Perfunctory puttering

Gov. Asa Hutchinson established a task force to come up with cosmetic tinkering that would provide him conservative talking points for saving the vital private option.

It was a political exercise, not a policymaking one.

The policy is easy, except for about 30 to 40 state legislators who are so ideologically consumed on the rightward fringe that they can’t admit that the private-option form of Medicaid expansion has been brilliantly and non-ideologically successful.

It saves state government loads of money by taking people off basic Medicaid, for which the state bears a steep matching obligation. It fortifies hospitals by covering previously uncompensated care. And it subsidizes all of our health-insurance premiums by routing Medicaid clients off the direct Medicaid program and into the private health-insurance market, where rates are based on the robustness of premiums as compared to claims. —————— If we’re going to have government subsidies, the best ones are those that help more than the subsidized private enterprise, but also the ensuing consumer and the general economy.

The private option is like a farm subsidy in that regard. Take both away and all of us would pay dramatically higher prices for groceries and health insurance.

Obamacare advocates chortle that Arkansas is embracing Obamacare with the private option. But actually, Arkansas isn’t, quite. Basic Obamacare calls for simple expansion of fee-for-service Medicaid, and thus provides no private-sector subsidy.

The private option is liberal spending combined with conservative privatization.

The task force’s first action, of course, was to spend needless taxpayer money on a consultant to tell it what I could have told it for the price of a newspaper subscription, and had.

The task force rejected a bidder favored by the most prominent private-option supporters. It went instead with The Stephen Group, from New Hampshire, favored by a nonsensical coalition of Tea Party Republicans and Democratic legislators.

The selection made no difference. In fact, it proved better for the private option that the opponents’ favored consultant fell in love with it.

The Stephen Group pronounced that the private option would save the state government budget at least $438 million over the next few years and recommended that, of course, we ought to keep it.

Then the consultant picked up on public signals from Hutchinson. It said the state ought to tinker around the edges of the program by making recipients closer to the high end of eligibility take some measure of responsibility for co-payments and premiums.

It even threw in some “out-of-thebox” suggestions such as requiring all these darned poor people to get jobs or actively enter job training.

That’s out of the box because the federal government, which provides most of the money, says Medicaid is for the purpose of paying for the health care of a sick poor person and that we’re not going to deny coverage to some poor sap in the emergency room because he can’t prove he’s employed or enrolled at Pulaski Tech or somewhere.

You’ll remember, also, that Hutchinson said that the perfectly fine name, “private option,” had become lethal, and should be changed. Did someone say cosmetic? Hutchinson meant it was lethal with the handful of right-wing resisters in the Legislature, who are always important because the state Constitution requires a three-fourths majority vote to spend this federal money.

So the consultant had an idea: Call the program T-HIP, for Transitional Health Insurance Program, stressing the idea that people shouldn’t stay on the dole but move on to independence.

Smarty-pants writer David Ramsey of the Arkansas Times, who knows more about the private option than just about anybody, wrote that T-HIP sounded like a geriatric rapper.

They can call the private option any lame thing they want. I’m calling it the private option.

The consultant actually earned some of his money by finding about 40,000 or so persons still on the Medicaid rolls, including some presumably getting premiums paid for them via the private option, who were either dead or had moved to another state.

Right-wingers latched on to that to show that the program is no good. Actually, it showed only that the monitors of it aren’t any good. You don’t take away everyone’s license plate because somebody with unexpired Arkansas tags is actually living in and driving around Kalamazoo.

Finally, the real meat of the consultant report was in how to save elsewhere in the Medicaid program to make it more sustainable over the long term.

That mainly will mean—if we possess the will and skill—to stop institutionalizing so many elderly and disabled people and start serving them more inexpensively via day care or community care or home care.

If we’ll quit arguing over spectacularly easy issues like the private option, then we can move on to those vital and challenging ones.