, where Hutchinson has no votes to spare. On the House side, three of his five candidates won, and one who lost was challenging an incumbent, Rep. Josh Miller, R-Heber Springs. Miller was already in the House, so Hutchinson’s situation didn’t change there.

The next day, Hutchinson addressed the Political Animals Club at the Governor’s Mansion. His mood was not quite jubilant, but it was definitely somewhat north of relieved.

“I think everybody in this room knows that if those three state senators had lost their race, it would not be a pleasant day for me in this room,” he said. “I would have to be explaining. It would have been considered a referendum on me and my leadership.”

Yes, it would have been, in a way that the presidential race was not. He was merely involved with Rubio for eight days, but he’s staking a big chunk of his first term as governor on Arkansas Works. That’s commitment.

Related: Coming health care debate a “cage fight,” says leading legislator.

Priorities and the Hogs

Business and economics, Health care, State government

Football on tee - transparentBy Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

Merriam-Webster’s online dictionary defines “juxtaposition” as “the act or an instance of placing two or more things side by side.” On January 27, an interesting one occurred at a University of Arkansas System Board of Trustees meeting.

The trustees were led on a tour of the University of Arkansas for Medical Sciences hospital campus in Little Rock. While parts are new and gleaming, what once was the main hospital needs $13 million just to become fire code-compliant, and even then it would be badly outdated and inefficient. UAMS would like $97 million to spruce up that building and other facilities, all for administrative space. Tearing the building down and replacing it would cost $250 million.

Board members later heard from the University of Arkansas at Pine Bluff. Students there enjoy a new science and technology building and a new fitness center, but in the middle of campus is an unused old multistory facility with weeds growing from the roof, and not as part of a science experiment. The campus security headquarters is an aging house, which can’t be reassuring to parents, and after a good rain, parts of the campus are underwater. UAPB would like money, too.

Then came the University of Arkansas Athletic Department, which seeks a $160 million expansion of its football stadium that would include 3,200 premium seats along with other amenities, such as a video board. The project would be funded through $40 million in donations and a $120 million bond issue repaid through higher ticket prices, paid mostly by fans not sitting in those 3,200 premium seats.

The trustees gave Athletic Director Jeff Long their blessing to continue gathering information, but not before former Sen. David Pryor had questions and abstained from voting. He said he was not necessarily opposed, but priorities should be discussed. This would be, he said, “the largest single bond issue in the history of higher education in the state of Arkansas.” He asked who would benefit, and how much of the costs students would bear.

“A bond issue is a debt of the University of Arkansas,” he said. “It is a debt of the people of Arkansas, and ultimately if something goes wrong, who’s responsible? And that’s the people.”

This is where the columnist perches in his ivory white tower and wags his finger at the trustees, right? Well, not necessarily. Pryor had it right. A discussion is needed.

True, it was quite a juxtaposition to see the state’s teaching hospital and one of its universities asking for money that’s currently not available for boring but necessary stuff like medical administration and drainage, which was then followed by a mostly celebrated $160 million request for football seats used six or seven times a year by rich people, along with other amenities.

However, the needs UAMS and UAPB are seeking to fill would be met partly by tax dollars that haven’t yet come from the Legislature. Moreover, it should never be assumed that public entities are spending the money they already have as efficiently as can be expected (or that they’re not).

Long, in contrast, was asking to pursue money paid voluntarily by donors and fans who, if they don’t like the higher ticket prices, could choose to watch the games on TV, which is what I do. The UA Athletic Department is one of the nation’s few big time college programs that turns a profit and is self-sustaining. In fact, it’s given money back to the university for academics for the newly built Champions Hall.

Finally, at what point do the Razorbacks add to the university, and at what point do they distract from it? The head football coach, Bret Bielema, is by far the highest paid state employee, including the doctors saving lives at UAMS. That seems like a misplaced priority. On the other hand, the Razorbacks are the university’s best marketing tool and a tie that binds the state together. And on the third hand, does all this send a message to young people that while we adults tell them to hit the books hard so they can become doctors, what we really value is how hard the Razorbacks hit the opposing players in the SEC?

It’s a complicated discussion, and it’s worth having before letting people spend $160 million of their own money on a football stadium, and making taxpayers responsible if something goes wrong.

Reducing debt and cures for cancer

Debt and deficits, Health care, Politics, U.S. Congress

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

During the president’s State of the Union address Tuesday, there was an elephant in the room, and I’m not talking about the Republican Party, whose mascot is the pachyderm.

The elephant would be the $19 trillion national debt, ignored by President Obama during an hour-long speech, which was otherwise pretty good, and alluded to a couple of times by South Carolina Gov. Nikki Haley in her Republican response, which was also pretty good.

What was good about the State of the Union speech was its optimistic tone and its call for reason on issues both at home and abroad. The United States should identify and respond to threats, not inflate them so that it makes bad decisions out of fear. Its politics should be messy, not ugly.

However, the president’s only referral to the government’s red ink was to say that annual budget deficits have been reduced amidst other aspects of an improving economy.

That’s true, but while deficits have decreased, they’re still occurring each year, and still adding to the national debt. At the tail end of the Bush administration and the first half of Obama’s, the United States government was spending more than $1 trillion more than it collected each year – more than $3,000 per American per year, and at its worst, $4,000. According to the Congressional Budget Office, the deficit for fiscal year 2015 was $439 billion, or almost $1,400 per American.

Yes, that’s an improvement. We’re adding to the debt less quickly than we were before.

