Monday, March 4, 2013

Republican lawmakers inch toward endorsement of expansion

Posted By on Mon, Mar 4, 2013 at 9:13 PM

John Burris pic
  • Rep. John Burris: making the pitch

For better or worse, Republicans have been enthusiastically embracing the new "private option" approach as an alternative to Medicaid expansion. It's looking more and more like they'll say yes to public money to give coverage to low-income uninsured folks in the state, which seemed impossible just a few weeks ago.

Rep. John Burris
has emerged as the point man for this new approach, and — while always stopping just short of endorsing expansion — has been out there making the pitch for the new plan. Here's Burris in an interview with Roby Brock yesterday:

We finally got some flexibility from the federal government that we have been consistently asking for for six months....Republican legislators in Arkansas were not comfortable with [full Medicaid expansion]....It gives a whole new framework for a policy discussion where we're starting from scratch....This is completely different, it's a 180 from where we were. It is a conservative, market-based, consumer-friendly option.

Nothing too new here, but just pointing out that this sounds like someone making the hard sell. He also consistently makes the "this ain't Obamacare!" argument that will be vital to winning over his colleagues. This plan, he says, is a "fundamental revision of the central tenants of the ACA."

Responding to cost concerns, these parts were kind of astonishing given the last few months:

You're adding a very large pool of what have been defined as typically young, working-age adults, a healthy population, low utilizers of the system...[There may be a] greater economic impact to this approach...we haven't seen any Arkansas-specific numbers. Again these are young, working-age adults, low utilizers of the system...We need to get some Arkansas-specific numbers because this is an Arkansas-specific plan...I also think there's a way to save state dollars by transitioning people out of our Medicaid system into a private plan.

Okay, so:

1) the Medicaid expansion pool is a less risky/old/sick pool than current Medicaid recipients, so costs per person will be lower for the new eligibles KIND OF LIKE DHS SAID ABOUT MEDICAID EXPANSION.

2) federal spending will lead to a big economic stimulus in the state KIND OF LIKE DHS SAID ABOUT MEDICAID EXPANSION.

3) Some folks, for example low-income pregnant women, will transfer from the current Medicaid program to the expansion pool. This will in fact be a little different, as the transfer will be from Medicaid to the exchange instead of within Medicaid. But in terms of how it saves money, it's KIND OF LIKE DHS SAID ABOUT MEDICAID EXPANSION: they'll go from current match rates to the higher ACA match rates (it's literally exactly the same folks transferring, only the savings to the state will actually be lower if costs are higher under the "private option"). *There were rumors floating around the Capitol that this meant moving current eligibles out of Medicaid; I checked with both DHS and Burris himself, and they confirmed movement out of Medicaid would be from the same transfer populations as under Medicaid expansion.

4) Also a hint that Arkansas might be uniquely positioned to contain long-term costs KIND OF...well, you get the idea.

Though I disagree with him on almost everything, Burris is a smart guy. So I believe it is not self-delusion but pure chutzpah that allows him to make arguments for the new “private option” that just months ago were anathema to his party when applied to Medicaid expansion.

Whatever, the main takeaway here is about politics, not policy. Brock tries unsuccessfully to get Burris to come out and say what seems pretty obvious — that details are being hashed out but the outlines of a deal are in place and there is widespread Republican buy-in.

I tried the same with House Speaker Davy Carter and he gave me the "we’re in a much better spot than we were a couple weeks ago" hedge.

The legislative leadership met with (their new best friends?) Medicaid Director Andy Allison and DHS Director John Selig today, and DHS agreed to work on some new projections. While they won't be as in-depth as the last round of projections because of unknowns about prices on the exchange, it sounds like DHS will have something for the legislators to grapple with before the end of the session, despite Gov. Mike Beebe earlier saying that this was a no-go. Based on what we know, DHS will be able to employ many of the same methods to illustrate that this is likely a good deal for the state's bottom line.

I'm going to go out on a limb and predict that Republicans are going to give it more of a fair hearing than the last go-round. Seventy-five percent is still a steep hill to climb, but sure feels like it's all over but the shoutin'. It will almost certainly cost taxpayers more, but Republicans are smitten with the new plan. I even heard one legislator complain that we're giving Gov. Mike Beebe too much credit for the idea in our cartoons, which should have the Expand-o-meter going through the roof: the majority party is taking clear ownership of this idea.

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