Behind the scenes peek: What state officials were thinking before Gov. Hutchinson's meeting with the feds on health care reform | Arkansas Blog

Thursday, January 29, 2015

Behind the scenes peek: What state officials were thinking before Gov. Hutchinson's meeting with the feds on health care reform

Posted By on Thu, Jan 29, 2015 at 4:33 PM

click to enlarge SELIG: Before the session, worried that "we do not have the votes to continue the Private Option as is" and hoped for flexibility from the feds.
  • SELIG: Before the session, worried that "we do not have the votes to continue the Private Option as is" and hoped for flexibility from the feds.
Earlier this month, Gov. Asa Hutchinson, along with a group of lawmakers and state officials, met with the federal Secretary of Health and Human Services, Sylvia Burwell, in Washington D.C. to discuss the future of the private option and health care in Arkansas. Just before they left, Arkansas Department of Human Services Director John Selig provided a one-page information sheet to the governor on possible areas of discussion with the feds.

, acquired by the Times via Freedom of Information Act, gives a window into the thinking of DHS officials heading into the meeting with Burwell, which took place the week before the governor's big private option speech at UAMS. Hutchinson's spokesperson, J.R. Davis, said that while the governor received the DHS notes, it was just one document among lots of information that he was inundated with in preparing for the meeting. Davis said that the governor didn't use the DHS notes for his meeting with Burwell, instead developing his own notes for areas of focus for a conversation with the secretary. 
Even if Hutchinson made no use of the notes, most of the highlights broadly correspond with the governor's public statements about the future of health care reform in Arkansas, as well as Sen. Jim Hendren's bill to advance the governor's proposal.

Selig suggested that state officials ask about the Secretary about these possible changes to the program: 

Promoting employment

Increasing cost sharing

Promoting Personal Responsibility and/or Healthy Behaviors

Limiting who is eligible or how long they are eligible and/or capping the number of eligibles

Limiting covered services (such as transportation)

Promoting employer-based coverage

Moving healthy people off of traditional Medicaid

For the most part, these are questions that will likely be looked into as potential avenues for long-term reforms by the task force. One short-term question from the list above that did come up at the meeting was whether there would be any potential option to cap enrollment. The secretary said no. 

Interestingly, Selig's one-pager suggested telling the feds that the private option was in political trouble and that they would need flexibility to enact conservative changes to the existing program in order to "keep some form of expansion in place." From his one-pager: 

Our situation: We do not have the votes to continue the Private Option as is. However, we may keep some form of expansion in place if there are substantive conservative changes and/or if it is paired with greater ability to control and reform the traditional Medicaid program. We need HHS’s maximum flexibility and creativity in crafting a package of changes to the Private Option and offering more state control over the Medicaid program.

As it happens, of course, Selig may have misread the political dynamic. Hutchinson ended up proposing that the private option be funded "as is" for two more years, with a legislative task force suggesting major changes to the state's health care system as a whole for 2017 and beyond, including an alternative coverage approach to the private option. Indeed, this was one surprise from Hutchinson's plan: rather than looking for immediate tweaks to the policy to bring in GOP votes, Hutchinson is leaving the policy more or less alone for now. The state is not pursuing any additional waivers with the federal government until the task force makes its recommendations. And legislators are on board — Selig's concern that  "[w]e do not have the votes to continue the Private Option as is" wasn't quite right. Hutchinson's promise of future reforms looks like it will be enough to gain the needed supermajorities for approval (the private option appropriation sailed through the senate this morning). 

"From where I sat, he was not focused on immediate action," Selig told me in a phone interview today. "From the start, my sense is he's wanting to take a thoughtful approach to this and have some time to really look at what the options are. His focus was on longer-term, broader, substantial reforms. And what options might be for coverage in the future."

On that note, Selig's one-pager also suggested a discussion of future reforms, and these are areas that will probably come up as the task force looks to 2017 and beyond: 

Medicaid Reforms: We have been encouraged to consider the following approaches to augment our current efforts. What, if any, benefits do these approaches offer, and are there others we should consider?

Block Grant/ Global Waiver

Managed Care

1332 Waiver

 was developed with input from former Surgeon General Joe Thompson and Medicaid Director Dawn Zekis. Selig described it as thoughts he had organized for Hutchinson to potentially use if he wanted, which the governor could "take or leave." The day before the meeting with the feds, Selig delivered the one-pager along with a packet of other documents to the governor: an analysis of what other states have been allowed (and not allowed) to do with their Medicaid expansion programs; a summary of Arkansas’ ongoing payment reform effort, the Payment Improvement Initiative; and a draft report from the Arkansas Health Insurance Marketplace board on how a 1332 waiver could be used (the Times published a copy of this report earlier this week).

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