Tuesday, July 22, 2014

Asa may waffle, but the private option is here to stay

Posted By on Tue, Jul 22, 2014 at 10:01 AM

Ernie Dumas gives Republican gubernatorial candidate Asa Hutchinson a jab for dodging a position on the private option expansion of Medicaid, while Democrat Mike Ross is loudly proclaiming his support for a plan crafted by Republican legislators.

But the main point of his column this week is this: The private option is a fact of life. It will endure because it must, for reasons practical and legal.

Asa's dilemma:

If he were forced to take a stand Hutchinson would have to say that he would keep the Medicaid expansion because scrapping it would wreck the state budget, end medical coverage for more than 200,000 of the state’s neediest citizens, imperil community hospitals, disappoint doctors who have begun to accept poor adults as patients because they now can pay, and end a big economic stimulus for businesses in every community. But openly embracing Obamacare like that could stifle his campaign to characterize Ross as a pawn of the evil people who saddled Arkansas with Obamacare.

Why won't it be scrapped?


If the state scraps the private option, it will have to once again shoulder Medicaid costs that were shifted to Washington last winter as part of the Obamacare bargain with the states. After seeing the big budget savings from the Obamacare shift, the legislature decided it could cut taxes last year. Hutchinson and Ross both promise more tax cuts next year but ending the private option would make that as fiscally reckless as it proved to be in Kansas.

A total of 185,000 persons have enrolled in expanded Medicaid and another 40,000 have bought insurance in the Obamacare exchange—together nearly half of all the previously uninsured citizens in Arkansas. When the new governor takes office, some 215,000 will be enrolled in expanded Medicaid alone. Will Hutchinson and, indeed, most Republican legislators want to end medical coverage for so many of their neighbors and constituents?
It was an easy vote for some Republicans last year because they viewed Medicaid, except for nursing home care, as welfare for all those black people in the Delta and south-central Arkansas. But they are learning that it is mostly a program for white working people and their children.

Dumas notes that 27,213 people in the virtually all-white six Northwest Arkansas counties have enrolled in the private option, against 27,871 in the 11 counties of the Delta, some but not all majority black.

By the way: The private option for now is all federal money. It can be appropriated by a simple majority vote. A quarter of the legislature can't kill it as with a state appropriation. Plus the case law is clear, Dumas writes: Once you create a program ("entitlement," if you will) you can't kill it by mere failure of a state appropriation.

Here's the whole column.
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