Category Archives: State government

Next year’s health care ‘cage fight’

CapitolBy Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

In mid-December, I wrote that legislators would decide how to reform health care in Arkansas by the end of the month. As the TV character Maxwell Smart used to say, “Missed it by THAT MUCH.”

What legislators actually did was give Gov. Asa Hutchinson a few months to negotiate with the federal government – and then sometime next year they’ll decide how to reform health care. It will be a “cage fight,” in the words of Sen. Jim Hendren, R-Sulphur Springs, chairman of the Health Reform Legislative Task Force (and Hutchinson’s nephew).

The task force was created last year to determine what to do about Medicaid and the private option. Medicaid is the health care program for the poor, the aged and disabled. The private option is the Medicaid program that buys private insurance for Arkansans with incomes up to 138 percent of the federal poverty level. The private option, which was created in 2013, currently is funded entirely by the federal government, but Arkansas begins paying 5 percent in 2017 and 10 percent by 2020.

The private option provides health insurance for about 200,000 Arkansans. It is the primary reason the state has cut in half its number of uninsured residents, lessening the unpaid care provided by hospitals. But critics believe it is an unacceptable concession to Obamacare that eventually will cost the state a lot of money. It must pass with 75 percent support from each house in the Legislature each year, which means nine senators can kill it.

Hutchinson, who wants to keep it, persuaded lawmakers this year to fund it through the end of 2016 while his administration and the task force create an alternative. He’s proposed a sequel, “Arkansas Works,” that like many sequels looks a lot like the original. It would, however, involve more personal responsibility on the part of beneficiaries, including requiring those with higher incomes to shoulder part of the cost for what is now essentially free health care.

Those changes will require a waiver from the federal government that Hutchinson has already started seeking. In January, he’ll meet with Sylvia Burwell, secretary of the Department of Health and Human Services. He’ll probably get part of what he wants because Burwell will know the private option is on shaky ground. But he already knows he won’t get everything he’d like.

He requested and received the task force’s blessing to proceed. During a voice vote on a motion supporting his efforts Dec. 16, zero legislators voted no.

But legislators weren’t necessarily endorsing Hutchinson’s overall goals. Sen. Cecille Bledsoe, R-Rogers, a private option opponent who had led the task force in applauding Hutchinson the day before, didn’t vote at all. She’s not opposed to seeking waivers because it can’t hurt to ask. But she remains deeply concerned about the program, whatever it’s called. Among her fears is that the federal government won’t hold up its end of the bargain of paying 90 percent, forcing Arkansas to pay more.

The next few months will be eventful. Hutchinson will request and then await the waiver. On March 1, Arkansas’ party primary elections could reduce the number of pro-private option lawmakers, though the new officials won’t take office until January 2016. There will be a fiscal session after the primaries and then a special session regarding health care that could be a doozy.

Somewhat surprisingly, the biggest debate for now is not about the private option but about adopting a managed care model where a private company would be contracted to manage parts of Medicaid. Even the Arkansas Department of Human Services’ director, John Selig, says private companies could better manage some services than DHS can.

But DHS’ record on contracts has been disappointing lately – the most notable example being a computer system for tracking Medicaid re-enrollments that is $100 million over budget. And not everyone supports managed care, anyway. Opponents include a group of mostly Republican legislators who make their livings in health care and believe Arkansas would be better served expanding the reforms it’s already undertaken. So the same day the task force gave Hutchinson its blessing on the waiver, it also instructed its consultant, The Stephen Group, to see if it could find enough savings over five years using the current model to cover the state’s 10 percent in 2020. Then lawmakers will decide if that route is better than managed care.

So changes are still coming to Arkansas health care. It’s just the cage fight will be next year, not this past one.

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For additional reading: Is health care a commodity or an entitlement? Neither.

For legislators, The Stephen Group report was an ink blot test.

Arkansans of the year

arkansasFlagBy Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Time magazine names a “Person of the Year.” Sports Illustrated has a “Sportsperson of the Year.” Who are the Arkansans of the year?

In politics, it’s not even close. On issue after issue, Gov. Asa Hutchinson either achieved his objectives or appointed a study commission to buy time to achieve his objectives. He wants to continue but change the private option, the controversial program that uses Medicaid dollars to buy insurance for lower-income Arkansans, so he asked the Legislature to fund it two years while a replacement can be found. That’s what’s happened – so far. He and the State Board of Education butted heads over the Common Core-related PARCC exam. He wanted to replace it; the Board wanted to keep it. It’s gone. In the debate over the Religious Freedom Restoration Act, Hutchinson was perhaps the only elected official who pleased (too strong a word?) both sides. His signature education issue, requiring high schools to teach computer coding, has resulted in 4,000 students taking a class. The only downside to Hutchinson’s year is that next year can’t be this good.