But during this prolonged period of economic growth, policymakers have failed to act to reduce future deficits. They haven’t make changes to the government’s retirement and health care programs that soon will help drive those annual deficits back to $1 trillion levels. They’ve failed to reform a tax code to juice the economy by, if nothing else, reducing the time we all spend doing our taxes. They haven’t created a sustainable method to fund the country’s infrastructure.

The economy is much better than it was in the midst of the Great Recession. Unfortunately, it remains dependent on debt – and worse, the kind caused by in-and-out spending, not investment.

That’s why potentially one of the most important paragraphs in Obama’s speech was tucked in the middle, when he said the United States should cure cancer.

That’s exactly the kind of investment that can make life better for Americans and help reduce all that red ink described earlier in this column. According to the National Institutes of Health, cancer cost the health care system $124.6 billion in 2010 and will cost $158 billion in 2010 dollars in 2020 – and that’s not including the impact of each invaluable life lost, nor the financial and emotional losses suffered by cancer patients and their loved ones. The disease often strikes people during their most productive years, or before they’ve even reached those years. All those things slow the economy, cost taxpayer dollars, and add to the debt.

At the same time we’re spending that kind of money to treat the disease, Congress recently appropriated $5.2 billion for cancer research this fiscal year, which is actually a raise from the previous $4.9 billion. That’s pretty good, but we could do better.

Since 2009, the national discussion over heath care has been about bureaucracies – what kind and how much. At some point, it would be helpful to talk about health care when we’re talking about health care. Curing the various types of cancer would be one of the greatest investments America could ever undertake. It would increase Americans’ ability to enjoy their inalienable rights of life, liberty and the pursuit of happiness. It would be a far greater service to the world than many of the things we’ve been doing since 2001. It would be a wonderful gift to future generations and sort of make up for the debt we’re passing down to them.

The research must take into account not only medical effectiveness, but cost-effectiveness. The NIH assumes in its analysis that new technologies and treatments will cost more, not less. So not only must cures be found, but costs must be affordable – both for Americans and for poorer countries.

We can do it. Americans put a man on the moon. Let’s find cures for cancer next.

Related: Who gets first dibs on Uncle Sam’s money? Its creditors, of course.

Executive orders, congressional disorder

Health care, Politics, U.S. Congress

U.S. Capitol for blogBy Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

This past week saw two big news events that weren’t actually very “new”: President Obama’s announcement that he is issuing yet another executive order, this one related to gun restrictions, and Republicans in Congress voting to repeal Obamacare.

Obama’s executive order, which attempts among other things to close the gun show loophole, doesn’t seem to be that significant a policy move or even a bad proposal. Sellers should all play by the same rules, and I’m not opposed to there being one less avenue for crazy people, convicted felons and terrorists-in-waiting to be able to purchase military-grade weapons.

The problem is the process. Congress has not voted to accomplish what Obama wants to accomplish. More concerning, executive orders are becoming a habit of his, the most obvious example being his attempt to completely bypass Congress on immigration policy. That effort is now being tied up in court, where it should be. And I write that despite the fact that, as with the gun show issue, I agree with Obama in principle that the United States should focus on deporting dangerous illegal immigrants while finding a path to legalization for those who have been here awhile and are otherwise obeying the law.

But that’s another column. This is about misusing the presidency’s powers.

I guess this is the part where I’m supposed to write about Obama in hysterical, apocalyptic terms. Let’s instead have a calm, rational discussion, shall we? President Obama is exceeding his constitutional authority. He should stop doing that.

Actually, Obama is doing exactly what the Founding Fathers anticipated a chief executive would do, which is try to exercise power. They knew that was a bad thing, even if the president’s goals were agreeable.

So they included in the Constitution a system of checks and balances to keep that from happening. Congress makes the law; the president enforces the law; the judiciary interprets the law.

Unfortunately, Congress is failing to check and balance the president, and it’s time for congressional Democrats to step up.

Members of Congress are supposed to place their branch above their political parties – which, by the way, are not even mentioned in the Constitution. Throughout American history, senators and representatives have stood up to presidents who have tried to usurp their role. Instead, with exceptions, congressional Democrats today too often are behaving as if this is a British parliamentary system, where a prime minister leads the government and most everybody falls in line most of the time.

Because I’m determined to offend everyone in this column, congressional Republicans share blame as well. The system is supposed to work through a system of checks and balances, not unending dysfunction. Republicans made a political decision from the beginning of Obama’s presidency to make him fail, no matter what. It’s worked for them – politically. They’ve made huge gains in Congress, in governor’s offices, and in state legislatures. But a more constructive approach would have been better for the country.

Now we’ve had yet another vote to repeal Obamacare – one that actually will make its way to Obama’s desk, where he will veto it.

This is happening because Republicans believe it will help them in November prove once again that President Obama supports Obamacare, along with Democrats, as if there were any doubt about all that. Meanwhile, Republicans still haven’t coalesced behind a plan to replace the system they would repeal. The bill they sent to his desk would give policymakers a couple of years to create an alternative, but if they don’t, or can’t, would we all go back to the days when insurance companies denied coverage to people because of pre-existing conditions, or cut them off when they became too expensive to cover? At the moment, I guess we would.

No one’s the hero, and no one is the villain. What’s happening is that a lot of officeholders are caught up in the big game up there, which is one reason why Obama’s approval ratings are only 45 percent, according to Gallup, while Congress’ are at 13.

Anyway, it’s 2016, and time for us regular folks to vote. If we do our jobs better, maybe they will too.