One euphoric day in 1999, Gov. Huckabee and his health director, Dr. Fay Boozman, announced a goal of his administration: providing health insurance in some way for every person in Arkansas. Huckabee will leave office in three weeks without having met that goal. But who will fault him for failing in such a noble endeavor when the national government has failed so miserably? Huckabee has taken a few steps.
It is impossible to say whether it is a big step or a very, very small one, but starting Jan. 1 the last Huckabee health initiative will kick in. It enables small Arkansas businesses — those up to 500 employees — to provide very basic medical coverage to their low-wage employees at only 27 percent of the cost. The federal government would pay the rest. The state would pitch in some of the administrative costs from the payments it receives from tobacco companies each year as settlement of state claims for the harm from cigarettes.
Dr. Joe Thompson, who headed a health insurance task force, came up with the idea of the joint employer-state-federal program to cover low-wage employees. Several other states are using their Medicaid programs in the same way, matching federal dollars with employer premiums, but Arkansas added its own wrinkle. To participate in the government-subsidized coverage for low-wage workers, a business will have to insure all its other workers, too, in some kind of private plan. There would be no government subsidy for those workers.
The program is patterned on the successful Medicaid program for children. States can match federal dollars and insure children in families with family incomes up to 200 percent of the federal poverty line, which would amount to about $40,000 a year for a family of four. Arkansas was one of the first participants in that program, starting in 1997. Starting the first of the year, whole families with incomes up to twice the poverty line can get insured if their employers agree to participate.
But how many will participate? Businesses have been dropping or scaling back employee health insurance, not expanding it. About 380,000 Arkansans 19-64 years old have no health coverage now. At the outset, for roughly the next 18 months, the state is going to limit coverage to about 15,000 people, but by the last half of 2008 it will expand it so that 80,000 people will be covered by either the Medicaid program or private plans for higher-paid workers.
We suspect that even the state’s initial limits will prove ambitious. Businesses that enter will have to insure all their employees, not just those who qualify for Medicaid assistance, and that new expense will be too daunting. Let’s hope that we are wrong and that the incentive of government subsidies will encourage employers to do what all of them want to do, which is to provide increased protection and security for their workers and families until the day that the national government undertakes the next and logical final step, which is to expand Medicare, the health protection for the elderly, to cover everyone.