Fixing Arkansas’ life-and-death department

Cindy Gillespie By Steve Brawner
© 2016 by Steve Brawner Communications, Inc.

The quickest route to saving the state millions of dollars may be the $119,000 extra it’s spending on one of its new employees.

That’s how much more money new Department of Human Services Director Cindy Gillespie is earning than her predecessor. He was making $161,038. Gov. Asa Hutchinson, with the support of the Legislature, bumped her salary to $280,000.

This was done because DHS is an important agency, and Gillespie has an impressive resume. The department spends $8 billion of your money and employs 7,000 people. It serves 1.2 million Arkansans through a variety of programs, many of which provide expensive services literally dealing with life and death: Medicaid, which serves disabled people and senior citizens living in nursing homes; the private option, which provides health insurance to lower income Arkansans; and the state’s foster care system, which serves more than 4,900 children. Gillespie was one of Mitt Romney’s health care advisors when he was governor of Massachusetts and, before that, she helped Romney rescue the financially troubled Salt Lake City Winter Olympics held in 2002.

When Gillespie started leading DHS about three months ago, her first act was to determine how big a mess the department was. She found during a 60-day review that its 10 divisions operate independently. Because of that, in many areas the department has had no central vision, while the director hasn’t been able to manage things properly or even to easily find out what’s going on. Because 10 divisions are buying things, the department hasn’t coordinated purchases or taken advantage of its economies of scale to get better deals with vendors. Each division is in charge of its own technology, meaning the department has hundreds of systems, with most tech duties outsourced to vendors.

Gillespie told legislators this week that the department is canceling contracts worth $174 million over the next seven years. Some of those may serve legitimate needs, and DHS may return to those vendors. But a change has to occur because in many cases, the state has been renewing contracts year after year without really determining if they were still needed and if they were written to serve the state’s best interest.

The reason it hasn’t changed before? “The easy path is just to keep it going,” she said.

Moreover, Gillespie has taken over an agency where morale is not great. The department’s turnover rate is 22 percent, which means, at any given time, more than one in five positions is in the process of being filled or is being staffed by someone new. That’s especially bad because half of the department’s employees are directly involved in patient care. Because each division manages its own human resources, there’s no department-wide strategy for hiring people and advancing them along career pathways. Sometimes there are problems with the job duties, such as the foster care caseworker who spends 30 hours a month making copies instead of helping children. Pay is lower than it should be – though, let’s be honest, state employees have benefits such as retirement that few others enjoy these days.

So now Gillespie is trying to fix the problems. As of July 1, about four months after she started the job, DHS will be reorganized. Instead of the divisions each doing their own thing, seven shared offices will each handle a major responsibility for the entire department – one to hire, one to buy things, one to handle technology, etc. A new finance office has already committed to find $25 million in savings this first year. When it’s done, she expects DHS to hire fewer people but make them better at their jobs and pay them more.

When the state hired Gillespie, it invested a little money in someone who’s going to run government more efficiently, like a business. Some people are really good at doing really consequential things, and sometimes, you get what you pay for.

That reality doesn’t always make sense, like when the state’s highest paid employee is a college football coach who makes $4 million a year. But it is the world we live in, which is why someone who can reorganize the state’s life-and-death department in four months should make at least 7 percent of that amount.

Related: What exactly is the private option?

Casinos among best bets to make the ballot

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

Where Arkansans practice pure democracy – we make the laws rather than elected officials doing it – is in the ballot issues. This year, those led by citizens could be a lot more interesting than those referred by the Legislature.

Here are some of the issues being proposed by citizens: casinos, medical marijuana, gay/transgender rights, term limits, limiting damages in medical lawsuits, campaign finance reform.

Here’s what you’ll be voting on courtesy of lawmakers: letting the governor retain his or her powers when out of state; increasing the terms of county officials to four years; and expanding the ability of local governments to fund economic development projects. Those are important, but no one ever got into a fight over the governor’s out-of-state powers. Well, maybe they did on Facebook.

When citizens try to place a measure on the ballot, the important first hurdle they must overcome isn’t gaining popular support. It’s having enough money to collect signatures and fight potential lawsuits. A proposed constitutional amendment requires 84,859 signatures. An initiated act, which creates a law, requires 67,887. To reach those kinds of numbers, it really helps if you can pay people to walk the streets with clipboards. So if you want to know which of those issues actually will make the ballot, look at the ones where backers who already have money are trying to make more of it.

