Category Archives: State government

Asa vs. Mike: Different, but not really

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

The race for U.S. Senate features two candidates of completely different ideologies, approaches, backgrounds and temperaments. If you believe that Sen. Mark Pryor is right, then you almost have to believe that Rep. Tom Cotton is wrong.

The race for governor between former Rep. Asa Hutchinson and former Rep. Mike Ross? Not so much. State government, as opposed to D.C. politics, tends to force both parties to the center anyway, and that’s definitely the case this year.

Friday night’s testy televised governor’s debate sponsored by KARK illustrated the candidates’ differences that are not so different. As they have throughout this campaign, they disagreed, sometimes personally, on policies but not so much on goals. You know those online roadmap programs where you type in your starting point and your destination and are presented three routes that eventually converge? One of those routes is Hutchinson, and one is Ross.

For example, Hutchinson says he wants to be the “jobs governor,” while Ross says he wants to be the “education governor.” But both men know the state needs a good education system to create jobs, and both men know it needs jobs to pay for a good education system.

Both candidates want to cut income taxes by reforming the state’s tax code, which hasn’t been modernized since 1971 and therefore places Arkansans earning only $34,000 a year in the highest tax bracket of 7 percent. Hutchinson would reduce rates for Arkansans earning from $20,400 to $75,000. Ross would raise the top tax bracket’s minimum income to $75,100, meaning it would capture fewer Arkansans. Hutchinson would implement his plan next year; Ross would phase in his over time but says his would be bigger.

Different? Sure. But either candidate could have proposed either plan.

On some other issues, the candidates largely agree. They’re both not crazy about the state spending $100 million to build another prison and would like to consider alternative sentences. They both support keeping the Governor’s Quick Action Closing Fund, which gives the governor a pile of money to use to attract employers.

Even some areas of disagreement are largely differences of degree. For example, Ross’ signature education proposal would increase state pre-kindergarten funding for four-year-olds so that it eventually covers all families with incomes up to 400 percent of the federal poverty level. It currently covers families up to 200 percent but is not fully funded. Pre-K is not really Hutchinson’s thing, but he says he’d fully fund it up to 200 percent.

Those are real differences with consequences, but they don’t represent radically different visions of what the state should look like.

As for the state’s Medicaid private option, Ross is clearly a defender. Hutchinson has not said he’s against it, which means he’s mostly for it. If Ross is elected governor, he’ll probably fight Republicans in the Legislature to keep it largely as it is. If Hutchinson wins, he’ll probably work with Republican legislators to change it without trashing it. Neither would jeopardize his tax cut plan by refusing billions of federal dollars currently insuring 200,000 Arkansans.

Even their backgrounds are not that different. They both tout their modest, middle class upbringings. They both are establishment-type candidates who have spent a lot of time in Washington, which is not necessarily a bad thing. Hutchinson was elected to Congress in 1996 and then served as director of the Drug Enforcement Administration and then as under secretary of the Department of Homeland Security. Ross spent 12 years in Congress. Ross is a conservative Democrat and Hutchinson is a conservative Republican, but neither are bomb-throwers.

Of course these two men are different, and they would be different governors. But if you are a Hutchinson supporter, you could probably live with Mike Ross, and vice versa. Arkansas state government under either man would look about the same, while 100 Tom Cottons in the U.S. Senate would produce very different results than 100 Mark Pryors.

The lieutenant governor: Change it, or get rid of it

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

For more than three years from 2003-06, your tax dollars were not spent very efficiently, and I was a beneficiary.

I was the communications director in the lieutenant governor’s office. My boss, Lt. Governor Win Rockefeller, was a very good man, but the lieutenant governorship, at least the way it is designed in Arkansas, is not a useful office.

Nothing occurs there that could not be done somewhere else. Under the Arkansas Constitution, the lieutenant governor presides over the Senate when it is in session (a ceremonial job) and serves as governor when the governor is out of state (an unnecessary responsibility in the 21st century). The other major duty, the one that really matters, is to serve as governor if the governor does not finish his or her term. Two of the past four lieutenant governors have been called upon to do that.

The office, when filled, consumes about $400,000 a year in order to employ state government’s backup quarterback and his or her staff. Currently, no one even occupies the office. With the resignation of former Lt. Governor Mark Darr, the doors have been locked and the lights off for months. As Sen. Keith Ingram, D-West Memphis, explained in an interview, “We’ve got an office that in all intents and purposes doesn’t exist right now, and there’s no clamor about some services that are not being met.”

Ingram and Sen. Jimmy Hickey, R-Texarkana, are proposing abolishing the office and making the attorney general next in line to be governor. This would require a constitutional amendment approved by the voters. Were it to pass, Arkansas would join five other states that don’t have a lieutenant governor.

The proposal has been far from universally embraced. There’s a natural resistance to changing the Constitution, which is a good thing. Plus, some legislators might want to be lieutenant governor someday and are reluctant to vote to get rid of the office. It’s hard to cut the backup quarterback when you hope to be one someday.

There’s some concern about making the attorney general next in line, which no state currently does, because doing so limits that opportunity to lawyers only.