Honorable mention: Baker Kurrus, superintendent, Little Rock School District. A non-educator in one of the state’s most high-profile education jobs, he’s trying to smooth ruffled feathers while telling hard truths. Does the Little Rock school superintendent belong in the “politics” category? He certainly does at the moment.

In business, I’m going with Donnie Smith, president and CEO of Tyson Foods. He and his company were questioned last year when Tyson bought Hillshire Brands for $7.7 billion. That was a lot of money, but buying the makers of Jimmy Dean Sausage and Ball Park Franks expanded Tyson’s already considerable reach. Tyson’s operating income rose 37 percent this year to $2.25 billion, and its sales of $40.6 billion are an increase of 9 percent over last year. That’s not chicken feed.

Honorable mention: George Gleason, CEO of Bank of the Ozarks. The $800 million purchase of Georgia-based Community & Southern Bank was the largest bank buy in Arkansas history and made Bank of the Ozarks an instant major player in Georgia. Full disclosure: I own a journalist-sized amount of stock in the company – meaning, not much.

In health care, I’m making New Hampshirite John Stephen an honorary Arkansan. Hired by the Health Reform Legislative Task Force to consult on reforming Medicaid, he and his firm, The Stephen Group, have offered information, insight and solutions, and as a result have much influence over Arkansas policymakers. They’ve argued the state shouldn’t completely ditch the private option while also shining a light on Medicaid’s problems. When he speaks, lawmakers listen, and he’s been speaking a lot.

Honorable mention: Hospital CEOs Troy Wells (Baptist Health), Dan Rahn (UAMS) and Chad Aduddell (CHI St. Vincent) are leading three of the state’s big institutions in a consolidating industry. You know how other areas of the economy such as banking and retail are increasingly dominated by a few players? It’s happening in health care, too.

In sports, it’s Brandon Allen, Arkansas Razorbacks quarterback. Has an athlete ever made such a quick turnaround from supposed “choker” to “clutch”? After missing late-game passes early in the season, he’s become one of the SEC’s most reliable quarterbacks and was one of the main reasons the Razorbacks won five of their last six games.

Honorable mention: Bret Bielema, Razorbacks football coach. He stuck with Allen and never lost faith in the team even when some were losing faith in his coaching ability. The Hogs have improved every year since he was hired.

In charities and nonprofits, The CALL and Project Zero are finding foster and adoptive homes for kids who really need them. The issue attracted attention this year when a report detailed problems with the state’s foster care system, and when Hutchinson spotlighted those children’s needs at his faith-based summit. Since 2007, The Call has brought 758 foster and adoptive families into the system, its website says, with more on the way. Project Zero, meanwhile, raises awareness through its Heart Gallery photos of waiting children.

Honorable mention: Too many great ones to name.

So who is the Arkansan of the year? There’s no way for me to know. What seems noteworthy today will be forgotten tomorrow, while seemingly minor events will have lasting consequences. (“Baby born in manger” probably didn’t make many headlines.) Maybe the names I’ve listed were important, or maybe they were just important to me.

At any rate, that’s my list. What’s yours?

Arkansas heads to front of coding class

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

During the 2014 campaign, when Gov. Asa Hutchinson’s main talking point on education was teaching computer coding in schools, I thought he was playing it small.

He did have a great commercial with his granddaughter. But the big, controversial issues in education are school funding, the Common Core, testing, charter schools – not whether or not students should take a computer class.

Sometimes, small is big. As a result of legislation passed earlier this year, all public high schools in Arkansas are required to offer a computer coding class. This semester, almost 4,000 students are learning to “speak the language of the computer in order to tell the computer what to do,” as Hutchinson described to school board members Dec. 11. Arkansas students have been participating in more than 850 “Hour of Code” events, including one at the Governor’s Mansion last week, where they play around on a computer to get a feel for coding. Bentonville Superintendent Mike Poore told Hutchinson at that school board conference that one of his students, ranked 800th in a class of 1,000 academically, has learned eight computer languages this semester and will have a $50,000-a-year job waiting on him when he graduates – high school, not college.

Arkansas is the first state to require high schools to offer a coding class, and some have noticed. The influential “Wired” magazine ran an online story headlined, “So, Arkansas is leading the learn to code movement.” Hutchinson – who can’t personally code himself out of a paper bag – appeared on CNBC this summer to talk about the program.

