Governor talks of realities of the Obamacare Medicaid expansion: Update | Arkansas Blog

Thursday, April 30, 2015

Governor talks of realities of the Obamacare Medicaid expansion: Update

Posted By and on Thu, Apr 30, 2015 at 9:33 AM

click to enlarge Hendren to council: Consider expense and who has to be covered under federal law.
  • Hendren to council: Consider expense and who has to be covered under federal law.
Gov. Asa Hutchinson is speaking this morning to his task force created to come up with some political cover for keeping the benefits of the Obamacare Medicaid expansion or otherwise pull a health care rabbit out of a hat that can cover a quarter-million Arkansans at no cost to the state.

I snark.

Leslie Peacock is on hand and will have more, but it's not snark to say that Hutchinson HAS laid out the difficult task ahead for a task force that includes many historic foes of Obamacare, for the simple reason that it was an expansion of government spending, no matter how beneficial.

She sends a brief note on Hutchinson's remarks:

Says group must consider both to keep federal money and figure out how to come up with arkansas's $200 million and to forego the $1 billion ... The latter might be a "political reality" and role of Missy Irvin and Jim Hendren is to remind group of that. Says hospital benefited by "stability and certainty, " and important to maintain certainty even if not ideal.

Arkansas currently has no financial obligations under the Obamacare expansion known here as the "private option." It will have to pay a small percentage in years to come and Hutchinson said the "political reality" might dictate the state's "swallowing hard" and foregoing this. But it will retain responsibility for a portion of Medicaid even if the private option is killed and the loss of $1 billion in federal money from an end to the program would have consequences — for his budget, for hospitals, for health care system employees. Oh, and, yes, for sick people.

Peacock adds that Hutchinson said he hopes the group will spend two to three months figuring out the status of health care today and what the state wants based on "political reality." (This is the dirty point Asa won't address directly. The political reality in Arkansas is that Republicans swept into virtually every office on promises to kill Obamacare.)

He State Sen. Jim Hendren (R-Sulphur Springs), who presented a power point to the group, listed things the group must consider — expense, the people covered now, who's required to be covered by federal law, what other states are doing and trends in medical spending.

Well, yes, It might also consider the empirical reality that people die when they have no insurance and can't afford health care.

Hutchinson Hendren said he'd been skeptical, but research confirmed "wellness programs" work. Regular doctor visits, early detection of problems, the healthier lifestyles encouraged by contact with the health care system and financial incentives (such as government-paid insurance) produce better health? Who'd have thunk it?

Hutchinson also said that continuing coverage for the more than 200,000 who've been added to insurance rolls is "essential."

UPDATE: There are 39 members of the Governor's Advisory Council on Medicaid Reform and the membership includes such diverse representatives as the Americans for Prosperity (David Ray), Arkansas Advocates for Children and Family (Rich Huddleston), the National Federation of Independent Businesses (Sylvester Smith, who in introducing himself reminded the group that the federation had sued to stop Obamacare, the source of the Medicaid reform), and the Arkansas Waiver Association (Keith Vire, who asked that the group not think of "reform" simply as "cutting costs," since cutting costs hurts people — may even result in their death. 

Department of Human Services Director said the governor had asked him to explore how Medicaid might be run through "managed care," though he did not define what he meant by managed care, except to say the department my decide that it is best for the state, and not an outside entity, to manage any portion of the Medicaid dollars (to behavioral patients, the elderly poor and the sick). He said DHS website would post on Monday a draft on the proposal and would invite public comment. The department will also post information on proposed changes to the Payment Improvement Initiative having to do with community-based services.

Selig's comments provoked comment by David Wroten of the Arkansas Medical Society that "our portion of Medicaid program has been doing managed care for 20 years," and he hoped DHS would be more specific — was he talking about capitated care? The Arkansas Hospital Association's Ray Montgomery said managed care was "problematic for hospitals." Business representative Smith asked that the council guarantee that all have a chance to speak so that no one entity dominated the discussion. And Rep. Stephanie Flowers (D-Pine Bluff) suggested that the council prioritize the goals as defined by Hendren and discuss whether there might be other goals as well.

All of this is to wonder: 39 people who don't agree on what form Medicaid should be administered in Arkansas are to come up with a consensus that informs the legislature's Medicaid Task Force? Best of luck to them. The governor's website will post documents coming out of the council; that should be an interesting read.

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