Category Archives: State government

Pay DHS director like a football coach

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

The highest paid state employee is Bret Bielema, the head football coach of the Arkansas Razorbacks. He will make $4 million this year. Meanwhile, the director of the Department of Human Services – an agency that serves 1.4 million Arkansans with 7,500 employees – will earn $163,000.

It might be time, if not to reverse that mindset, then at least to rethink it.

The current DHS director, John Selig, announced last week that he is leaving his post at the end of this year, and Gov. Asa Hutchinson is searching for his replacement. It needs to be a good one, but there are challenges. Talking to reporters Wednesday, Hutchinson said, “There are some salary constraints for being able to attract someone from the private sector or someone that’s led a large organization, so we’ll have to look at that, but we’ll see what we can do.”

We’ll see what we can do. Those are not words that University of Arkansas Athletic Director Jeff Long has to say when looking for a new coach.

DHS is state government’s largest agency. It has an $8.35 billion budget. It pays for medical care for lower-income Arkansans. It serves patients in nursing homes and serves clients with a range of disabilities. It’s in charge of state adoption and foster care services.

It juggles a lot of balls, and lately it has been dropping a few of them. Costs for a new system to determine Medicaid eligibility have ballooned to $200 million, more than twice the expected amount. A consultant advising legislators about reforming health care found almost 43,000 Arkansas Medicaid beneficiaries with out-of-state addresses. It’s not clear exactly what that means, but it’s not good.

This is not meant as a criticism of Selig, who’s had a tough job managing a sprawling agency. In the past few years, DHS has had to respond to many big changes, including health care reform and the private option, which is the controversial program where federal Medicaid dollars buy private insurance for lower-income Arkansans.

The important question is, who is the best person for the job moving forward, and how do we get him or her? And the answer is, we’re not going to, not with a salary of $163,000 a year. That’s the kind of money you might pay a longtime state employee who’s worked his way up and is not far from retirement, not a dynamic visionary who can modernize and streamline an organization.

It’s not just the director’s position, but also the salaries of his or deputies. One of the reasons Bielema came to Arkansas was his frustration with what he could pay his assistants at Wisconsin. He knew an organization is only as strong as its second layer of leadership.

Hutchinson said that he’s “looking outside the norm” in his job search, meaning the next DHS director doesn’t have to be a person with experience in human services. Instead, he said, “We’ve got to have somebody that can understand $200 million (information technology) contracts, that can minimize the risk for the taxpayers, that can work with the Legislature, that can recruit the right talent for the different levels of DHS as well.”

Those people are hard to find. In fact, you’ve got to make them want to come to you. The Legislature should pony up and raise the salaries of the director and his top officials significantly. That’s how you attract qualified people who know, like Bielema and his staff do, that if they don’t produce, someone else will take their jobs.

Meanwhile, maybe state leaders should consider funding a private foundation to supplement salaries for top jobs across state agencies. Private sources pay most of Bielema’s salary. A foundation increased the salary for Mike Preston, the new Arkansas Economic Development Commission director.

There’s a reason why football coach Nick Saban won national championships at LSU and then Alabama, and why Urban Meyer won national championships at Florida and then Ohio State. Some people are the best at what they do.

Arkansas should try to hire the Nick Saban of DHS directors. Spending hundreds of thousands on leadership can save hundreds of millions in costs. When the Razorbacks had a head coaching position open, everyone knew the job would pay a high salary, because failure on the football field is unacceptable. Likewise, when managing state government’s largest agency whose responsibilities include nursing homes, the disabled, and foster kids, it’s not enough just to see what we can do.

Drivers, can you spare a dime?

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

Considering a gallon of gasoline is now $2 less than it was not long ago, is now the time to raise gas taxes a dime? Some say yes, if the state is committed to maintaining its highways. Others say no, including legislators and, in a recent poll, a clear majority of Arkansans.

Here’s the problem. Highways traditionally have been funded by the people who use them – drivers of passenger and commercial vehicles through gas and diesel taxes. However, those taxes have remained the same for a long time – effectively cut, actually, because they were not indexed to inflation. The federal gasoline tax of 18.4 cents per gallon has been the same since 1993 even though it costs more to maintain highways. The state gasoline tax of 21.5 cents per gallon hasn’t changed since 2001.

Inflation isn’t the only issue facing the Arkansas Highway and Transportation Department. Since 1993, vehicles have become more fuel efficient, which means drivers pay less in fuel taxes to drive on roads that are becoming more expensive to maintain. Because continuing to increase fuel efficiency is a national goal, the entire transportation infrastructure is funded by a revenue source that is destined to decline.

