Feds encouraging about possible private option tweaks, but Hutchinson not seeking immediate changes | Arkansas Blog

Thursday, January 22, 2015

Feds encouraging about possible private option tweaks, but Hutchinson not seeking immediate changes

Posted By on Thu, Jan 22, 2015 at 1:45 PM

click to enlarge HUTCHINSON: The times they are a changin'...in 2017. - BRIAN CHILSON
  • BRIAN CHILSON
  • HUTCHINSON: The times they are a changin'...in 2017.

One surprise in Gov. Asa Hutchinson's speech today on the private option: While he's setting up a task force to look at major changes to the design of the health care coverage expansion in 2017, he's not going to to be seeking immediate tweaks or additional "conservative reform" wrinkles.  

Last week, Gov. Asa Hutchinson met with federal officials in Washington D.C. to discuss options for flexibility in the state's private option Medicaid expansion program. Most assumed that would be part of his pitch for continuing some version of the policy. The private option is made possible by a waiver of Medicaid rules. The state could ask additional waivers — perhaps something related to wellness programs, job training programs,etc. The feds have drawn a line in the sand and said no to work requirements. States can try to incentivize or encourage work, but they can't make it a requirement for folks to keep their health care coverage. They can't kick someone off Medicaid because they don't have a job. But that still leaves some wiggle room, which Utah is exploring now.  

The  that Hutchinson received from Secretary Sylvia Burwell, of the federal Health and Human Services, is vague, but reading between the lines, it seemed to be relatively encouraging in terms of negotiating toward adding a few GOP hobby horses (while still apparently maintaining the line in the sand on work requirements). 

Most assumed that Hutchinson would demand something this year to try to offer a policy enticement — or political cover— to GOPs on the fence. Instead, Hutchinson was explicit that his focus was on broad, aggressive reform starting in 2017 — with his task force leading the charge. In the mean time, he is asking the legislature to continue the private option "as is."  When I asked explicitly about seeking waivers in the mean time, he responded:

That's not the design. The purpose of the overall Medicaid reform is focused on this task force. Waivers and flexibility, there may be some items that come up, but the focus is [the task force] and the recommendations that they make. 

The current private option will remain through December 31, 2016. Period. The task force will determine the future. those recommendations should come before the end of this year to allow time next year for any waiver requests, authorizations or any other actions. And it will require additional legislative action. 

The gist here is that Hutchinson is going to try to sell state GOPs on the prospect of big changes to the health care system in Arkansas (not just the private option) come 2017. Another set of waivers made available by Obamacare will give the state more options, not just for Medicaid but for the Arkansas Health Insurance Marketplace as a whole. The coverage expansion would remain in place, but it would presumably have more red-state vibes at the margins. 

Politically, it's an interesting gamble. Can Hutchinson bring over Republicans on the fence or opposed to the private option if he's offering no immediate concrete changes, but instead a more dramatic re-thinking health care policy down the road? 

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