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Saturday, February 22, 2014

The private option: minority of lawmakers try to force the end of a policy, working as intended, supported by overwhelming majority

Posted by on Sat, Feb 22, 2014 at 11:39 AM

My talking head was on “All in with Chris Hayes” last night talking about the private option fight in Arkansas. TV is hard, so two quick points I think are worth clarifying:

1. The talk about appropriations and supermajorities can get bogged down, and I think it’s helpful to remember this simple fact: The private option law remains on the books, voted for and supported by an overwhelming majority in the Arkansas General Assembly, and there are nowhere close to the votes to overturn it. When I talk about “radical precedent,” what I mean is that the state has traditionally operated under norms by which legislation and policy is determined by the will of the majority in the legislature. Here we have a small minority using a tool (yes, available in the constitution unless a court says otherwise) in a radical way: blocking an entire budget, including stuff even the obstructionists want, to try to force the majority of legislators to cave on an existing policy within that budget. The “offer” from the obstructionists: end the private option and we’ll agree not to stop the entire Medicaid program. That’s it. The threat to implement a terrible outcome that nobody on either side wants is the means by which a small minority is trying to bend the overwhelming majority.

2. Hayes asked "is the private option working?" Our discussion focused, as it should, on the core goal of the private option — providing health insurance to low-income Arkansans. On that front, as readers of this blog know, the private option has been an enormous success. While nationally, Obamacare enrollment via healthcare.gov had a disastrous rollout, the implementation of the private option has gone swimmingly. The state-run websites work fine, folks responded overwhelmingly to direct mail informing them of eligibility, the process of getting folks signed up to private health insurance they're now able to utilize has gone as smoothly as anyone could have hoped. After just two months, the state has put a huge dent in the uninsured rate, with 100,000 people gaining coverage. But it's also worth noting that the policy details — once projections, now facts on the ground — have also brought good news. The per-person costs thus far are coming in nearly on the nose to what was projected by actuaries. The pool is leaning younger, and likely healthier. Both the size and the makeup of the private option population have been vital for the Arkansas Health Insurance Marketplace, likely leading to lower premiums and more choices for Arkansans shopping on the Marketplace, and helping to attract more carriers into the state down the road and keeping the ones we have. From the perspective of conservatives, the Burris amendments give teeth to the promise of Republican-friendly changes to the private option in 2015. The doomsday scenarios peddled by some private option opponents have not come true. The private option is working as intended. 

Now obviously, if you are someone who believes that providing health insurance to 100,000 (and counting) Arkansans is a terrible policy mistake, any talk of the private option "working" is beside the point — from the perspective of diehard opponents, it's probably working all too well! But even some of the lawmakers most fervently opposed to the private option have admitted to me privately that they're a bit baffled by those who voted for it last year and have flipped to no after the policy has been operating for just two months. There simply isn't much in the way of substantive policy reasons for people like Rep. Ann Clemmer or Rep. Allen Kerr or Rep. John Hutchison, to name just a few, to have changed their minds. They just got spooked by the politics. 

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