Wednesday, December 16, 2015

On Medicaid "lockout" provision, Gov. Asa Hutchinson hedges

Posted By on Wed, Dec 16, 2015 at 5:08 PM

LOCKOUT? Hutchinson dodged questions about the Medicaid lockout, an idea he appears to be backing off from.
  • LOCKOUT? Hutchinson dodged questions about the Medicaid lockout, an idea he appears to be backing off from.

Gov. Asa Hutchinson
today once again went over the changes to the private option he plans to seek in negotiations with the feds (work referral programs, small premiums for some beneficiaries, etc.). 

For the most part, this is the same stuff we've been hearing from the governor for months, but on one issue, he may be wavering: the so-called "lockout" provision, which would punish beneficiaries subject to premiums who failed to pay by locking them out of coverage for six months. At the task force meeting today, the governor avoided the word "lockout," and he dodged questions from reporters about whether he still wants to pursue the policy. 

In a speech just last week, Hutchinson highlighted the lockout provision as an important component of the changes he was seeking, saying that beneficiaries who failed to comply with the program's requirements needed to face "consequences." However, a number of lawmakers from both parties, stakeholders, and advocates for beneficiaries have expressed concerns about the lockout. Some argued that it would unfairly punish poor people with very little disposable income; others worried about the impact on uncompensated care if the "consequence" was basically to make people uninsured. Meanwhile, it's not clear that the feds would give Arkansas permission to impose a lockout in any case. 

In his prepared remarks to the task force, Hutchinson seemed to address and echo those concerns and sounded like he was backing away from the lockout concept — although he didn't clearly say whether or not he had nixed the idea altogether: 

What do you do if they don't pay the premium? Accountability is important. But it has to be accountability that is workable, does not increase the uncompensated care for our hospitals or increase costs to the state from an administrative standpoint. To be achievable, all these waivers, we have to make our case in Washington that this fits within the constraints of the law. But then secondly we have to show that they're workable from an administrative standpoint. 

Afterward, a reporter asked Gov. Asa Hutchinson whether he was walking away from the lockout. Here is his response in full. I will leave to to readers to divine what Hutchinson is saying here: 

I said today that we need accountability in any provision that we put in so that's how I expressed what we need to do. And that's not really appropriate — you know, sometimes they use catch phrases,  and that does not really describe what we need to do as a state. Accountability is the key and I've always said incentives are better than punitive measures and you don't want to — as I said today, increase uncompensated care — so I've indicated to legislators that expressed some concern about that that we'll work through what is the right accountability for those premium requirements. 

I thought that wasn't just vague and non-responsive but actually wasn't recognizable English. So I followed up: Does that mean that the governor wants to pursue a lockout or not?

"I said what I said," he responded.  

So let me do a little reading between the lines. I think that there is a very good chance that the feds have already signaled to the governor that the lockout is a no-go. If so, the question is whether to go ahead and ask for it anyways (as the governor plans to do with other provisions likely to be vetoed by the feds, like an asset test). The reason that the governor went out of his way to avoid endorsing the lockout or even using the word today is that he has gotten pushback, both from Democratic lawmakers worried about the impact on beneficiaries and from lawmakers from both parties worried about cost-shifting and uncompensated care (Tea Party Republican Rep. Joe Farrer, for example, opposes the lockout because he's worried that providers will be left holding the bag). 

Given all of that, perhaps the governor has decided to abandon the lockout. But on the other hand, there are some conservatives (like Rep. David Meeks) who love the lockout. There is a real political appeal among the Meeks crowd to looking tough when it comes to demanding "personal responsibility" from beneficiaries. And, Farrer aside, the lockout's biggest fans are precisely the right-wing legislators who might be on the fence about whether to support the governor's continuation of the private option. 

One possible political sweet spot, then, might be to make it publicly clear that the governor is asking for a lockout provision. Hutchinson could assure Democrats by telling them not to worry because the feds are going to block it. And he could tell his right flank that he pushed for a lockout but the feds said no. 

My guess: Hutchinson hasn't decided what the best political strategy is around the lockout. So he's doing what Hutchinson often does: hedging, dodging, bobbing and weaving, buying time. 

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