Friday, February 15, 2013

TOP STORY >> Tailor Medicaid to fit Arkansas, legislators say

Leader senior staff writer

Thirty-five percent of Arkansans are poor enough to qualify for Medicaid under the Affordable Care Act and that’s just “unacceptable,” according to House Speaker Davy Carter (R-Cabot).

But that doesn’t necessarily mean that going whole hog on Medicaid expansion is the best idea, Carter told The Leader on Friday.

“We’ve got to work a lot harder to get that number to where people are able to ...have more success and prosperity and live better lives,” he said.

Carter and state Sen. Jonathan Dismang (R-Beebe), who joined Carter in the interview, agreed that as Republicans, they were not supportive of President Obama’s Affordable Care Act. But since it became law and has been upheld by the Supreme Court, they say they want to see how the law can be best tailored to suit Arkansans.

Carter said that by reading between the lines, it appears that there is flexibility in implementation.

Through Gov. Mike Beebe, that question has been posed to Kathleen Sebelius, secretary of the Health and Human Services Department.


“This is probably the most important decision that any General Assembly has made for a long time,” Carter said. “I mean for the next 10, 20, 30 years of our state’s future — if we get this wrong...well, we can’t get this wrong.”

Toward that end, the General Assembly is about to contract with an independent auditing firm to try to nail down numbers — the numbers of new Medicaid recipients and the cost over time to the state of providing Medicaid under the new rules.

Many legislators are not comfortable with numbers they are getting from the Congressional Budget Office nor from the state Department of Human Services.


Currently, about 208,000 Arkansans receive Medicaid, but under the president’s plan that number could grow by a factor of eight to 1.6 million, Carter said.

The cost of Medicaid expansion would be nothing for the first three years, but by the end of 10 years, Arkansas would be paying 10 percent, the federal government the balance. Currently, Arkansas pays 30 percent of the costs of the 208,000 recipients.

In the first full year of expansion, the new Medicaid would cost the state $1 billion a year, according to Dismang.

“We need to make sure we are looking at the long-term,” he said. “We need to have agreed-to numbers.”


If the state doesn’t participate in Medicaid expansion, families earning 100 percent to 138 percent of the poverty level would still qualify for a Medicaid subsidy that would cap their monthly premium at $14 to $26.

By way of example, a family of three earning $32,040 a year would qualify for the subsidy. Carter said that subsidy disappears if the state approves the Medicaid expansion.

Carter said that somewhere in the debate, legislators get down to the question of whether they keep spending on Medicaid, or whether they spend more money on education and better tax policy to create more jobs and opportunities.


Medicaid expansion is not the only big issue Carter and Dismang say needs review by an independent auditor. They cite the proposed $125 billion state subsidy in support of the the Big River Steel Mill at Osceola (Mississippi County).

“I’m optimistic about it,” Carter said. “We haven’t seen the economic analysis from the (Arkansas Industrial Development Commission) yet. When we get that analysis, we’ll do due diligence.

The proposal includes a $75 million construction grant from the state and a $50 million loan.

Barring discovery of a red flag, both Carter and Dismang say it seems like a good thing, and highly recommended by AIDC.

While a large number of bills have been filed this session, there hasn’t been much action. Dismang said each session develops its own rhythm.