Category Archives: Legislature

The larger debate: How Arkansas works

Health care, Legislature, Politics, State government, Uncategorized

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

This debate at the Capitol over health care is difficult to write about day to day because things change quickly. So let’s talk about what it might mean for the future.

First, the background. Legislators are debating the private option, which uses federal Medicaid dollars to purchase private health insurance for Arkansans with incomes up to 138 percent of the federal poverty level. It came about as a result of the Affordable Care Act, which created Obamacare. As of the end of January, 267,590 adults were eligible. It has helped Arkansas reduce its number of uninsured adults and gotten hospitals paid more often for their services – probably saving some of them, in fact.

However, some Republican legislators say it’s an unsustainable expansion of Obamacare leading to more government dependence and a bigger national debt. Gov. Asa Hutchinson is trying to make the program more agreeable to them by requiring more from recipients while changing the name to Arkansas Works. For many, it’s still not agreeable enough.

During the recent legislative session, Arkansas Works passed, but just short of the three-fourths majority needed for any kind of state spending. Arkansas Works is part of the larger Medicaid budget, which also funds nursing homes and other programs. So at least five members of the House and two in the Senate who voted against Arkansas Works must now vote to fund the entire Medicaid budget, including Arkansas Works.

This has been a huge debate. There’s been talk about how close to the cliff the state would get. The opponents haven’t wanted to fund Medicaid with Arkansas Works, and the supporters haven’t wanted to fund Medicaid without it.

The three-fourths requirement for funding is a high bar. It means that any nine senators can block anything.

So in the future, will they? If some nine senators don’t support the Common Core next year, will they threaten to withhold funding for public schools? What if nine senators want to spend more money on programs for poor people and threaten to withhold their votes for something else?

In fact, the Arkansas Constitution gives one-fourth of either House the ability to shut down the entire state government. It requires that, before anything else is funded, funding must be secured for general appropriations, which includes legislative reimbursements and such. So it’s possible for that one-fourth minority to refuse to fund general appropriations, and then nothing happens. In fact, as part of the political brinksmanship being played at the Capitol, House Democrats did just that while saying that Arkansas Works must be settled first.

Nine senators can exert their will over potentially the other 126 legislators. That’s a powerful weapon. But it’s perfectly legal and constitutional.

Is it the wave of the future? If so, it would require a complete change in the culture of the Capitol, which is a remarkably collegial place where legislators generally like each other, regardless of party. Arkansas Democrats and Arkansas Republicans, after all, are much more alike than Massachusetts Democrats and Alabama Republicans. In a body dominated by Republicans, the Senate chair of the powerful Joint Budget Committee is the universally popular Sen. Larry Teague, a Democrat from Nashville. That kind of thing wouldn’t happen in Congress. Moreover, legislators don’t want to be seen as obstructionist because they want to pass their own legislation.

Legally, nine senators can block anything, but culturally, they would pay a heavy price if they did. When cultures shift, the law remains. On the other hand, laws are always interpreted through the lens of culture.

Ultimately, Arkansas Works probably will be funded. On Tuesday, supporters pushed through the Joint Budget Committee an amendment that would end the program at the end of the year. The governor has said he will veto the amendment but not the bill, and the Legislature won’t be able to override. Voila! Arkansas Works passes without anyone having to convince two of those senators to go on the record voting for it.

Where will this lead? The Legislature is supposed to fund with a three-fourths majority, not a simple majority. It might get Arkansas Works funded, but it probably will draw a legal challenge.

Got all that? While the debate today is about Arkansas Works, the larger debate is about how Arkansas works.

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

Why governor thinks the private option is the best option

Legislature, Politics, State government

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

The question came to mind as Gov. Asa Hutchinson addressed reporters Tuesday: “Governor, when you were a young man fighting to make the Republican Party more than a tiny minority concentrated in the state’s northwest corner, did you ever think it would eventually dominate state politics, and you would lead it, and your most important priority, for a time, would be saving a government health care program?”

The question was not asked. It wasn’t the time or place. Hutchinson makes himself available to reporters and respectfully tries to answer questions. But he’s not a soul-barer.

At issue is Arkansas Works, Hutchinson’s version of the private option. That’s the program created in 2013 after the Supreme Court ruled states under Obamacare could choose whether or not to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level. Arkansas bucked the trend of other Republican states by accepting the money, but instead of expanding Medicaid, it used it to buy private insurance for that population. As of the end of January, 267,590 Arkansans were eligible.

In the recent special session, Arkansas Works passed 70-30 in the House and 25-10 in the Senate, with support from majorities of Republicans and Democrats in each chamber. But while those votes made it the law of the land, it still must be funded during the Legislature’s current fiscal session. Those majorities fell a little short of the 75 percent needed in each chamber to fund the Department of Human Services’ Medical Services Division, which includes Arkansas Works and other Medicaid programs, including nursing home care.

Opponents, all Republicans, say the private option/Arkansas Works is another health care entitlement for able-bodied adults that neither the state nor an indebted nation can afford. The talk around the Capitol has been whether they will successfully hold up the entire Medical Services Division budget to stop Arkansas Works.

Going into Thursday, the program had enough votes in the House for funding, but none of the 10 Senate opponents had publicly said they were budging. On Thursday, a plan was hatched where legislators would fund Medicaid without Arkansas Works, but Hutchinson would veto just that part of it, and legislators wouldn’t override the veto. But that idea failed, at least temporarily, to advance out of the Joint Budget Committee. So we’re still stuck.

It’s too much to say Hutchinson’s governorship depends on this government health care program, but it is really important to him – important enough that he’s never going to allow 10 senators to stop him. Over the next five years, Arkansas Works is projected to bring $9 billion into the state’s health care economy at the same time the state will lose $5 billion because of other aspects of Obamacare. The state has 19 hospitals that are considered financially vulnerable. Dropping the program would add $1 billion to the amount of uncompensated care they and other providers would provide their uninsured patients.

It also would have a $757 million impact on the state budget, which was one reason why Hutchinson spoke before reporters Tuesday. He wants to call legislators back into special session after this current one to increase funding for highways. The state needs to find about $50 million a year to become eligible for $200 million in federal funding. Hutchinson said that without Medicaid dollars, the state can’t find the matching money for those highway dollars – without raising taxes, which he won’t do.

Like all Republicans, Hutchinson takes pains to declare he opposes Obamacare, even as he depends on Obamacare money. He’s been accused by some of being hypocritical.

He says he’s playing the cards he was dealt. He’d prefer the federal government send those Medicaid dollars to the states as a block grant – still federal government money, by the way – and let the states use that money as they choose without all the strings attached.

Currently, the federal government under President Obama won’t do that. However, you may have noticed we’re in the middle of a presidential election. Maybe the next president will be more open to that idea. That being the case, Arkansas had better stay in the game, Hutchinson says.

That means putting his office on the line, and grappling with members of the party he helped build, so he can save a government health care program that depends on an idea he doesn’t support. Does that make sense? In politics, sometimes yeah.

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

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?