The legislation applies only to high schools. On Dec. 4, Hutchinson announced that the Department of Education is developing computer education standards for grades K-8. Those standards would go into effect in the 2017-18 school year. Again, Arkansas would be the first state to do this.

The result of all this could be that Arkansas produces the next Bill Gates. Even if not, then at least a lot of students will be prepared for those well-paying jobs. Some no doubt will take advantage of opportunities offered elsewhere. But as Hutchinson explained Dec. 4, he noticed when visiting Silicon Valley in California, the nation’s tech industry home, the sky-high benefits companies were offering in order to attract talent. Companies will realize their costs will be lower here, leading Arkansas to become a “microhub” for the tech industry.

Even if students don’t go into coding, they’ll have a better understanding of an integral part of American life. Just as a law degree can be useful even if you don’t become a lawyer, coding skills can be useful elsewhere. If you own or manage a business, you may not code – but you’ll likely hire or contract with someone who does.

One more benefit to coding is what it does for the students while they are still in school. A generation of students raised to use computers – or often, just play with them and passively be entertained by them – is instead learning to actively program them. When you and I were in school, the end result of most learning was to answer a test question correctly. For a student in a coding class, the end result is taking charge of a computer and making it do something new. How cool is that?

Challenges? One is getting female students involved. Anthony Owen, Department of Education coordinator of computer science, said current enrollment in computer coding courses is about 74 percent male. The event at the Governor’s Mansion was targeted to girls.

The big challenge has been finding teachers, because few of them know how to code. In many high schools, students are learning the skill through the state’s online Arkansas Virtual Academy while an untrained teacher facilitator in the classroom offers whatever help they can. Kids can learn this way, but it would be better for a local classroom teacher to lead the class. The state has provided $5 million in grants for teachers to be trained in the skill. The faster that money is spent, the better.

Might some of those teachers use that training to leave the profession and become coders themselves? Probably, but every industry deals with that issue. As young thinker Max Farrell once told me, “The CEO says, ‘Why are we training all these people if they ultimately wind up leaving?’ And the vice president says to the CEO, ‘Well, what if we don’t train them and they stay?’”

Same applies to students, doesn’t it?

Reforming health care – next week

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Next week – Dec. 15-17, to be precise – a legislative task force will try to reform health care in Arkansas while deciding what to do about the state’s most contentious issue in years. That’s all.

Here’s the background. After the passage of Obamacare and then a U.S. Supreme Court decision on the matter, states could choose whether or not to expand Medicaid, which provides health care to poor Americans and others. Blue states said yes to the expansion. Most red states like Arkansas said no.

Arkansas said, “Yes, but …” Instead of expanding Medicaid, it would use that money to buy private insurance for Arkansans with incomes up to 138 percent of the federal poverty level.

The program has insured 250,000 Arkansans at its height. In fact, Arkansas has led the nation in reducing its uninsured population. Several states have followed its lead and adopted or considered their own versions. However, some legislators are opposed because the state is scheduled to begin paying part of the cost in 2017, and because this is Obamacare, and because it contributes to the national debt.

The private option barely passed in 2013 and barely was reauthorized in 2014. Because money is being spent, passage requires a three-fourths majority, which means nine senators can block it.

Instead of having yet another political battle this year, Gov. Asa Hutchinson asked legislators to fund it through 2016 and, in the meantime, reform it along with the overall Medicaid program. To accomplish that task, a Health Reform Legislative Task Force has been meeting this year and will make its report by the end of this month. Their big meeting is scheduled for Dec. 15-17. Then there will be a special session next year where the full Legislature will vote.

The task force was composed of about half private option supporters and half opponents. It hired a national consultant, The Stephen Group, that offered suggestions for changes but certainly didn’t advocate scrapping it.

Hutchinson has offered his own reforms, similar to The Stephen Group’s, that he’s calling “Arkansas Works.” Speaking to a health care group this week, he insisted the private option would end on Dec. 31, 2016. But while Arkansas Works clearly changes the private option, it’s not radically different. The government still would pay for poor people’s private health insurance.

The changes instead would make it less of a welfare program. Beneficiaries who work would be required to be insured through their employer when available rather than through the private option, with the state chipping in to help with costs. Those who don’t work would be required to obtain work training. Recipients earning at least 100 percent of the federal poverty level – and maybe some making less – would be required to pay part of the costs for what is now free health care. Those who don’t pay would lose their health insurance and be locked out of the system for a period of time. Hutchinson also floated the idea of a lifetime cap, meaning a person can’t stay on the private option forever.

