Friday, January 23, 2015

EDITORIAL >> Asa’s healthy state of mind

It could have been no surprise to anyone, except the new lieutenant governor, that Gov. Asa Hutchinson wants to continue to insure more than 200,000 Arkansans under the Patient Protection and Affordable Care Act, the infamous Obamacare. What may have been surprising to many is that the conservative Republican did so not grudgingly but warmly.

Hutchinson announced Thursday that he would ask the legislature to appropriate money for the expansion of Medicaid at least through the end of 2016, when the state will assume 5 percent of the costs from the federal government. He hopes by then to have a plan to make broad changes in Medicaid—all its services, not just the so-called “private option” plan for insuring poor adults—that will expand access and also improve care and lower costs.

In announcing his long-expected support for the private option, Hutchinson said the overarching concern should be the human aspect—people who need medical care and the means to pay for it—not the political, ideological or even budgetary issues. He told stories about people who had been helped, their lives changed, by getting Medicaid coverage under the Affordable Care Act. He acknowledged that like all Republicans, he had opposed Obamacare but noted that he had lost that fight.

Hutchinson’s position had been widely presumed since he had refused during the long campaign to adopt the standard Republican campaign position of opposing Obamacare and the private option or to adopt any other position on it. But Hutchinson’s long career in government at the national level told you that he was not much of an ideologue and that, like his predecessor, Mike Beebe, he leaned to the practical rather than to the ideological.

Lt. Gov. Tim Griffin apparently got different vibes. Moments after the governor’s speech at the University of Arkansas Medical Center, which is heavily dependent upon continuation of the expansion of insurance under Obamacare, Griffin issued a statement praising Hutchinson for shutting down the private option and halting insurance for low-income people.

Obamacare, if we may use its Republican label, is supposed to insure, ultimately, more than 25 million Americans who are not insured, most of them because it is too expensive. About half of them are to enroll in a private insurance plan chosen from a market set up by the federal government or by the states. If their incomes are between 138 and 400 percent of the federal poverty line, the federal government will subsidize their premiums, on a sliding scale.

The private option—the label adopted by the plan’s Republican authors—is the part of the Affordable Care Act that covers people whose incomes are so low that they cannot afford any part of a health-insurance policy, those whose incomes are below 138 percent of the poverty line. In Arkansas, the legislature in 2013 chose to let most of those people select a plan from the market and have the government pay the premiums. Those who are grievously ill are covered by regular Medicaid, where the government pays the costs directly but at lower hospital and doctor reimbursement rates.

More than 200,000 low-income adults have signed up for Medicaid coverage in Arkansas. By the end of March, more than 300,000 Arkansans will be covered by insurance for the first time—the most dramatic improvement in the uninsured rate in the country. Hutchinson, with no seeming reluctance, told about the dramatic improvements for hospitals, where unreimbursed charity care is rapidly disappearing, and about people whose desperate situations had been reversed by getting insurance and the treatment that had previously been denied because they couldn’t pay for it. He might have mentioned the sharp reduction in the number of Arkansans going on the federal disability rolls since the central features of Obamacare went into effect in October 2013.

Now, the big question is how persuasive the new governor will be with his party, which now controls both legislative houses by big margins. Many of the legislators ran on the promise of killing the private option. A perverse sentence in a 1934 constitutional amendment has been interpreted as allowing a small minority of legislators—referred to generically as the tea party—to block funding of any program they don’t like. Can Hutchinson persuade enough of them to preserve funding for the program that he considers vital to the state’s health and to the state budget? Our guess is that he can.

If he can’t, more than 200,000 people will lose their insurance and ability to get health care on July 1, community hospitals and the state medical center will find themselves suddenly in dire straits and the governor and the legislature will have to find lots of money somewhere to cover a giant hole in the state budget when the federal government returns a large Medicaid program to the state.

Aside from the reflexive hatred of anything associated with the unpopular president, the opponents’ chief argument is that the state will be required to shoulder 10 percent of the costs of the Medicaid expansion after 2020 and that the state will be unable to afford it and will cut off all those people who will have come to depend on it. Better to cut them off now, apparently, before they become accustomed to getting medical care when they need it.

Here is the mystery: If the threat of paying 10 percent of that program is so frightening, what about the rest of the Medicaid program? No Republican flinched in 1997 and afterward when Gov. Mike Huckabee launched a far bigger Medicaid program—covering most of the state’s children. He claimed it as his biggest achievement as governor. More than 400,000 children are covered now, at much greater expense than the Obamacare program, and the state pays not 5 percent or 10 percent but nearly 30 percent of all those costs. Why is paying 5 or 10 percent scarier than paying 30 percent of an even bigger program?

As we’ve said before, it makes no sense. Apparently, it makes no sense to our pragmatic new governor either.