At first glance, that would include the casino initiative. A group of investors wants to build three casinos, one each in Washington County (Fayetteville-Springdale); Miller County (Texarkana); and Boone County (next door to Branson). Attorney General Leslie Rutledge has certified the amendment’s popular name and title, so now it’s in the signature-collecting phase.

This will be the latest of many efforts to bring casinos to Arkansas. Most if not all of the backers of this amendment have been involved in one or more of those previous efforts. So far, those have always failed, either by not gathering enough signatures or not withstanding a legal challenge of some sort. Asa Hutchinson, then a private attorney representing the secretary of state’s office, helped keep one such effort off the ballot in 2012.

The arguments have been the same since Mississippi rolled the dice with its first casino in Tunica in 1992. Opponents point to the human and societal costs that casinos cause – the lost money, the addiction, the broken marriages. They call it “gambling.” Supporters say casinos already exist across the state border, so Arkansas may as well have some fun and create the jobs and tax revenue. They call it “gaming.”

And on the third side are Oaklawn and Southland, which race horses and dogs on the side while operating their own casinos. Thanks to a 2005 law, these feature “electronic games of skill” with digital versions of playing cards and dice. They don’t want competition and will spend their own money to fight it – on lawyers to try to keep it off the ballot, and on a political campaign if they can’t. In a good example of “politics makes strange bedfellows,” they work in parallel with family values groups to defeat the casino initiatives. So far, they’re all undefeated.

As usual, this year’s casino proposal would bestow on its backers a permanent monopoly enshrined in the Arkansas Constitution, which is a pretty good deal if you can get it. They and only they, or their designees, could operate these three casinos forever, with no one allowed to compete with them unless they also pass a constitutional amendment.

What else? A proposal limiting medical lawsuit damages has a good chance of making the ballot for the same reason that the casino gambling measure does: People with money would be able to make more money. Under that standard, the term limits measure – it would tighten legislative terms to 10 years – faces an uphill climb, but it does have a passionate group of supporters who’ve been working for a while. Medical marijuana has some momentum as a concept but not the financial muscle, and supporters are divided into competing camps.

What ultimately will make the ballot? The three referred by the Legislature are the only sure bet, but you could roll the dice on the casinos and a couple of others.

Maybe we should just turn it into a museum

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

Some things in government are hard, such as providing health care to 250,000 poor Arkansans, maintaining the state’s highways without raising taxes, or taking care of 4,900 foster kids. What should not be hard is maintaining a house.

Yet here we are again, spending more than a million dollars on that old place where the state’s chief executive lives – the Governor’s “Mansion.”

The house is once again making headlines after a law passed in the recent special session turned the Mansion Commission from a governing body that makes decisions into merely a consultant, and gave the governor the ability to dismiss any commission member. He already appoints them.

The Arkansas Democrat-Gazette began asking questions and was given a tour of the Mansion. It leaks, there are plumbing and wiring issues, and the reporter could smell the remains of rat urine in the governor’s private office. There’s been some disagreement between the first lady and the Mansion Commission about the condition of the house, about the decor, and about the number of public events in the adjoining Great Hall, by far the nicest structure on the grounds.

So now the state will spend $1.1 million next year for maintenance and remodeling as well as expenses that are less than necessary. The original grant application of $1.4 million included a sculpture on the grounds that first lady Susan Hutchinson wants to hang at a cost of $128,000, as well as a 72-inch television and a private washer and dryer for the first family. They currently use the same ones the staff use. Because the grant was for less than what was requested, the list will be pared.

Does all this sound familiar? You might recall that, in 2000, then-Gov. Mike Huckabee and wife Janet moved a triple-wide onto the grounds while $1.4 million in upgrades were done to the house. That triple-wide produced a lot of jokes as well as an invitation for the Huckabees to appear on “The Tonight Show” with Jay Leno.

There’s some he-said, she-said to this latest story, and I’m leaving out a lot of details that you can find elsewhere. Reasonable people can disagree, especially when they don’t have all the information.

What’s pretty clear is that, over less than two decades, the state is spending $2.5 million on a house that has been a problem since it was built – in 1950, which makes it not much older than many houses in Arkansas. It looks big from the outside, but the actual upstairs living quarters are not, and there’s not much privacy when events are occurring in the Great Hall. Other governors before the Hutchinsons have complained about problems with basic maintenance such as wiring and water leakage. My wife worked there in 1998 and recalls her downstairs computer flickering followed by a frustrated Janet Huckabee exclaiming from upstairs that she was just tying to blow-dry her hair.

