Sunday, January 10, 2016

Sen. Jason Rapert casts doubt on the future of the private option

Posted By on Sun, Jan 10, 2016 at 3:28 PM

I wrote this morning that Gov. Asa Hutchinson was taking a political risk in conflating his desired Medicaid reforms with the private option. If Republicans started actually taking seriously the baloney he was peddling — that his proposals were necessary to pay for the private option — they might decide they'd rather scrap the PO altogether. 

And right on cue, Sen. Jason Rapert came out with a string of tweets today that seemed to signal new skepticism — if not quite outright opposition — to the private option, in part rooted in the misunderstanding of the PO's impact on the state budget that Hutchinson has encouraged. 


Rapert produced a string of 18 tweets, which you can read here. I won't touch on every point in his rant, but the gist is that Rapert says he supported the private option "to help our state survive until Obamacare was overturned." He called it "making lemonade out of lemons." But now he's frustrated because Obamacare is still on the books. The Supreme Court hasn't overturned it. Congress can't get around the president's veto. Rapert says the Court has acted illegally and Congress is inept, but in any case, he is worried that "Obamacare is here to stay." And so, he says, "The Private Option probationary period is now over for me because Congress has not overturned Obamacare."

If Rapert actually flipped his vote, it would be bad news for the private option. He's been a key GOP backer in the Senate, where the margins are always going to be tight. But while Rapert floats the idea of an "exit ASAP" from the private option, he gives himself a lot of wiggle room. There's a lot of "prove it or lose it" and "fish or cut bait" talk in Rapert's tweets that seem more designed to establish that he's going to be tough on the PO (that his support is conditional, that he must be won over) than a statement of outright opposition at this point. 

Here's one of his tweets: "If the federal Govt. does not give @AsaHutchinson everything he wants on conservative reform- I say we exercise our option to exit the PO." Okay. But depending on how Hutchinson defines his wish list, the governor can say that he got everything he wants, or at least everything he asks for during this negotiation. Hutchinson himself will be the one selling whatever negotiation he hammers out with the feds. In other words, this may be a lot of sound and fury from Rapert, signifying his anti-Obamacare bona fides to his base. That doesn't mean Rapert is actually going to withhold support for the governor's "Arkansas Works" plan — which, well, continues the private option.  

The most telling tweet is this one: "With Obamacare still in force -illegally in my opinion - and the promises of PO savings not apparent to me, I am now ready for alternatives." 

Oh, now? See ... we've been debating this for three years. There is no magic alternative! The state can either continue the private option (or continue the coverage expansion via traditional Medicaid) or it can forego the billions of dollars in federal Obamacare money — which means sending out 200,000 cancellation letters, hitting the hospitals with tens of millions in uncompensated care costs, and blowing a hole in the state budget over the next five years. Aginners like Rep. Joe Farrer and Rep. Bob Ballinger promised alternative plans years ago. They never arrived. The task force hired a million-dollar consultant and has been meeting for a year! If opponents of the private option wanted to offer up an alternative, this was the time. None emerged because once you refuse the federal money, there is no workable and affordable alternative for the state to cover these folks. The alternative is a return to the pre-expansion status quo, and kicking hundreds of thousands of Arkansans off of their health insurance.

Indeed, that's been precisely the dynamic at the task force — lawmakers on both sides of the PO debate dug into the details, considered the alternatives, and wound up right where we started. It will be no different if Rapert wants to spin the wheels again. 

Rapert has it exactly backward, it seems to me. If Obamacare ended, as he fantasized would somehow happen, the private option would end with it. If Obamacare is "here to stay" that's an argument for the private option. As long as the law is on the books, the state will continue paying in for the law, in the form of Medicare reimbursement cuts, higher investment taxes, and other pay-fors. Under the circumstances, it would be a disaster for the state to turn down the billions of dollars available to it via Obamacare. That's precisely the argument that many Republicans have made for the private option.

In any case, Rapert's tweets today suggest that he's at least more volatile on this subject than he has been previously. That could be a headache for the governor come April, when a special session will convene to determine the future of the private option. 

The best arguments that the governor could make to Rapert are right there in the report from the state's consultant — the private option projects to save the state more than $400 million over five years, with the net savings continuing even when the state has to start chipping in its full 10 percent share in 2020 and beyond. Unfortunately, Hutchinson has refused to acknowledge those aspects of the report.  That's the trouble with the governor's fuzzy math and slippery rhetoric — some lawmakers might actually buy it. 

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