Even members of Congress agree this is a problem, though they can’t agree on a solution. The federal Highway Trust Fund, which funds 70 percent of Arkansas highway construction, is being kept on life support by yet another one of those half-baked measures passed this summer at the last minute that merely postpones a difficult decision. Faced with a similar situation last year, Congress paid for one year of spending by borrowing from the next 10 years’ worth of revenues. That year is over, and now Congress is trying to find a longer term solution on a short deadline. Its recent track record doesn’t inspire confidence.

In Arkansas, a bill this year by Rep. Dan Douglas, R-Bentonville, would have dedicated to highways the taxes collected from sales of new and used cars. Those taxes currently go into a big pot that pays for a lot of other things. The bill passed a House committee but then went nowhere. Gov. Asa Hutchinson was opposed, as were a lot of other interests funded by that big pot.

Hutchinson did, however, appoint a task force that has been trying to craft a solution. One idea by the Arkansas Good Roads Foundation, a business group, would increase fuel taxes by 10 cents per gallon and then gradually shift new and used car sales taxes to highways, with the fuel tax lowered back to current levels as that shift occurs.

Some legislators, including Douglas, say a fuel tax hike isn’t going to happen. Legislators won’t support anything that looks or even smells like a tax – not even a dime, and not even when fuel prices are low.

They’ve been hearing from their constituents, who voted for a half-cent sales tax for roads three years ago and don’t want to pay more taxes. A recent poll by the Arkansas chapter of Americans for Prosperity, an anti-tax group, found that two-thirds of Arkansans said fixing the state’s highways is a crisis (16 percent) or a major problem (50 percent). But almost that same percentage oppose raising the gas tax. In fact, 45 percent strongly oppose it. Half said a legislator’s support of a gas tax increase would make them less likely to vote for them.

In other words, they’re saying, “Fix the roads, but take the money from state government’s big pot – or at least, some other pot besides mine.”

There are other partial solutions. Only about two-thirds of state highway taxes go to state highways; most of the rest goes to city and county roads and some unnecessarily to state government administration. That formula certainly could be tweaked. Moreover, the state maintains a lot of highway miles that are really local arteries, such as busy Cantrell Road in Little Rock. There’s talk of letting cities and counties assume some of those responsibilities. Guess who’s opposed to that?

There’s one other argument: Some say enough money is devoted to highways, but it’s going to the wrong places. Some legislators say the money should better follow the cars.

That solution may not be affordable, either. Maybe the Highway Department should focus on maintaining what it has and let the cars follow the roads that are already laid. Those roads might be crowded, but at least they would stay paved, and paid for.

The private option ink blot

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

You know those tests where therapists ask clients to describe an ink blot because people see what they’re inclined to see? This week, legislators were given a 450-page one.

That would be the report by The Stephen Group, the consulting firm hired by the Health Reform Legislative Task Force to help it decide what to do about the private option in particular and Medicaid in general.

Here’s the ink blot part: Legislators who support the private option can be encouraged by the report because it recommends changing it but not ending it. Meanwhile, opponents can point to a finding that 43,000 people served by Medicaid and the private option may not live in Arkansas, while the programs combined enroll 500 people who are deceased.

Here’s the background. Medicaid is the government health program serving the poor, the disabled, and the aged who live in nursing homes. It’s mostly but not entirely funded by the federal government and mostly administered by states. The Affordable Care Act, which created Obamacare, expanded Medicaid in all the states to cover more lower-income people. In 2012, the Supreme Court ruled that Obamacare is constitutional but that the Medicaid expansion must be only voluntary. Many states said no.

Arkansas created the private option. Instead of expanding Medicaid, it uses those dollars to buy private health insurance for Arkansans not covered by Medicaid and having incomes of no more than 138 percent of the federal poverty level. Republican legislators had the idea and worked with then-Gov. Mike Beebe, a Democrat, to implement it.

In some ways, it’s been a success. It’s currently serving about 200,000 Arkansans, give or take tens of thousands because the state is in the process of redetermining eligibility. According to a Gallup poll, the state’s uninsured rate fell from 22.5 percent in 2013 to 9.1 percent during the first half of 2015. That’s the best in the country, and the private option was a big reason why. Without the private option, hospitals would provide $1 billion in uncompensated care from 2017-21, according to the report. The private option is bringing $1 billion in federal funds to the Arkansas economy every year.

