Friday, July 26, 2013

EDITORIAL >> How counties, state will save

Whatever people think of the Affordable Care Act’s controversial mandate that nearly everyone carry health insurance, it is turning out to be a bonanza for local and state governments in Arkansas.

When the insurance mandate takes effect Jan. 1, the Affordable Care Act (a.k.a. Obamacare) will relieve the state government of scores of millions of dollars of state obligations each year for Medicaid payments because it will move many current Medicaid patients fully to the federal ledger and also pay all the costs of some 250,000 new Medicaid eligibles for three years.

It seemed like such a good deal to penny-pinching Republican lawmakers that they jumped at it, although they had all denounced Obamacare and sworn that they would do their best to block it. By implementing Obamacare and its state budget savings, they were able to cut state taxes on people with large incomes and give manufacturers a state tax break.

We would have preferred that they cut the taxes of working people instead, but you can’t have everything.

Then this summer state prison officials and county administrators figured out that the same piece of Obamacare offered even greater economies than they had imagined. The state penitentiary and county jails now spend tens of millions of dollars a year on medical care for prisoners, and starting Jan. 1 many, perhaps most, of the costs—those incurred at hospitals—will shift to Washington.

People whose annual incomes are below 138 percent of the federal poverty line will qualify for Medicaid, and nearly all the 16,000 inmates of the penitentiary and the Community Correction Department meet the test. The state will still have to pay the medical expenses of treating inmates at prison infirmaries, but if they are treated at a hospital the federal government will bear the full cost. Prison officials said it would spare the state budget millions of dollars a year—$3 million to $4 million in the Community Correction Department alone.

It will be an even bigger blessing for the counties, where a single catastrophic illness by a prisoner can break the county budget. The Pulaski County Detention Center—the county jail—spends $4 million a year on inmate medical care and that sum will be significantly reduced. Many county lockups house state prisoners because the state penitentiary is nearly always filled to capacity. Their hospital costs will be shifted to Washington.

Sheriffs worry rightfully about the extra administrative nightmare of qualifying their prisoners for Medicaid and enrolling them so that the medical costs will be paid expeditiously. What if a surly prisoner refuses to enroll in Medicaid? A conservative Republican legislator thought of that. He introduced a bill allowing sheriffs and prison officials to enroll them against their will so that the county and state will be relieved of the expense of their care. The bill became law.

Whether a person is a prisoner or a free man or woman, determining qualification for Medicaid or for federal help in buying insurance and then actually enrolling the person in one of the private insurance plans that will be available in Arkansas is going to be a very simple proposition. That is what the state Insurance Department and state health officials promise. The insurance exchanges will be open for business Oct. 1.

Sheriffs and the state penitentiary should have a stack of forms and enroll every new inmate in medical aid as a part of his processing. It is good economy for the jail and the county’s taxpayers, but also a long-term service to the inmate, even if he has done little as yet to deserve it.