Hutchinson said the program must cut costs, explaining, “We have to have the savings if we’re going to do what I believe is our responsibility, and that is to cover that expanded population.”

Note that Hutchinson said covering those people “is our responsibility.” It’s been clear since his 2014 campaign that while he might want to change the private option, he doesn’t favor replacing it with nothing.

Nor do that many legislators. There are some, but even many of those who originally opposed it now would keep something in its place. Otherwise, many Arkansans would lose their health insurance and go back to waiting until they are really sick and then accessing the health care system without insurance – and their local doctors and hospitals would eat the cost. If that happens, hospitals will close. It’s happened in other states.

Actually, the private option isn’t the biggest controversy now. The big debate is about whether the state should adopt a managed care model where parts of the Medicaid system would be run by a private company and not the state. Supporters say it would create efficiencies. Opponents say managed care companies will take taxpayer dollars and skimp on care and on payments to providers. Several Republican legislators – generally they work in health care somehow – are among the opponents.

That debate is worth more space, but I only have 750 words to talk about health care. The task force, meanwhile, has one more week to reform it.

Adoptions turn blue balloons red

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

After Andrew Rodgers Jr. was adopted, he changed not only his last name but also his first.

The 15-year-old had grown up as “Marcus,” but that name was part of a childhood that saw him placed in foster care and moved from home to home. Separated from his three siblings, hope seemed in short supply. After he and two of his siblings were adopted by Andrew and Sabrina Rodgers of Maumelle, he decided to change his name.

“I was excited to be named after my father,” he said.

That father, Andrew Rodgers Sr., grew up in a Mississippi home with 23 brothers and sisters. Before 2011, he and Sabrina had no children. Now they have six, all adopted, including Andrew Jr. and two of his siblings.

The family was featured in a ceremony at the Pulaski County Juvenile Court building Nov. 19 marking National Adoption Day, which was two days later. With his children by his side, the elder Rodgers described what he called “an amazing journey.”

“It has been a time where we must commit, a time when we must be patient with each other, a time when we become the student, and we let the children be the teacher,” he said. “They teach us how to love. They teach us how to understand. They teach us how to prepare ourselves for a life-changing event, which is simply being called Mama and Daddy.”

The Department of Human Services’ Division of Children and Family Services finalized 711 adoptions last year. This year, the focus is on older children, the theme being, “We never outgrow the need for family.” Of the 600 Arkansas children who are legally free to be adopted, 39 percent are above age 10, and more than half of those are at least 14. The average length of stay in foster care for those children ages 10-up is 4.6 years, and their chances of adoption fall each day until they age out of the system. As DCFS Director Cecile Blucker explained, 204 children reached age 18 in fiscal year 2015. Of those, 128 chose to leave the system; the rest stayed to take advantage of state transitional services offered up to age 21.

Two-thirds of foster children will move seven or more times while in the system, according to the Annie E. Casey Foundation. Many who age out enter adulthood lacking a permanent support system. They don’t have a permanent family to guide them through high school and their late teenage years. They don’t have a parent who understands their abilities and who shares their hopes and dreams. No one is there to help them file their tax return, or point them to a trusted car salesman, or warn them if they are headed in the wrong direction, or provide a home if things don’t work out at first. And so, within four years of aging out, 25 percent have been homeless, less than half have graduated high school, 80 percent can’t support themselves and yet 42 percent have become parents. Adults who have been in foster care suffer from post-traumatic stress disorder at double the rate of combat veterans.

There are organizations in Arkansas that provide that needed support for a small number of these young people, including central Arkansas-based Immerse Arkansas (www.immersearkansas.org) and Northwest Arkansas-based Saving Grace (www.savinggracenwa.org).

Their leaders would agree that the better alternative is for their services never to be needed. Working to put Immerse Arkansas and Saving Grace out of business by finding adoptive homes for foster children are The CALL (thecallinarkansas.org), Project Zero (http://theprojectzero.org), and the state’s Department of Human Services, whose Arkansas Heart Gallery features photos of children waiting to be adopted at dhs.arkansas.gov/dcfs/heartgallery.

Were it not for Andrew Rodgers Sr., then Andrew Rodgers Jr. might have ended up as part of the problem. Instead, he plans to be part of the solution. Someday, he said, he’ll “most definitely” be an adoptive parent himself.

Balloons were released into the sky at the event Nov. 19 – red to signify those like Andrew who have been adopted, and blue signifying those waiting for that opportunity. The balloons were different colors, but they had this in common: They flew away.

So do young people. The question is, how many of them will have a home to come back to?