But that’s still a billion dollars in taxpayer money, opponents say, which increases the national debt. While the feds are paying for all of it now, Arkansas will be responsible for 10 percent of the cost in the next few years. It was supposed to serve the working poor, but 40 percent of its beneficiaries had no income last year, so it’s still a health care entitlement program. It’s still Obamacare.

The private option was created in 2013. It must be approved by 75 percent of legislators each year. It barely passed the first time and barely survived in 2014. We can’t keep doing this. So this year, Gov. Asa Hutchinson asked legislators to extend the private option through 2016 while it created the task force to decide what to do next.

Back to the ink blot. The small consulting firm found what the state’s huge Department of Human Services could not: 42,891 Medicaid and private option beneficiaries whose best addresses appear to be located out of state, including 3,220 whose best addresses are in California. Almost 500 on the rolls were dead before they even became a part of the program.

It’s unknown how much of this represents waste and abuse. It’s unclear how many actual dollars are going to the wrong places. A program this big will have challenges with its mailing list. Some people with California addresses may have moved to Arkansas recently.

Still, private option opponents can point to this report and say they were right all along, that government can’t do anything correctly, and the private option should be scrapped.

But the report didn’t recommend that. Instead, it said the private option should be retooled to become more of a transitional program that encourages work and personal responsibility – which, supporters would say, was the plan all along. Participants should look for work and meet health and wellness goals. Legislators might consider limiting participation in the private option to a few years. Meanwhile, the state should create an office that monitors the eligibility of all Arkansans seeking state services, including the private option.

Members of the task force must make their own recommendation by the end of this year. Will they vote to end the private option, or change it? It depends on what they see in the ink blot.

Hutchinson will wrestle less with execution role than previous governors

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

Sometime in the very near future, a night will come when Arkansas will execute its first inmate since 2005.

Eight inmates have exhausted their appeals, and a recent U.S. Supreme Court ruling seems to remove the biggest obstacle that has kept them alive – concerns over the effectiveness of the sedative that puts the condemned to sleep before the lethal drugs are administered. Still, there will be legal challenges, including one already filed over a state law passed this year that shields the identities of the drugs’ vendors.

The night of the first execution, assuming it occurs, Gov. Asa Hutchinson will be the one person in the world who could throw a life preserver to a drowning man – who, of course, will have been convicted beyond a reasonable doubt of drowning someone else. Hutchinson alone could stop the execution with a phone call.

Asked in his office if he’d considered what that night will be like, the former director of the Drug Enforcement Administration, undersecretary of the Department of Homeland Security, and U.S. attorney, said, “I’ve been in law enforcement a long time, but I haven’t thought about that. … It’s a serious thing. My objectives in life in terms of these type of cases is that you’re sure that the system works; that innocence is protected; guilt is established; and the system works; and it is reviewed; and they have competent counsel; then it’s my responsibility to carry out the law. We’re not there yet, so … you just simply do your duty until you get to that moment and you address it then.”

Some previous governors have felt more personally responsible. Hutchinson’s predecessor, Gov. Mike Beebe, never had to preside over an execution and said he was glad he didn’t. Gov. Mike Huckabee did preside over executions, and it troubled him to his core.

In January 1997, Arkansas efficiently executed three men in one night. Three weeks before it happened, I asked the then-new governor in a press conference how he felt about his role in the process. It was not his first execution. He said it was much easier to talk about the death penalty before he was responsible for carrying one out. Tears appeared in his eyes as he described the burden he felt.

“”There’s never a night in a person’s life that’s more god-awful, gut-wrenching than the night you personally have the responsibility to stop a man’s death, or not,” he said. “Anybody who feels good about it is a very sick person.”

Despite his misgivings, Huckabee allowed those executions, and others, to proceed. One of his predecessors, Gov. Winthrop Rockefeller, did not. Deeply opposed to the death penalty, he ordered a stay of all executions. After his defeat in 1970, he announced that he was commuting the sentences of all 15 men on Death Row.

“What earthly mortal has the omnipotence to say who among us shall live and who shall die? I do not,” he said in an emotional news conference. “Moreover, in that the law grants me authority to set aside the death penalty, I cannot and will not turn my back on lifelong Christian teachings and beliefs merely to let history run out its course on a fallible and failing theory of punitive justice.”

