Sanity gets a fighting chance

Leading state Republican legislators seemed to concede last week to the concepts of universal health insurance and cashing in on the federal government’s willingness to subsidize health care.

We’re liable to get somewhere now that we’re gathering smartly under a tent of centrist politics embracing common sense. Welcome, I say. It will take some time for Republicans elected by Tea Party madness to realize and admit what tent they’re in. But the fact is that now we’re mainly negotiating the sticker price on Medicaid expansion. The sale seems to have been made.

Movement in this debate since the election, which I feared to be the day logic died, has been remarkable.

First, on Tuesday, state Rep. John Burris of Harrison, a bulldog rightwing Republican and chairman of the House Public Health Committee, got contentious. It happened when Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, testified that Medicaid expansion was vital to the hospital’s financial security.

Expressing a view that other Republicans had begun mentioning to me days before, Burris said that hospitals weren’t factoring into their doomsday scenarios another number. That would be the additional payments they’ll start to reap from non-Medicaid people who will be moved from the uncompensated-care category into the privately insured category through the new health-care exchanges created to serve the individual mandate of the Affordable Care Act.

Most likely, the young Burris was trying to stall on the overpowering logic of Medicaid expansion.

Yet he was making a valid point, which was that we need to compile and consider all factors in our projections. Newly mandated private insurance will reimburse more generously than Medicaid, for one thing.

But, in so doing, Burris essentially was articulating Obamacare’s essential

tenet, to wit: We will begin to address and conceivably fix a lot of our health-care inefficiencies if everybody is mandated to get insurance.

Second, on Wednesday, state Sen. Jonathan Dismang, a sly right-wing Republican from Beebe, got to thinking aloud in his pointed questioning of Surgeon General Joe Thompson at the other end of the Capitol in the Senate Public Health Committee.

Basically, Dismang was saying that we could try to get the federal government to let us expand Medicaid only to 100 percent of poverty rather than 138 percent.

That, he pointed out, would move our estimated 50,000 to 60,000 adults falling between 100 and 138 percent of poverty into the new health-care exchange. There, he said, they would be federally subsidized to the extent that their out-of-pocket costs for private insurance would range from only $19 to $26 a month.

Then, Dismang suggested, the state might even pick up that personal premium for those people. The cost of that to the state, he speculated, would be less in the long term than what the state would pay under Medicaid expansion after the federal government reduces its share from 100 percent to 90 percent.

It would surely be a more reliable cost, Dismang said. Insurance is a known rate. Medicaid coverage depends on the extent of care.

Again, like Burris, Dismang was advancing Obamacare’s central tenet: Health insurance good, unknown medical costs bad.

Of course, all of Dismang’s speculating would be dependent on Gov. Mike Beebe’s securing a waiver from the currently operative federal mandate that states must take all or none of Medicaid expansion.

Here, then, was Dismang’s money quote, literally: “The bottom line is that I don’t want to lose cost-shifting whatever we can to the federal government.” Wow. Abandoned wholesale, apparently, is this once-raging conservative argument that it’s all our money and that we in Arkansas bear a responsibility—unilateral, if necessary—to save the federal government from its own borrow-and-spend excess.

Dismang’s intended point, as valid as that of Burris, was that he and other Arkansas legislators owe a responsibility to get the best deal they can get for state government.

But left unsaid, to blaring implication, is that the best deal for budget-balanced Arkansas means the worst deal for the debt-laden federal government.

You can be a federal deficit hawk and a sane state legislator at the same time. The broader imperative of bringing down our federal deficit and debt should be taken up, separately and vigorously, on matters of defense and Medicare and taxes.

And it should be taken up in Washington, not Little Rock.

And it should be taken up not by state-level office-holders, but by persons named Obama, Boehner, Pelosi, Reid, McConnell, Pryor, Boozman, Crawford, Griffin, Womack and Cotton.

To give up health-care subsidies in the meantime is nuttier even than asking the federal government to close the Little Rock Air Force Base.

So let us celebrate the conceptual consensus emerging in Arkansas, where common sense always seems to stand a fighting chance.

John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.