The line-item veto plan continues the Medicaid expansion and gives the Tea Party Ten nothing | Arkansas Blog

Saturday, April 16, 2016

The line-item veto plan continues the Medicaid expansion and gives the Tea Party Ten nothing

Posted By on Sat, Apr 16, 2016 at 8:32 PM

It's easy to get lost in the weeds of the procedural wrangling in the Medicaid budget. Ultimately, the reason we're having this debate in the first place is the policy outcomes, the human stakes: The private option Medicaid expansion provides health insurance to more than a quarter million Arkansans. People like Anita Bacon of Madison County and George Coleman of North Little Rock and Crystal Bles of Morrilton and so many more of our neighbors, of our families, of our fellow citizens. 

If you want to read the details on the governor's procedural maneuver to continue Medicaid expansion, see here. But let's look at the big picture. Let's look at the actual terms of the deal: A total surrender for the Tea Party Ten and a total victory for backers of "Arkansas Works" (the governor's plan to continue the private option), who would give up no policy concessions whatsoever. 

Here's the situation: The governor and the overwhelming majority of the legislature — all Democrats and a majority of Republicans — support continuing the private option via "Arkansas Works," signed into law last week. The private option has cut the state's uninsured rate by more than half, brings in billions of federal dollars into the state's economy, saves hospitals hundreds of millions in uncompensated care costs, and saves hundreds of millions more for the state budget. However, a rump group of ten Republican senators are so committed to taking health coverage away from those 267,000 people that they have threatened to shut down the entire Medicaid program unless the majority caves to their demands. 

The governor's proposed line-item-veto maneuver would allow the Tea Party Ten to make a meaningless show vote that would pretend to end the private option (the governor would veto this empty gesture within twenty-four hours). In exchange, a handful of the Ten have agreed to an ignominious surrender. In terms of policy, instead of getting the outcome they wanted, they would get the opposite. There would be no negotiation. They would get no concessions. They would get no deal. They would get nothing. They would get a cover vote that their funders have already indicated is no cover at all. As Donald Trump might say: "Sad!" 

What about the deal from the other side? The backers of "Arkansas Works" would get the outcome they wanted: the Medicaid budget impasse would be resolved and the private option Medicaid expansion would continue. Hundreds of thousands of people — our neighbors, our families, our fellow citizens — can breathe easy that they will not have their health insurance snatched away. The budget process can continue without nasty across-the-board cuts. In exchange, the backers of "Arkansas Works" have to play a role in a procedural ruse that almost no one outside of the Capitol is paying attention to. 

By analogy, imagine a deal between Johnny and Joe, who are disputing the ownership of a house. Johnny gets to write his name on a deed in colored pencil, but the deed is then immediately transferred to Joe, who erases Johnny's name. Joe gets the house. Johnny gets nothing. Most people would say that Johnny did not get much in that deal. Similarly, the line-item-veto deal suggested by Hutchinson does not give much to Sen. Bart Hester

Some Democrats are understandably irritated by the Tea Party Ten and their shutdown tactics. They argue that the Tea Party Ten should not get anything for misbehaving. There may be other reasons for Democrats to be wary of the line-item-veto approach, but the belief that the Ten should not be rewarded for their threats is actually an argument for the strategy. Again, the Ten are being offered no policy concession whatsoever and being given only the "cover" of a humiliating charade that enacts the outcome they oppose.

(Would Hester or others playing along with the line-item scheme be more likely to get help from Hutchinson in the future? Probably so, but that would be just as true if they flipped votes the old-fashioned way.)

It's useful to think through the alternatives. Of course, private option backers would like the Tea Party Ten to do "the right thing." But the Ten think that the right thing to do is end the Medicaid expansion. Sadly, the chance of them simply changing their minds on the merits is quite slim. I would not bet the well being of a quarter million people on two of the these ten seeing the light. Bryan King is not going to offer a weeping apology for the trouble he has caused. 

