Tuesday, January 27, 2015

A tribute to Mike Huckabee and Asa Hutchinson, the health governors

Posted By on Tue, Jan 27, 2015 at 11:07 AM

click to enlarge THREE CHEERS: For Hutch and Huck.
  • THREE CHEERS: For Hutch and Huck.
I just finished writing a column for the Times this week on Asa Hutchinson's promising start as governor. I'll post it after a while. Now comes Ernest Dumas, with a column devoted to health care and the laudable efforts by Mike Huckabee and now Asa Hutchinson to move Arkansas toward universal health coverage despite strong opposition in their own Republican Party.



One fine day in 1999, Governor Mike Huckabee, with his earnest but sometimes zany public health director at his side, announced that before he left office he intended to see that everyone in Arkansas had health insurance.
Huckabee had discovered the health issue soon after taking office and decided he was going to be the Health Governor. He still deserves the honorific, for more than any other governor in Arkansas history he talked about public health and undertook more health initiatives, a few substantive like arranging federal insurance for children and pushing smokers out of most workplaces.

But when he left office the state was only a little closer to the goal of universal insurance than that euphoric day in 1999. Huckabee had deplored the fact that Arkansas was the third unhealthiest state in the country, behind West Virginia and Mississippi, and suffered economically as a result of it. By his exit in 2007, Arkansas was still at the bottom, and more of its people were uninsured than almost any other state.

Here’s the irony: Asa Hutchinson, his one-time quiet nemesis in the Republican Party, is apt to be the governor who actually achieves the goal of insured medical care for nearly everyone except undocumented immigrants. The 1999 model of Huckabee would have wanted to insure them, too.

When Hutchinson announced last week that he wanted to continue unchanged the big Medicaid expansion authorized by the Affordable Care Act, a.k.a. Obamacare, at least through 2016, he virtually assured himself of attaining Huckabee’s goal. He will have done it by the grace of the widely despised Obamacare, but that should not detract from the achievement. He will have done it against odds that both Huckabee and Mike Beebe would have found insurmountable.

More about that in a moment, but first let’s be sure to give Huckabee his day. He’s about to run for president again and this time he is apt to leave out the best part of his record because it is anathema to his party’s right wing.
Only weeks in office in 1996, Huckabee assembled people to talk about things he could do in his first legislative session. Amy Rossi of Arkansas Advocates for Children and Families suggested exercising the option under Medicaid to cover infants and youngsters under 19 whose parents could not afford insurance. We insured the elderly, disabled, pregnant women, kids in foster care and certain others with medical needs, like women with breast or cervical cancer, but no governor had advocated the costly program of insuring virtually all kids. The state would bear about 25 percent of the cost. Huckabee jumped on it, state Sen. Mike Beebe sponsored the bill and the legislature passed it.

Medicaid now insures 495,000 Arkansas children and pays for about 65 percent of all births. People under 20 account for two-thirds of Arkansans on Medicaid and 45 percent of all payments. The state picks up nearly 30 percent of the costs, the feds 70 percent. The state, by the way, will never pay more than 10 percent of the Obamacare/Beebe/Hutchinson expansion.

His proudest achievement Huckabee called it.

But he did more. The University of Arkansas for Medical Sciences told him he had diabetes, which set him on a crusade to improve his own health and that of all Arkansas’s fat people. He dieted and furiously ran himself into the 2008 presidential race. He began programs to educate people on healthy lifestyles, got changes in school nutrition services to emphasize healthy food, beat back the legislature to direct millions in tobacco-settlement funds into smoking cessation and other health services. Eventually, he overcame his own addiction to tobacco money—the industry was a big political donor and Philip Morris set his table with fine new china—and signed the Clean Indoor Health Act in 2006, which ran smokers from most workplaces. Unable to come up with a way to insure everyone, he got a waiver from the feds in 2006 to put low-income small-business employees on Medicaid.

In his final crazy days in office, Huckabee took $2 million in grants to universities and tried to give it to UAMS, $800,000 to the doctor who crafted his diabetes program for an endowed chair that would do obesity research and $1.2 million for a cancer research center for the day when another governor found the many millions to match it, after which they would no doubt name the center for Huckabee. Advised by state fiscal officials that it would be an illegal appropriation, UAMS said it couldn’t take it. The angry governor took the money back and gave all $2 million to his friend Lu Hardin, whom he had installed as president of the University of Central Arkansas, which had an appropriation to cover it. Hardin spent the $2 million before he was removed from office 20 months later and convicted of wire fraud and money laundering.

The big question, of course, is whether Asa Hutchinson can preserve the Medicaid coverage when the sizable tea-party faction of his party wants to destroy it and some want to go further and undo the big payment reforms (encouraged by Obamacare) that Governor Beebe counts as his greatest legacy. I think he can. What was most impressive about his health-care message at UAMS last week, in which he acknowledged the political troubles of Obamacare, was the candid recognition that the first consideration in the battle had to be the health of people who are covered and are about to be covered under Medicaid and the individual and employer insurance markets, not the politics or the budget. He knows, if the tea party doesn’t, that the financial advantages of the insurance reforms more than pay for the state share, even after it reaches 10 percent. Mike Huckabee with judgment.

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