Our wobbly way
Several months ago Gov. Mike Beebe got a phone call in his office from Utah’s Republican governor, Gary Herbert, who was inquiring about the Arkansas private-option form of Medicaid expansion.
As the conversation unfolded, Beebe told his Utah counterpart that, actually, two of the legislative architects of the private option happened to be in his office. And they, Beebe happily told Herbert, were Republicans.
So Beebe put the conversation on the speaker phone so that state Sens. Jonathan Dismang of Beebe and David Sanders of Little Rock could participate.
What I’m told is that the Utahan inquired and listened and said … “hmmm,” more or less.
—————— As states go, they don’t get more conservative than Utah, where, on Thursday, Herbert unveiled his Healthy Utah proposal for what amounts to a modified replication of the Arkansas private-option form of Medicaid expansion. Surely you already sense the irony. Utahans imitate Arkansas at the very time a newly Republicanized Arkansas—so superficially and viscerally opposed to Barack Obama and Obamacare that it can’t always think straight—places abandonment of the highly successful prototype under active consideration.
It’d be about like Arkansas to show others the way and then lose its own way.
Among those standing behind Herbert in support of his announcement was the presiding bishop of The Church of Jesus Christ of Latter-Day Saints, which presumably would be politically helpful in Utah.
What the Utah governor announced was that he hadn’t yet secured a waiver from the federal government, but that he did have receipt of a letter permitting the state to go forward with what he had in mind.
And what he had in mind— though he didn’t put it that way directly—was the Arkansas private option with a few added conservative flourishes such as emergency-room and other co-payment requirements for persons with incomes higher than 100 percent of poverty who would be provided private health insurance with Medicaid expansion dollars.
Herbert wanted a work requirement, or a work-training requirement. But that’s contrary to federal Medicaid rules, which won’t allow public health coverage to be denied to someone on the basis that the recipient isn’t seeking or taking employment.
Herbert’s plan does include, however, a “work-effort” provision by which recipients would be encouraged to volunteer to enroll in job-seeking programs and potentially subjected to unspecified state sanctions—withholding of driver’s licenses, perhaps—if not volunteering.
The Utah governor said his plan was conservative in these ways: It seeks for Utah to get back money it sends to Washington that otherwise would be squandered in the way only Washington can squander money. It takes the supposed lemon of Obamacare and seeks to fashion lemonade.
And it is less a matter of Medicaid expansion than a major policy remaking with conservative principles of the system of delivering health care to the poor. Where have we heard that before? To be certain, press accounts from Utah quote Republican legislators as cool to the governor’s notion. And two right-wing private foundation bloggers for the Forbes website who regularly assail the Arkansas plan as an abject failure—which is anything but—were writing Thursday that Herbert had sold out to liberalism and that his plan was even worse than they had feared.
Behold for a moment that supposed abject failure of the Arkansas private option: More than 200,000 poor people are newly insured; hospitals have reduced their uncompensated costs, and the state budget has been saved tens of millions in matching costs under basic Medicaid.
Oh, and one other thing, a correction, if you will: Previous computations that health-exchange rates in Arkansas were dropping an average of 2 percent next year were inaccurate. That’s according to the federal Health and Human Services Department, which says the rate reduction actually will be … uh, let’s see … closer to 3 percent.
That’s while the rest of the nation experiences rate increases.
Obviously, the local application is that Arkansas needs now to imitate Utah in the way Utah seeks to imitate it.
Apparently the private option has no chance for legislative reauthorization in our new Arkansas next year unless somehow newly revised with additional conservative features. And apparently it stands a slim chance if newly revised with additional conservative features and embraced wholly by the new Republican governor, Asa Hutchinson.
Perhaps Asa and the state’s Republican legislators need to engage in a speaker-phone conversation with parties in the Utah governor’s office, and perhaps they need to come away saying “hmmm.”
Iowa, Pennsylvania and Montana have previously adapted or proposed features of our private option. Now comes Utah. There are business and civic leaders in Georgia making new inquiries.
Yet here we threaten to go all wobbly.