Wednesday, December 12, 2012

Arkansas Republicans complain about federal inflexibility on Medicaid expansion

Posted By on Wed, Dec 12, 2012 at 12:26 PM

Republican lawmakers feign disappointment in this morning’s D-G (paywall) at the no-surprise announcement from the U.S. Department of Health and Human Services that the generous Obamacare federal matching rates on Medicaid expansion are an all-or-nothing deal — partial expansion won’t cut it. We blogged about the letter from the feds when it was released last Monday; it’s not really a new announcement so much as a reaffirmation of what HHS has said from the get go, daydreams from Arkansas conservatives notwithstanding.

If you hear Republicans complaining about the feds being unwilling to negotiate, keep in mind that the feds are already offering a giant handout to allow poorer states like Arkansas a chance to catch up with wealthier states and offer health insurance to hundreds of thousands of its needy citizens AND save money on the state’s bottom line in the process.

Of course, thanks to the Supremes, Arkansas can say no. No one is forcing our hand. If the legislature really wants to continue having one of the stingiest Medicaid programs in the country, they’ll just have to be willing to turn down federal dollars to keep the privilege.

One of the stranger complaints I’ve heard comes from former Arkansas Medicaid director Ray Hanley. From the D-G article:

“It doesn’t allow the flexibility that some states and governors should be given—138 percent of poverty just makes no sense. It’s one size fit all and paints every state with the same rigid brush,” Hanley said.

Someone with an income of $15,400 in Arkansas doesn’t face the same economic challenges as someone with the same income in New York or California, he said.

First of all, really? Someone making $15,000 a year in Arkansas has the disposable income to buy private health insurance? Regardless, notice the sleight of hand: that $15,400 number is the ceiling (138 percent of the federal poverty level) for an individual. But without expansion, childless adults aren’t covered at all, and neither are parents all the way down to 17 percent of the poverty line (down to 13 if not working). There is a huge group of folks ineligible for Medicaid in Arkansas that are poor by any standard, in rural Arkansas or New York City or anywhere in between (here's a look at who falls through the cracks without expansion).

Once again, these are the kinds of folks that don’t qualify for Medicaid in Arkansas now but would under expansion:

*All childless, non-disabled adults aged 19-64, whether income is $15,000 or $7,500 or no income at all.

*Parents in a family of four with an income more than $4,000.

*Single mother with two kids with an income more than $3,245.

*A disabled person with an income more than $8,377.

This has nothing to do with the cost of living in different places. This is about providing a safety net to our citizens most in need of one.

As Arkansas Surgeon General Joe Thompson put it, it’s a “one-time opportunity to catch up to the richer states. It is not fair that a working mom in Arkansas could be disadvantaged in the same way that if she were in Maine she would be advantaged. We have an obligation to our citizens to level the playing field.”

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