But it not the attorney general, then who? The next highest statewide position after attorney general is the secretary of state, a job that deals primarily with running elections and maintaining the Capitol – not really governor-type duties. Still, that position ascends to governor in three states that have no lieutenant governor – Arizona, Oregon and Wyoming. In New Jersey, the lieutenant governor and the secretary of state are the same officeholder. Legislators deal with many of the same issues as the governor, so the speaker of the House or the Senate president pro tempore would make sense. The objection is that neither are elected by voters statewide, but that hasn’t stopped Maine, New Hampshire, Tennessee and West Virginia from making the leader of the Senate their next in line. In fact, Tennessee and West Virginia give their Senate leaders the title of “lieutenant governor.”

We could just make the lieutenant governor a real job. At one time, Arkansas’ lieutenant governor exercised real power in the Senate by appointing committees and committee chairs. There’s no way legislators are giving up those powers now, but perhaps the lieutenant governor could be made the head of a state agency or a member of some important commissions.

Or, the governor and the lieutenant governor could be yoked together on one ticket, like the president and the vice president are, instead of running separately as occurs now. That way the governor and lieutenant governor could be a team, maybe even share staff. That would be the opposite of what the state had before Darr resigned: a Democratic governor and a Republican lieutenant governor who couldn’t work together and didn’t even like each other.

Changing anything in government is hard, particularly when there’s no deadline forcing it to happen. We don’t have a crisis. We have an office that doesn’t do much when it has an occupant and currently doesn’t even have that. Ideally, Arkansas could either make it useful or just get rid of it.

Or we could just leave things as they are. It’s only $400,000 a year. Of your money.

Here’s a KARK-TV report about this subject.

Arkansas’ other health care reform

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

Let’s play a word association game. I write “health care reform.” What comes to mind?

Probably “Obamacare,” and probably, if you live in Arkansas, not in a positive light. You might next think, “private option,” the state program that uses federal dollars under Obamacare to buy private insurance for lower-income Arkansans.

Meanwhile, there’s another important health care reform effort underway. While Obamacare and the private option are mostly about expanding health coverage, the Arkansas Payment Improvement Initiative is meant to address the biggest problems with the health care system today – costs and incentives.

The United States spends 18 percent of its gross domestic product on health care, far more than the rest of the industrialized world, and gets no better overall results. Too much of the care provided really doesn’t help the patients. These high costs and inefficient process occur largely because the system is based on what policymakers call “perverse incentives.” Medical providers are paid by the procedure, not the outcome – not for making us well and certainly not for keeping us from ever getting sick.

They don’t try to make us sick, of course, but the system’s incentives do influence their focus – how much effort they expend on preventive care, for example. As CHI – St. Vincent CEO Peter Banko told me, “Until you change how we’re being paid, you’re not going to see changes in the system.”

So Arkansas is changing the way they’re being paid.

As part of the Arkansas Payment Improvement Initiative, state agencies, insurance providers Blue Cross and Qualchoice, the Arkansas Hospital Association, and the Arkansas Medical Society collaborated to try to determine appropriate practices and acceptable ranges of costs for various “episodes of care.” They started with five situations: pregnancies; total hip/knee replacements; outpatient upper respiratory infections; congestive heart failures; and attention hyperactivity disorder.

For each of those episodes, a principal accountable provider now serves as the “quarterback,” meaning he or she is the main decision-maker responsible for coordinating all providers who are delivering care. That’s unlike a typical health care episode, where no one is in charge and patients are just handed off from provider to provider – each of whom runs their own tests for which they charge insurance companies and taxpayers. For hip and knee replacements, the quarterback is the orthopedic surgeon, who is responsible not only for the procedure but also for the 30 days prior and the 90 days afterwards.

After 12 months, the quarterbacks’ total insurance and Medicaid claims are totaled. Those whose costs are below “commendable” levels receive a bonus payment, and those whose costs are above “acceptable” levels pay back part of the excess cost.

Early results are promising. According to the Arkansas Center for Health Improvement, providers are performing more preventive tests for diabetes, HIV and other conditions in pregnant women. That makes sense, because they’ll be penalized if they don’t catch these health issues and costs rise later. Unnecessary antibiotic prescriptions for unspecified upper respiratory infections have dropped 19 percent. That’s important because antibiotics have no effect on, say, a cold virus, but the overuse of them leads to harmful effects, such as creating drug-resistant bacteria.

Again, incentives are the key. As Arkansas Surgeon General Dr. Joe Thompson, a pediatrician, explained, “It was easier for me to write the prescription for the mom whose kid had a cold than it was for me to spend the 10 minutes telling her why she really didn’t need the antibiotic.” Now that doctors face a financial penalty for prescribing a useless drug, they’re more likely to give that explanation.

One obvious concern is that providers will cut corners in order to shave costs, but that’s not been the intent. Providers still have plenty of incentives to provide effective care, including of course, their desire to serve patients. Keep in mind that more care is not necessarily better care and can be much worse for the patient. CHI – St. Vincent is participating in a similar pilot program through Medicare where the hospital and doctors are paid a set amount for joint replacement procedures and must control costs to make a profit. The result? Hospital readmissions have been reduced by two-thirds.

