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.

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.