On Dec. 31, 1970, two days after that announcement, Rockefeller visited what had been Death Row and personally spoke to each inmate there. His 22-year-old son, Win, was at his side as an observer. The man who defeated Rockefeller, Dale Bumpers, later said he appreciated his predecessor commuting those sentences because it meant he would not have to preside over any executions.

Will Hutchinson be as conflicted as Huckabee, Bumpers or Beebe? It seems unlikely.

For a man who has spent much of his life in law enforcement, the execution will be the last act in a process that has involved many steps and many people. It will be the judicial process that will be responsible – and of course, the condemned. A horrific crime was committed, a fair trial occurred, and guilt was determined beyond reasonable doubt. And so while theoretically on that night he could toss that life preserver, I don’t think he’ll see that as part of his role.

He’ll see his role as carrying out the law regarding executions, while some previous governors couldn’t help but feel like they were sort of the executioner itself.

Health care reforms: These would be easy

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

Health care reform is difficult, in large part because it’s so hard to achieve consensus on many issues related to it. Repeal Obamacare, or amend it? Keep the private option, or replace it?

So maybe more attention should be paid to reforms where agreement is possible. For starters, here are two.

One would be for hospitals to make fewer people sick. According to the federal Centers for Disease Control and Prevention, 648,000 Americans contracted infections while in an acute care hospital in 2011, and 75,000 of them died while a patient, though not necessarily from the infection. One in 25 hospital patients is infected during their stay.

Not all of those infections were the hospitals’ fault, of course. Many patients have weakened immune systems. But many infections are preventable if hospitals follow simple procedures. Sometimes it’s as simple as making sure physicians and nurses wash their hands.

That’s one of the practices at Unity Health in Searcy, one of nine hospitals in the country and the only one in Arkansas given a top rating for infection control by Consumer Reports.

The magazine recently rated 3,000 hospitals based on five infections: clostridium difficile, or C. diff, which develops in 290,000 patients each year and contributes to the death of at least 27,000; methicillin-resistant staphylococcus aureus, or MRSA, which contributes to more than 8,000 deaths annually; catheter-associated urinary tract infections; central-line associated bloodstream infections; and surgical-site infections.

Unity Health staff members told me there’s no magic bullet. Instead, they just follow nationally recognized guidelines, such as using a bleach-based cleaning procedure to combat C. diff infections. They avoid unnecessary catheterization. The housecleaning staff keeps the rooms clean.

How can more hospitals be encouraged to follow Unity Health’s lead? One way is to continue changing the perverse incentives surrounding health care. Medical providers traditionally have been paid by insurance companies and government payers under a “fee for service” model. They bill for each service they provide, so if a patient is infected while in the hospital, the hospital gets paid for treating that infection. That doesn’t mean hospitals are purposely careless, but it does give them less reason to be extremely careful.

Arkansas is a national leader in creating an “episodes of care” payment model based on appropriate costs for select procedures, such as knee and hip replacements, from the beginning to the end of treatment. If average costs for all such patients fall below a certain threshold, medical providers are paid a bonus, and they face a penalty if costs are too high. So if enough patients contract an infection, the hospital’s bottom line will suffer.

The model was created with input from government agencies, insurance companies and medical providers. In other words, consensus was created. The state started with five episodes and has been increasing the number. The federal Medicare program is experimenting with the model as well.

Makes sense, doesn’t it? If health care is to remain a free market entity, then providers should face the same expectations as other businesses: If I hire you to fix something, you don’t get paid more if you break something else.

Another health care reform where consensus should be possible is increasing the number of medical professionals.

Recently, 214 physicians completed their residency training at UAMS and are ready to practice medicine. Unfortunately, that’s only a drop in a bucket with a hole in it. According to a 2015 study sponsored by the Association of American Medical Colleges (AAMC), the United States faces a shortage of between 46,000 and 90,000 physicians by 2025.

A medical education is costly. According to the AAMC, 84 percent of 2014 medical school graduates had education debt, with a median debt of $180,000 – and that comes after many years of school, long after law school graduates are making money suing doctors.

Gov. Asa Hutchinson has made increasing the number of high school students with computer coding skills a top priority. How about an effort to produce future doctors? Could we agree on that? If Arkansas can award more than 168,000 lottery scholarships, many to students who aren’t particularly focused or directed, can it reallocate resources to qualified medical school students?

More doctors are needed, and hospitals shouldn’t make people sick. Solving those problems won’t be easy, but coming to a consensus will be easier than it’s been with Obamacare and the private option. So can we talk about the easy stuff more often, and fight about the hard stuff a little less?