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Asa Hutchinson: trying to please 

click to enlarge TALKING ABOUT MEDICAID: Gov. Asa Hutchinson at a meeting of a task force considering the future of Medicaid expansion in Arkansas. - BRIAN CHILSON
  • Brian Chilson
  • TALKING ABOUT MEDICAID: Gov. Asa Hutchinson at a meeting of a task force considering the future of Medicaid expansion in Arkansas.

Mike Beebe is celebrated for the finesse with which he governed Arkansas with a legislature that for two years was effectively controlled by the other party and for his last two years with Republican numerical control as well.

So what will they say about Asa Hutchinson, who must govern with his party owning lopsided majorities in both legislative houses? We may know the answer by year's end, but all we can say now is that Hutchinson is finding it harder to govern with his party in control than Beebe did with the enemy running the lawmaking branch.

If he pulls it off, he also should get more credit than Beebe did, but right now it does not look promising.

From a solid beginning, when he announced he would continue for a year the medical services program for some 260,000 low-income Arkansans that was the essential feature of Obamacare, he has lurched left and right, clumsily at times, to co-opt, to bypass, to accommodate or to surrender to the far right of his party, which though a minority in the legislature holds the key to his keeping the ship of state upright.

The surrender, if you asked, was ordering the state Medicaid staff not to pay for gynecological medical services like cancer screenings for poor women if they are treated at a Planned Parenthood clinic, a policy that his Medicaid people surely told him would be illegal. That actually may work out for him. When a court orders the state to obey federal law and not favor some medical providers over others, he can tell the hotspurs in the legislature who demanded that he punish Planned Parenthood that at least he tried.

Tea party Republicans, who want to end health insurance for the quarter-million Arkansans at the bottom of the economic ladder, say that the so-called "private option" — the rebranding coined in 2013 for the unpopular "Obamacare" — is not essential for Hutchinson's success. But Hutchinson knows that it is, although he seems to be preparing for the chance that he cannot tinker with it enough that more Republicans can claim that it's not really Obamacare.

Ending the Medicaid part of Obamacare, whether it is the private option or traditional fee-for-service Medicaid, would cost the government and the Arkansas economy billions in federal dollars, drive up the state's costs for old Medicaid services, end tens of millions in insurance tax receipts that the governor uses to pay for prison expansion and other services, create a fiscal crisis at state medical institutions, and, presumably, lay off several thousand workers who have gotten jobs in the health sector since Obamacare kicked in three years ago.

Hutchinson's dilemma is the same as Beebe's was. He must not seem to be giving any quarter to the black president or his signature achievements, even while feasting upon them. Beebe did it for six years; Hutchinson has to walk the tightrope for only two.

You will remember Beebe's deft handling of the big Obama stimulus program enacted in 2009 and then the Affordable Care Act, a.k.a. Obamacare. Like other Arkansas Democratic officeholders, he never offered a good word about either program, at least in any way that associated them with Obama, whose name was toxic. For three years, the stimulus financed a big highway program, including the giant interchange in West Little Rock, that created jobs during the Great Recession, and it pumped $825 million into the state Medicaid program, which enabled the state and Beebe to weather the recession without cutting services and also to cut grocery taxes while still producing a budget surplus every year. Most other states floundered and their governors' popularity plummeted. National journals took note of the rare success and popularity of the Arkansas governor.

Obamacare and Arkansas's special but expensive way of implementing its Medicaid expansion accounted for a sizable part of Beebe's record. Arkansas reduced the number of its citizens who were uninsured from 22 to 9 percent, a mark no other state achieved. While nearly all the Southern states and many others repudiated help for their poorest, Washington flushed another couple billion dollars into the state treasury and the health care system in Beebe's final two years, which enabled him to complete his grocery tax phase-out. It also allowed the Republican legislature, albeit over Beebe's objections, to lower the taxes of corporations and the well-to-do.

Hutchinson began his term with unusual grace, proclaiming that the benefits of the Medicaid expansion "are facts that we cannot deny, should not deny, and should rejoice in." Let me just keep it for a year, he urged his Republican skeptics, while I will find an even better, more Republican and cheaper way to give all those people medical care.

It is proving to be a harder task, at least politically, than he imagined. First, to appease the Medicaid expansion's angriest critics, he ordered the Medicaid staff to send cut-off notices that would stop insuring tens of thousands of poor people who didn't quickly furnish the state fresh evidence of their incomes, creating a new nightmare for the already overwhelmed bureaucracy.

Then, last week, the wizards at the renowned corporate consulting firm that Republican legislators hired for a million dollars to explain the inefficiency and exorbitance of the Arkansas Medicaid expansion produced an analysis that showed just the opposite. At least well into the next decade, the Medicaid expansion will be a bonanza for the state budget, not a drag on it, they said. The additional income for the state treasury will far more than offset the expense to the state starting in 2017, when the state begins to pick up a small share of the cost of insuring those 260,000 people.

Ignoring the consultants' report, Hutchinson told the lawmakers the ideas that he is exploring to change the program enough that Republicans could call it theirs and not Obama's. A few are undoable because they violate the law, like refusing to subsidize medical care for people who are out of work. Others, like imposing adjustable premiums on the least desperately poor or pushing low-income workers onto employer health-insurance rolls, just add more bureaucratic red tape, which already is the Affordable Care Act's biggest problem.

But he's trying, he's trying.

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