'Working' for private option's survival | Arkansas Blog

Friday, January 16, 2015

'Working' for private option's survival

Posted By on Fri, Jan 16, 2015 at 10:10 AM

click to enlarge 'MIGHT BE OPEN': Sen. Cecile Bledsoe, her son now Gov. Hutchinson's surgeon general, has a changed tune on private option.
  • 'MIGHT BE OPEN': Sen. Cecile Bledsoe, her son now Gov. Hutchinson's surgeon general, has a changed tune on private option.
Gov. Asa Hutchinson is in Washington today with an entourage that includes a legislator (Sen. Jim Hendren) who opposed the private option expansion of Medicaid under Obamacare. Also on board the flight was new Surgeon General Greg Bledsoe, son of another private option foe, Sen. Cecile Bledsoe.

Hutchinson will give a speech next week on his view of the private option, a position he avoided taking throughout his successful political campaign.

The trip to see Obama officials today is to talk about further departures from federal rules on how the Arkansas program operates — "waivers" is the term of art. In a pre-departure interview with the Democrat-Gazette, the subject of work was much on Hutchinson's mind, as it has been before. He made a point of saying 40 percent of the recipients of the private option expansion of Medicaid don't work.

The formulation sounds a lot like it comes from someone with a core disdain for the program as welfare for the undeserving. Maybe not. But even if so, the figure is at least somewhat deceptive.

The figure is based on national population estimates of employment in the income category covered by the expansion, 138 percent of the federal poverty level.

But the figure covers many different situations — though not children and the fully disabled and elderly, who have coverage under other programs. The private option covers those 19-64.

Amy Webb at DHS said the agency tried in November to determine the number of private option recipients with no income, in terms of what is counted for eligibility.

It was a point-in-time data pull, meaning at that moment they had no income. It doesn’t indicate whether they had income prior to enrolling or if they have since notified us that they now have income. At that time, there were 80,000 people (of the 220,000) whose households had no income that was counted for eligibility (Child support is not counted, for example). This seems to track or be in line with the unemployment rate in Arkansas. However, we would like to get a better picture or profile of the individuals on the Private Option. So we are now looking deeper at the data and trying to do some additional analysis to get a better picture of the work history of enrollees and the household that they live in. Hopefully, we'll also be able to learn how many of these individuals are, for example, students. How many had jobs and then lost those jobs. It will take us some time to get to that level of detail, but we are working on it.

So, one point to make is that "not working" doesn't mean "not trying to work" or recently laid off and so forth. Or students. Or people with medical problems short of disability that makes work difficult. Or mothers with young children who couldn't make enough at low-paying jobs to justify putting children in care while they worked. By one estimate a quarter to a third of private option recipients are parents with dependent children. Remember, too, that the unemployment rate covers those actively seeking work, not those who've given up job-finding efforts.

For now, the feds have shown no inclination to weaken the rule that prevents states from making work a requirement to receive government assistance. But they have approved states' ideas to make work training and similar job development efforts a requirement. At a minimum, that seems likely to be part of what I still believe is Asa Hutchinson's imperative — for simple dollar reasons — to fight to continue the private option.

Required job training. Drug testing. Bigger co-pays. Incentives for healthier living. Any number of things might contribute to incentives for some recalcitrant Republicans to join Hutchinson in a "new way" survival of the private option. But a significant number of Republicans remain opposed for the reason that has driven opposition from the first — it is an expansion of the federal budget. That it pays for itself in a variety of ways — not the least, we hope, a healthier population — isn't sufficient to overcome that firm Tea Party belief. But it's true that Hutchinson has a better chance at swinging the hardened than a Democratic governor. Witness Bledsoe's comment this morning. "I might be open to some things," she said. She included a gradual phaseout of the program, but that's farther than she's gone before.

Openness was not part of Bledsoe's pitch when she barnstormed the state in October in behalf of Republican legislative candidates committed to voting a resounding NO on Obamacare. Those candidates, particularly in Northeast Arkansas, were a big part of the Republican's giant gain in majority.

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