So if this were a car, we’d call it a lemon.

Maybe we should challenge the assumption that the first family should live in a house funded by the taxpayers, maintained by the government, beset with politics, and shared with everyone. Until 1950, governors were responsible for their own dwellings. The state doesn’t provide free living quarters for other officials; some congressmen have slept in their offices in Washington, D.C. Some states don’t even have a governor’s mansion.

It’s tempting to write that perhaps the state should knock down the house and keep the Great Hall. The Governor’s Mansion isn’t the White House. It’s not that old, it’s not an office building, and it’s not the center of Arkansas politics. That would be the Capitol, which despite being twice as old, works just fine.

Two other solutions are probably better options: Gut the thing and fix it up right, or turn it into a museum like another public building that outlived its original purpose, the Old State House. Maybe the governor should work hard during the day and then come home to, well, a home.

It’s proving unnecessarily challenging to maintain a public building of which the occupants are temporary while respecting those occupants’ privacy and well-being. This is a problem that can be solved without a special legislative session. Arkansas is not wealthy, but also not destitute. The governor and his/her family should not live like royalty, but they should have a nice house – if necessary, their own.

Donald Trump and Dale Bumpers

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

The late Arkansas Sen. Dale Bumpers and Donald Trump have had two things in common: similar names, and their skillful use of a similar communication technique when running for their first major offices.

After starting the 1970 governor’s race in obscurity, Bumpers defeated the old guard in his own party, including former Gov. Orval Faubus, and then beat his obviously well-financed opposing party candidate, Republican Gov. Winthrop Rockefeller. The charismatic Bumpers frustrated his opponents with his issues-free, platitude-heavy campaign, leading Vice President Spiro Agnew to say in Fort Smith that he offered little more than “a smile and a shoeshine,” as recounted by the Arkansas Times’ Ernie Dumas.

Bumpers is hardly the only elected official to rely on broad themes rather than specific policy proposals, and this is not a criticism of him. The American people look for big ideas and shared values knowing that political candidates can’t or won’t keep their campaign promises, anyway.

And that brings us to Trump. The other night, Scott Adams, the creator of the “Dilbert” comic strip, told TV host Bill Maher that, far from being the shoot-from-the-hip buffoon that a lot of intellectuals think he is, Trump is actually a master persuader who will beat Hillary Clinton in the fall.

Adams, a trained hypnotist and student of persuasion, recognizes some of the communication techniques Trump is using.

One of those techniques D-Trump is using is the same one used by D-Bump in that 1970 race: vagueness. Like Bumpers then, Trump speaks often in generalities – we’re going to start winning at these trade deals, we’re going to make America great again – which gives opponents fewer targets. As Adams earlier told Reason magazine, “Sometimes you want to tell the story in a way that lets people fill in the blanks with whatever would make them the happiest.”

Why put so much stock in Adams, a comic strip artist? Because he first predicted Trump would win on Aug. 13, 2015. That’s back when the other 16 Republican candidates and their high-paid political consultants either were expecting Trump to flame out, or they were building their strategies around being the last candidate standing against him. It’s back when Nate Silver, who everybody in the political world thought was some kind of data-driven prophet because he correctly predicted all 50 states in 2012, was saying Trump had little mathematical chance.

And it’s about the time when, after Trump insulted Sen. John McCain and other prisoners of war by saying he likes people who weren’t captured, I wrote dismissively, “So that’s probably enough about Donald Trump.”

Before a mob of Arkansas Democrats attack, let’s be clear that “vagueness” may be the only similarity between the early Bumpers candidacies and Trump’s current one. For example, Bumpers avoided insulting his opponents, at which Trump is quite good. Adams says that when Trump started calling Jeb Bush “low energy,” it effectively stuck to him partly because that’s a new insult in the political world. Now he’s helping shape public opinion by referring to Clinton again and again as “crooked Hillary.”

Adams isn’t just saying Trump, who wrote, “The Art of the Deal,” is good at this persuasion stuff. He told Maher that Trump is “taking a flamethrower to a stick fight. There’s nobody using the same tools he’s using.” Among those tools is “anchoring,” or presenting something big and visual to give his audience something to think about. While others debate fuzzy illegal immigration policy, Trump describes a big wall. And when asked in a debate about his previous demeaning comments about women, Trump replied that he was referring to “only Rosie O’Donnell,” which made his audience see her and her personality, not him and his.