Under the circumstances, most people accept that in order for a politician to submit to a total, very public surrender, that politician probably needs at least some sort of nominal cover or fig leaf. Happily, in this situation, the "something" that Hutchinson is offering is, substantively, nothing. That's actually a quite important point. In a situation in which a political group is trying to use shutdown threats to issue policy demands, the last thing you want to do is give them any sort of policy concession. That will only encourage further demands. I've been startled to hear from a few private option proponents who don't like this deal that they expected that Hutchinson would "buy off" the last two votes. But that would be a bad thing! First of all, whatever means the governor used to buy off two of these ten would no doubt be an ugly business. Moreover, that would only encourage further shenanigans. 

Similarly, it is absolutely crucial that Hutchinson not give any sort of unrelated policy concession to the Ten. Leaving aside the terrible stuff that the Ten would no doubt ask for, that would guarantee shutdown shakedowns in the future. That's the advantage of the line-item-veto deal: instead of giving them something that they want in order to switch their votes (which would encourage copycats) it gives them something pathetic and sad. I feel confident that Hester's desired endgame was not slinking out of the controversy with a vote that everyone understands is phony. I've heard arguments that this deal would "empower" future shutdown efforts, but such a complete surrender would empower or encourage no one. Whatever the governor offered as cover (or secret deal, etc.) if he had swung two votes the old-fashioned way would almost certainly be worse.

None of that is to say that the Ten or lawmakers like them wouldn't try this again in the future. But again — think of the alternative. Would getting the vote the old-fashioned way make that any less likely? I would submit we already know the answer: In 2014, Mike Beebe got the 27 the old-fashioned way with some arm-twisting and a special deal for Sen. Jane English. Yet here we are again.  

So here's what happened last week: Hester, Sen. Blake Johnson, and likely a few more from the Ten are waving the white flag in exchange for a show vote. The hardcore aginners in the Ten are furious, because they recognize that Hester and Johnson folding means that all of their shouting accomplished nothing and they have been resoundingly and totally defeated, once again. Likewise, advocacy groups like Americans for Prosperity that have worked so hard to end the Medicaid expansion are apoplectic. Their leader is giving up and getting zero in return. 

So why are Hester and Johnson (and whoever joins them) taking a deal so rotten from their perspective? The likely reason is that they are painted into a corner and they have no politically viable options or endgame whatsoever. As far as optics go, the line-item-veto deal forces them into a maximally obstructionist position. They can only continue the shutdown by voting against their own appropriation and denying the governor the opportunity to exercise his own constitutional prerogative to veto. Their only hope for winning this fight, from the get go, was for the governor to simply cave to their demands. At this point, that is clearly not going to happen. So what's left for somone like Hester, widely believed to have an interest in higher office? Flip flop his vote after all this? Literally shut down the entire Medicaid program, kick Grandma out of the nursing home, and end his political career? The line-item-veto deal is surely a nasty pill for him to swallow, but it's essentially his only path.

Hester probably botched the politics of this from the beginning (that "crash" quote in the paper was a disaster). Now he's taking the least-bad political route out of the fiasco he's created. That doesn't change the fact that he's getting nothing, that he's waving the white flag, that he's lost this fight. 

I will save the political, legal, ethical, and other angles for another post. My intention here is to highlight the substantive policy outcomes, in part because I keep hearing Medicaid expansion proponents express the worry that this deal gives something up to the Ten, and I keep wondering what that is. 

Enacting and maintaining the Medicaid expansion, given the makeup of the Arkansas legislature, politics in the state, and the supermajority requirement, is an incredible — even miraculous — achievement by the Democrats and others. They have reason to be proud. And they should fight like hell to make sure that the Medicaid expansion continues and that a quarter million Arkansans don't lose health insurance. This is the outcome that surely stands as the primary objective for the Democratic Party in the fiscal session.

I do not know whether the line-item-veto trick is the best means to achieve that outcome and I do not begrudge the Democrats' principled hesitation or strategic questions with regard to the deal. But I can speak to the terms of the deal. It achieves that outcome while giving up nothing of substance. It would be a total policy victory for backers of "Arkansas Works" and happy news indeed for Arkansans who depend on the private option. 


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