Friday, February 22, 2013

Carter: Florida's sunset provision for Medicaid expansion "makes a lot of sense"

Posted By on Fri, Feb 22, 2013 at 1:43 PM

Arkansas Speaker of the House Davy Carter image

Speaker of the House Davy Carter continues to strike a relatively open note on Medicaid expansion, telling reporters today that he would take a leadership role on the issue and giving a thumbs up to the idea of a sunset provision, included in Florida Gov. Rick Scott's surprise endorsement of expansion earlier this week.

With Gov. Mike Beebe set to meet with Secretary of Health and Human Services Secretary Kathleen Sebelius this afternoon to discuss possible expansion options, the debate on expansion is moving to the forefront after being overshadowed by social issues in the first half of the legislative session. Carter yesterday explained to reporters the questions and concerns he had shared with Beebe, which focused on the possibility of some form of partial expansion, as well as questions about the DHS projections showing that expansion actually saves the state money, both short-term and long-term.

I asked Carter today about Scott's sunset idea, which would implement expansion for three years but then require the legislature to re-approve it in three years time, after the 100 percent federal match rates expire. This has always seemed like the perfect approach for Republicans worried about long-term costs since it would 1) lock in the first three years of fully paid-for expansion, 2) give the state three years of hard data to look at instead of relying on projections, and 3) allow debate on the more controversial out years to take place with that hard data in hand.

Carter said that he was unaware of the sunset provision in Florida but said:

That's certainly something that I have been considering in my office...if you look at it solely through the prism of Arkansas and you look at the math, the math says that it works for some period of time. I can't argue that, it is what it is. The numbers speak for themselves. Beyond years 3, 4, 5, it becomes harder to reach that conclusion...On the sunset question, that's something I've been thinking about for weeks. That kind of takes it beyond a trigger setup. You could envision campaigns [discussing whether to continue expansion] in two years, in four years....I am absolutely against committing the state unconditionally forever....Having some kind of sunset makes a lot of sense.

Let's leave aside the fact that the state can already opt out at any time and just applaud the logic: Carter acknowledges here that at least those first three years are a good deal for the state. Why not take that, and let the debate continue down the road when we have hard numbers?

Of course, no matter what the math may say about the fiscal impact of expansion, the trickiest math remains: how can the Republican-controlled General Assembly possibly get to the three-fourths approval needed to enact expansion? Some, including Max here at the Times, believe that there's simply no way 75 Republicans in the House will vote for expansion. Carter has taken a relatively backseat role as Speaker thus far, letting the members lead the way. I asked him whether, if he was convinced that an expansion deal was good for the state, he would take a leadership role in trying to convince members and get a deal across the finish line.

Careful to remind me that being convinced of a good deal was still a big "if" he responded:

If I reach the point that I’m convinced that a certain path is good for the state, than yes. That’s why we’re all here. I’m not 100 percent there yet because there’s some information that I need to know. I realize this is politically charged. We’re going to do what’s best for the state but if I reach that point, that’s why I’m standing here. I have an obligation to do that.

As he did in an interview with Roby Brock earlier this week, Carter equivocated by saying that he does not believe the federal government can afford expansion in the long run and voicing general disapproval of the Affordable Care Act, but was clear that his responsibility was to make the best decision for Arkansas given the "cards that have been dealt." Worth noting that this is a similar frame to that used by the various anti-Obamacare Republican governors who have endorsed expansion.

But, with Max on an airplane, I'd be remiss not to throw a bucket of cold water on all of this! Carter referred twice to a "180-degree turn" from the feds regarding possible flexibility and mentioned deals in other states. In fact, on the core request from Republicans — partial expansion — there is still no public record of any state getting ACA match rates without expanding all the way up to 138 percent of the federal poverty level, as required by the law. (Some of this seems to have grown out of confusion about Florida's deal, which could move some Medicaid recipients to private care via the state's managed care system, which doesn't exist here in Arkansas.)

No harm in Beebe asking and it sounds like the feds may be open to giving folks between 100 and 138 FPL a choice between going on the exchange and going on Medicaid. But if the additional information that Carter and company receive is that partial expansion is a no-go? A steep climb gets that much steeper.

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