In the same way Nate Silver’s data-driven analysis was proven to be imperfect, so too can Scott Adams’ skills-based one. Clinton enters the race with advantages, including the fact that states with 242 electoral votes have voted for the Democrat in six straight elections, leaving her needing only 28 more to win. Every election cycle, the country’s demographics move in a direction more favorable to Democrats. And voters, after electing the country’s first African-American president, may still be in a history-making frame of mind and ready to choose a woman.

On the other hand, that’s the same kind of analysis that led people, including me, to dismiss Trump before, until he closed the deal on the Republican nomination.

Related:
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What Dale Bumpers was

Health insurers want to raise prices. What now?

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

The big news in health care this week was that most of the state’s insurers are asking for rate increases for policies purchased individually or through the state’s Arkansas Works program.

The bigger issue – rising health care costs, and the political system’s inability to address them – is not new.

The two Blue Cross providers are asking for 14.7 percent increases, while QualChoice Life and Health and QCA Health Plan are asking for increases of just under 24 percent. The state’s fifth insurance company, Ambetter, is asking for less than 10 percent and is not required to publicly disclose or justify that amount. The sixth insurance company, UnitedHealthcare, unable to make a profit, is leaving the market.

The Arkansas Insurance Department still must approve the requests. Commissioner Allen Kerr sounded skeptical in a statement released by his office.

There are many reasons for the requested hikes. I’ll summarize those given by Arkansas Blue Cross spokesperson Max Greenwood. Patients are using more health care than expected. Costs are rising, particularly for prescription drugs and catastrophic claims of more than $50,000. The Affordable Care Act’s transitional reinsurance fee, which offset higher cost enrollees, is going away.

One other factor pertains to Arkansas Works, the program formerly known as the private option that uses federal funds to purchase private insurance for lower-income Arkansans. Remember last year when we learned many people living out of state, or not living at all, were being covered? When that was more or less fixed, Blue Cross lost a population of 25,000 members whose premiums were being paid but who didn’t use much health care, especially the dead ones. So now the insurer says it has to adjust.

Of course this all happens in the context of Obamacare. Sen. Tom Cotton, Rep. French Hill and Rep. Bruce Westerman released statements calling once again for the Affordable Care Act to be repealed and replaced with patient-centered reforms.

That’s easier to say than do. Since the Affordable Care Act was signed into law more than six years ago, congressional Republicans have voted dozens of times to repeal it. Replacing it? Not so much. True, Rep. Tom Price, R-Ga., a physician, has been offering alternative bills since 2009, and Donald Trump’s website lists a framework of reforms. But the party has never coalesced behind a detailed, specific plan and then spent political capital selling it to the American people. Instead, it’s mostly just voted to repeal Obamacare knowing that, ultimately, President Obama would veto the repeal anyway.

Health care is by far the most difficult issue facing policymakers. There are many reasons, including that it’s a service Americans believe should be unlimited and cheap, which is a high standard. We need health care like we need groceries, but with food, most of us want steak but will buy canned tuna if that’s all we can afford. With health care, we all want nothing less than steak, but at canned tuna prices.

Like any other service, someone has to pay for a health care provider’s costs, and there are only three imperfect ways to do that. One is the free market approach where the consumer pays, which offers more freedom but less security and doesn’t have a clean answer when the consumer can’t afford the care. Another way is for the government to pay, which offers more security, at least initially, but less freedom. In that case, the government is deciding how life and death resources are allocated. Then there’s the third approach: Someone else pays, typically an insurance company. That method tries to strike a balance between freedom and security but gives a lot of power to a private corporation and in recent history has not effectively controlled costs.

The American health care system was a convoluted concoction of those three payment methods before Obamacare, and it still is. Prices were rising before Obamacare, and they still are. Undoubtedly, more Americans have insurance now than they did, and that’s a positive that shouldn’t be ignored. But many still are uninsured, and the big problem – cost – has not nearly been solved.

Republicans at the national level would do well to follow the example set by Republicans in Arkansas, who have done most of the creating, amending, defending and opposing of the aforementioned private option/Arkansas Works.

We can debate whether Arkansas Works is a good idea. But at least it’s a new one, with specific details that are clearly communicated and fought for.

Related: The real goal of the private option: Changing U.S. health care