I asked Banko why the hospital and doctors didn’t make those changes beforehand. He replied, very forthrightly, “There was no financial incentive to.”

Who knows if all this is going to work, but it seems promising. What America needs isn’t more health care – but better and more affordable care. That will only happen when the incentives change.

Must the governor be a Farm Bureau member?

By Steve Brawner
© 2014 by Steve Brawner Communications, Inc.

Do you know how to join Farm Bureau, and if you didn’t, would that mean you couldn’t be governor?

I’m asking because, during a joint appearance Tuesday at a Farm Bureau meeting, Asa Hutchinson and Mike Ross were asked if they were members. It was not Hutchinson’s best campaign moment.

“I didn’t pay any money,” he said. He then added somewhat awkwardly, “I don’t know whether I’m a member of the Farm Bureau. I haven’t – I’ve been in Congress. I worked with the Farm Bureau. I’ve been to your meetings and gatherings. I’m not sure what it takes to be an official member.”

Ross pounced when it was his turn to speak. “I am a member of Arkansas Farm Bureau. I pay my – what is it – $35 annual fee? And I always get that free dinner at the Prescott-Nevada County Fairgrounds.”

The audience applauded. Ross clearly won the exchange. His campaign issued a news release saying this was an example of Hutchinson being disconnected and out of touch with Arkansans, which is the narrative the campaign is trying to push. The Hutchinson campaign, meanwhile, is trying to paint Ross as an Obamacare-enabling Democrat.

Beware of trusting campaigns’ narratives about their opponents.

In real life, of course, the fact that Hutchinson doesn’t have a membership in Farm Bureau means only that he never had a reason to purchase one. Really, do these guys have to pay a fee to every organization in Arkansas?

What matters – to farmers, to those who work in agriculture and food processing, to Farm Bureau – is the candidates’ records, their priorities, and their competence.

I asked both campaigns to name their top priority in agriculture. Hutchinson’s campaign sent a statement saying his priorities are expanding the marketplace for Arkansas farm products, including increasing access to world markets, and supporting research funding for Arkansas agriculture. He said his secretary of agriculture must understand row crop farming. Ross’ campaign said he would strengthen the state Agriculture Department’s Arkansas Grown initiative, which connects Arkansas producers with buyers. He said increasing export opportunities “no matter how large or small the producer” would be a top priority.

Sounds like they both would do all right.

Hutchinson’s Farm Bureau flap was forgettable enough that I’m conflicted about writing about it. But there is a larger picture, and it’s the tendency for too much to be made of inconsequential moments in campaigns – you know, gaffes. Remember Texas Gov. Rick Perry saying “Oops” when he couldn’t remember one of the federal agencies he would abolish during a debate in 2012? He got killed for that, even though most everyone’s mind goes blank occasionally, and when it does, they might say “Oops.” In a 1988 debate, Democratic presidential candidate Michael Dukakis was asked by CNN’s Bernard Shaw whether he would support the death penalty if his wife were raped and murdered. He answered the question calmly and rationally, and afterwards he was raked over the coals because of it. His poll numbers dropped the day after the debate, which the pundits blamed on his lack of emotion in answering a hypothetical question.

Gaffes do the most damage when they play into a developing impression. Questions were already arising about Perry’s unpreparedness and Dukakis’ cool detachment. Hutchinson stubbed his toe, but had the Ross campaign already succeeded in painting him as out of touch, the Farm Bureau exchange might have been a bigger deal. You can bet Ross will not make the mistake of saying anything positive about Obamacare.

For the record, I am a member of Farm Bureau because it’s how I insure my cars and home. I do not own a farm. And yes, the annual membership fee is $35.

Now what’s this Ross was saying about a free dinner?

Ross, Hutchinson explain their number one priority in education

If you could accomplish only one thing in public education during your time as governor, what would that be?

Democrat Mike Ross and Republican Asa Hutchinson were asked that question at the Arkansas School Boards Association’s Summer leadership Conference in Hot Springs Friday.

Ross touted his plan to expand pre-K classes for four-year-olds. Currently, free pre-K classes are available through the Arkansas Better Chance program for families making 200 percent above the poverty level. Ross would expand that to families at 300 percent. As the program is phased in, families making 400 percent of the poverty level would be eligible for the ABC program by paying a reduced rate of 50 percent.

Total cost of the plan would be $35 million a year. He said it would be funded through “revenue growth”

“If you’re a parent and you’ve got a four-year-old and you want them in a public pre-K classroom, there should be a desk for them regardless of your income and regardless where you live in Arkansas,” he said.

Hutchinson wants computer science to be offered in every public Arkansas high school in four years. He said fewer than one in 10 high schools currently offer it. Under Hutchinson’s plan, a high-level computer science class could serve as a math or science credit and potentially a concurrent college credit as well.

Total initial cost would be half a million dollars to train teachers, Hutchinson said.

Hutchinson said that if 20 percent of Arkansas students took computer science, 6,000 would leave school with that skill every year, which “could change the dynamics of this state for decades and decades to come.”