Friday, April 8, 2016

Sen. Hester threatens game of "hard chicken" to "crash" funding for ARKids, the elderly in nursing homes, and the disabled

Posted By on Fri, Apr 8, 2016 at 6:07 PM

click to enlarge HESTER: Willing to play chicken with state's most vulnerable citizens. - BRIAN CHILSON
  • BRIAN CHILSON
  • HESTER: Willing to play chicken with state's most vulnerable citizens.

Sen. Bart Hester
 made a rather shocking statement, quoted in the Democrat-Gazette this morning: 

"We're playing some pretty hard chicken right now with both people's feet on the accelerator. I think the only thing that's going to bring resolution to this is a crash."

The game of chicken that Hester is playing, and the crash that he is suggesting, is a potential shutdown of funding for some of the state's most vulnerable citizens, including the aged, disabled, and the blind; people in nursing homes; children on ARKids; and foster kids receiving medical care. And more. If Hester makes good on his threat, a humanitarian disaster would follow. 

Here's the situation: a small minority of Tea Party lawmakers are threatening to shut down the government in order to try to block "Arkansas Works," the governor's plan to continue the private option Medicaid expansion, which provides health insurance for 267,000 Arkansans. 

The "Arkansas Works" legislation passed with overwhelming bipartisan majorities in both the House and Senate, supported by all Democrats and a majority of Republicans. The Medical Services appropriation for the Department of Human Services — which includes not just the Medicaid expansion population but the entire Medicaid program — requires 75-percent approval in both houses. While these appropriation votes are typically routine, a rump group of ten senators feels so passionately about ending that coverage for 267,000 that they are willing to use an unusual tool: They say that unless the overwhelming majority caves to their demands, they will shut down all funding for Medicaid.

That's the "crash" that Hester refers to: kicking Grandma out of the nursing home, suddenly stripping coverage from severely disabled people and poor children, eliminating medical services for foster children, and so on. That is the game of "hard chicken" that the Tea Party Ten is playing.

What happens if Hester and company make good on their threat and drive the state over the cliff? At the end of June, all funding would end for the following: 

* Medical care for the aged, disabled, and the blind, covering 142,077 people. This includes the elderly in nursing homes and people with severe disabilities. 

* ARKids, providing coverage for more than 400,000 low-income kids. 

* Home and community-based services for 11,000 elderly people and people with severe physical disabilities. 

* Medical services for nearly 5,000 foster children (the Division of Children and Family Services is not part of the relevant Medical Services appropriation, but medical care for many foster children is funded via the Medicaid budget). 

* TEFRA, a Medicaid program that provides care to disabled children in their homes. Hester's game of chicken threatens funding to help families with children with severe health challenges such as cerebral palsy and wheelchair-bound children. (I am waiting on DHS to provide a precise number of families impacted.)

Funding to help more than 60,000 elderly Medicare beneficiaries with care and costs not covered by Medicare. 

* Coverage for thousands of extremely poor parents of dependent children. 

* Coverage for more than 10,000 low-income pregnant women who are not otherwise covered by the private option. 

* Closure of the 250-bed Arkansas Health Center, a public nursing home that takes patients that few or no other nursing homes will take, such as patients on a ventilator and patients with severe cognitive dysfunction. 

* State hospitals that provide care for civilly committed patients having acute and severe behavioral health crises would lose 30 beds. 

These are the human beings — these are the Arkansas families — that would have funding for their medical care evaporate if Hester makes good on his threat of a "crash." (This is not an exhaustive list.) Most would find themselves without good options for access to medical care that they desperately need. 

On top of that, billions of dollars in Medicaid payments to providers, hospitals, nursing homes, and clinics would immediately halt. And DHS would face massive layoffs, likely with unforeseen consequences throughout the department. 

When Hester says that both feet are on the accelerator, this is the cliff he is threatening to go over.  

Just to be clear, all of this is on top of the more than a quarter million Arkansans who would lose their health insurance if Hester got his way and ended Medicaid expansion. The elderly, disabled, kids, and others in the traditional Medicaid program are the hostages — Hester is threatening to shut down funding for all those folks in order to try to make a demand to shut down funding for quarter million on the Medicaid expansion. 

I asked Hester today about his statement today. "We have until the end June to work something out," he said. "I don't think we'll have to have a shutdown." 

However, Hester said that he would be willing to go through with a full Medicaid shutdown — immediately ending all of the funding described above for the state's most vulnerable citizens come July 1 — if that was the only way to stop the Medicaid expansion from continuing

I made sure to clarify that we were talking about the disabled, the elderly, the blind, children. He would make good on his threat to cut off that funding in order to stop Medicaid expansion? 

"I would," he said, but added that he hoped the legislature would come up with a creative solution to avoid that scenario. 

Hester's hope is that the aginners can pass a Medical Services appropriation with "Arkansas Works" stripped out — in other words, it would fund the above, but would eliminate Medicaid expansion. The problem is that Hester's group is a tiny minority. The legislature just voted overwhelmingly to approve "Arkansas Works." Hester does not have anywhere close to a supermajority to pass an appropriation that kills the Medicaid expansion. He does not have anywhere close to a simple majority. He does not have anywhere close to the votes to even get it out of committee. 

All he has is a threat, which he promises he will make good on: to crash the government and unleash an unimaginable nightmare on the state of Arkansas and our neediest citizens.

Support for special health care reporting made possible by the Arkansas Public Policy Panel. 

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