Last-ditch presser: anti-"Arkansas Works" dead enders to present their (likely DOA) Medicaid alternative tomorrow | Arkansas Blog

Monday, April 18, 2016

Last-ditch presser: anti-"Arkansas Works" dead enders to present their (likely DOA) Medicaid alternative tomorrow

Posted By on Mon, Apr 18, 2016 at 6:07 PM

CLARK: Let's make a deal.
  • CLARK: Let's make a deal.
As Max mentioned earlier, six of the Tea Party Ten currently threatening to shut down the Medicaid program in order to kill the private option will tomorrow announce their latest "compromise" proposal. I put compromise in scare quotes because past proposals have always ended the Medicaid expansion, a non-starter for those fighting to preserve the Medicaid expansion. 

Senators Alan Clark, Bart Hester, Terry Rice, Scott Flippo, Blake Johnson, and Gary Stubblefield will present their latest proposal in a press conference tomorrow morning. Two of those six have already agreed to surrender and go along with the governor's line-item-veto plan to continue the Medicaid expansion. All indications are that those two (Hester and Johnson) as well as one more are still on board with the line-item-veto scheme regardless of this presser tomorrow. 

Clark declined to provide any details at all on the proposal but said that he thought that I might be surprised. "It will be a compromise proposal and it will show which side are actually the extremists," Clark told me. "And [it will show] whether this is about the poor and hospitals or about money and specials interests." 

My initial guess was that the aginners would once again present an idea that killed the private option but did so later rather than immediately. Some compromise. But a close ally of the Senate aginners told me that this proposal will be a new plan altogether. The chances of it being anything that the governor or Democrats would ever accept are quite slim. My source was coy on details but admitted that there would be some stuff that Medicaid expansion proponents would hate. But he said there were parts that someone like me would like. Well, we'll see. 

How will the governor respond? "I think the administration will dismiss it out of hand," Clark predicted. "[But] I think a lot of Democrats could go for it and a lot of other Republicans could go for it." Again: color me skeptical, but we'll see! Clark described it as "a very generous compromise." He would not comment on whether the proposal involved curtailment of the coverage expansion (which is the whole goal of the Tea Party Ten, and which would be DOA for Democrats). 

A rumor floating around is that the plan would involve putting some (or all?) beneficiaries on traditional Medicaid rather than on the private plans in the private option. Many analyses suggest that this would be cheaper overall (although it might not necessarily be any cheaper for the state, which gets certain advantages from the "private option" approach, such as premium taxes). Ironically, many Democrats would have preferred traditional Medicaid expansion to begin with.

Clark declined to comment on whether the proposal involved moving anyone to traditional Medicaid. He also declined to comment on whether the proposal was something genuinely new or a re-hash of previous "compromise" proposals to kill the Medicaid expansion later rather than immediately. 

As much as anything, this seems like a gambit to try to cause confusion and throw a monkey wrench in the nearly completed negotiations to move forward with the line-item plan.  (If you're actually trying to close a deal, you don't normally start off with a press conference!)  Even if the plan involves using traditional Medicaid instead of private plans, based on the folks proposing it, it's hard to believe that it will be a proposal that Democrats will ever accept under any circumstances. Another thing to keep in mind: One thing that has been very consistent with the aginners' proposals is that, either intentionally or via lack of research, they include poison pills that would mean whatever they propose is DOA with the federal government. 

As I mentioned earlier, previous "compromise" proposals plan floated by this gang ended the Medicaid expansion altogether. Instead of doing that by ending coverage immediately (which not even the Ten wants to do), they propose picking a later date to kick everyone off or using a wind-down approach. Under the wind-down approach, there would be no new enrollment and then people would gradually transition off if their incomes went up and they were no longer eligible. Eventually the program would end entirely and none of the low-income adults currently eligible would have access to this coverage. If you lost your job and fell below the poverty line? Sorry, you're out of luck. This is a plan that no proponent of Medicaid expansion would ever accept under any circumstances because it would end the program. It kills the private option slowly instead of right away.

There is also zero chance that the feds would allow it (under the ACA, you can't cap enrollment in the Medicaid expansion). It's not a compromise offer, it is a request that the governor and the overwhelming majority in the legislature unconditionally surrender and fully cave to the demands of the Ten. It is a laughable non-starter. (The "compromise" of killing the private option a bit later instead of immediately was also a laughable non-starter offered up in 2014 — see here and here for more on this baloney.)

My guess is that these six senators (including at least two of the three senators who have agreed to go along with the governor's line-item scheme to continue the Medicaid expansion — widely rumored to be Hester, Johnson, and Irvin) plan to use tomorrow's presser to lambaste the governor for refusing whatever their preposterous "compromise" turns out to be. This is politically useful both for those who are caving and going along with the governor's line-item scheme and those who aren't. For those continuing the obstructionist game, they can claim that they tried to be reasonable (heh). For someone like Bart Hester, who plans to surrender, this will allow him to argue that he did everything to stop the Medicaid expansion (including offering compromises!) but was thwarted by the governor. Hester and co., in other words, may try to pin all the blame on the governor for continuing the Medicaid expansion.

I have seen no indication that the presser will change the underlying dynamic: the Ten is asking for something that the governor will never give and three of them have agreed to surrender via the line-item scheme. 

It's worth noting the context here: Democrats appear to be lining up behind the plan and the mood at the Capitol is bullish. It looks like backers of "Arkansas Works" — the governor's plan to continue the private option — are going to win this fight, funding the Medicaid budget and continuing the PO Medicaid expansion. 

The last few times we had this budget fight, the aginner dead-enders would always try all manner of last-minute gambits and goofy press conferences in the final days. They get in front of the press claiming a reasonable compromise and then offer a poison pill or something that actually demands that the other side cave. It's silly. 

I have no details on the proposal itself beyond assurances that it's not the same old "wind-down" plan and floating rumors that it routes folks from private plans to traditional Medicaid. But here's my guess: The line-item plan is moving ahead, "Arkansas Works" will be implemented to continue the Medicaid expansion, and the aginners are gasping and grasping at straws. In other words, it's all over but the cryin'. 

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