Medicaid is scary

The plan is for the Legislature to re-convene Monday and formally end its regular session and then immediately go into special session.

It’s to hear at that point from Gov. Asa Hutchinson on a few bills that would conservatize further our otherwise progressive Medicaid expansion program, which, for all we know, Republicans in Washington may again try to kill.

The special session thus will assume that we are blessed with a functioning Republican majority in Congress, indeed even a reasonable and competent one. It’ll be leap of faith, then, as legislators stay in town through Wednesday of next week, which is all the time this special session ought to require.

The Republicans possess big enough majorities to pass these measures. Anyway, these bills merely will be of a contingency or authorizing nature. Their actual effectiveness will depend on the Trump administration’s granting waivers and the existence of a surviving system of health care on which to apply those waivers.

The three-day exercise ought to be uneventful. The Democrats worry about the details, but they don’t have enough votes to force any issue.

This is all about Hutchinson wanting to put additional conservative and Republican-brand flourishes on the private-option form of Medicaid expansion he inherited, renamed and nobly saved.

It’s also about the fact that the growth of the population served by Medicaid expansion seems to scare the governor half to death—conceptually and financially.

He thinks we need to keep poor people from depending on the program and that we need to curb the cost spirals of it, which could most directly be accomplished by throwing people off.

To secure from the Trump administration waivers the Obama administration wouldn’t grant, Hutchinson must have laws in place to which federal regulators can refer. That’s probably about all that the Trump administration will require. Presumably, these new guys are all about letting states run their own business.

Here, then, are the four proposals the governor has talked about:

Throwing off Medicaid expansion up to 60,000 people making between 100 and 138 percent of the federal poverty level—between $12,000 and $16,000, give or take, for an individual—and pawning those people off on the federal government. They would then get federal subsidies on the health-care exchanges, which, unlike Medicaid expansion, require no state matching funds.

Of course, that assumes we’d still have health-care exchanges and subsidies— meaning Obamacare. The House plan recently pulled down would have phased them out. The Tea Party fringe of the Republican House caucus wants to end them.

Imposing a work requirement on Medicaid expansion recipients, which worries some rural Arkansas Democrats who wonder what you do for Medicaid expansion recipients living in areas without many or any work opportunities. This issue is less about the authorizing bill than the regulations that would come later. For example: A single mom on Medicaid whose child care would cost more than her job would pay—could she be exempted? These things aren’t as easy as rhetoric, you see.

Requiring that a Medicaid expansion participant who takes a job offering an employer health-insurance plan must go on that employer plan. Medicaid would pay to fill in the gaps between the employer-plan benefits and whatever was better under Medicaid expansion. The administrative problem with that is that poor people often take temporary work and can move in and out of jobs providing varying benefits.

A designation from the federal government that Arkansas may determine Medicaid eligibility on its own instead of leaving the last word to the federal government. That’s alarming news for Arkansas poor people considering that, two years ago, the Hutchinson administration set out to throw people off Medicaid who didn’t respond to prove the continuing paucity of their incomes within 10 days of the snail-mailing of a notice they might not have received until the seventh or eighth day. The Obama administration had to step in and tell the Hutchinson administration to behave a little less draconianly and give these people more time.

The Trump administration probably would accept throwing them off within 30 seconds of the sending of a text to a cell phone they used to have.

Even so, with all of that, my position remains that Hutchinson is to be lauded for saving Medicaid expansion and is the best we could hope for in a Republican governor right now.

That’s unless there’s one who would have both saved Medicaid expansion and not scheduled eight executions in 11 days.