Friday, September 25, 2015

EDITORIAL >> The future of Asacare

Confusion and indecision rarely serve the public interest, but they can be useful for a government official in the throes of a terrible political dilemma. So it is for Gov. Hutchinson, who must somehow persuade quarrelsome members of his own party to accept a program they viscerally hate. You know what that is—Obamacare and particularly the giant part of it that has insured medical care for 250,000 Arkansans for much of the past two years.

On the day he took office nearly 10 months ago, Hutchinson outlined a strategy that immediately worked. If you will vote to continue coverage of poor adults, which is paid fully by the federal government, for just this year, Hutchinson told lawmakers, I will find a “replacement” for the program by year’s end. And that is what he has been trying to do, with the help of millions of dollars paid to corporate consultants and a task force of advisers.

The program has been in convulsions ever since, even as the governor and the teams of consultants, advisers and legislators stumble toward producing the “replacement” for the so-called “private option,” the name that moderate Republicans gave to the alternative plan for covering previously uninsured poor adults and, in some cases, their children.

Obamacare—the Patient Protection and Affordable Care Act of 2010—called for all those people under 138 percent of the federal poverty line to get their medical attention through Medicaid, the government program that has insured some 700,000 of the elderly, disabled, poor youngsters and certain other vulnerable categories generally since 1965. The young Republican upstarts in the legislature in 2013 said, “Why don’t we have nearly all those poor adults buy health insurance in the private market created by Obamacare (the premiums paid, of course, by the federal government)?”

They convinced most of their colleagues in the legislature and Gov. Mike Beebe to do just that and it has been a roaring success, as the new governor, Asa Hutchinson, acknowledged. It has insured 250,000 Arkansans, saved community hospitals all over the state, filled the state treasury with cash that allowed the state to cut taxes and created thousands of jobs. And, of course, it was a bonanza for insurance companies.

But the new governor faced a new dilemma. The election that brought him into office also brought more firebrand Republicans dedicated to killing Obamacare root and branch. They had all promised to kill the private option, which many voters had figured out was still Obamacare even if it had a Republican twist.

To demonstrate his bona fides as an Obama foe to the arch-  conservatives, Hutchinson in early summer ordered the state Medicaid office to cut off insurance for people if they had not provided proof of their income status to the Medicaid office within 10 days of the state’s sending a letter requiring them to prove their continued eligibility for Medicaid.

Tens of thousands lost their insurance, even though most of them were clearly eligible and many returned the information on time. That was because the state Medicaid program found itself in utter disarray. The state office had wasted tens of millions of dollars on private contractors that were hired to develop a new computerized system for enrolling people in the various Medicaid programs, old and new, and none of it worked. Adding to that chaos were the tens of thousands of demands for income data from recipients. The department was overwhelmed.

Doctors and hospitals across the state find themselves waiting for many months to get reimbursed by the state, which once paid with amazing promptness. Unwilling to show weakness to the hard right in his party, Hutchinson held firm to kicking poor people off their insurance even if the state and its contractors were responsible.

Charitably, his sternness with the poor may help him in the end to bring the recalcitrants along to continue the program once he perfects it.

Amid all that confusion—can anyone casually following all the developments have the faintest idea what is going on?—the governor and the business consultants have outlined a few changes in the private option that the legislature can adopt this winter to make it more “conservative” and economical so that they can claim that the big insurance program is no longer Obamacare or even the private option. Or at least convincing enough that the necessary three-fourths of the legislature will approve the Medicaid spending bill for 2016-17.

All the changes they have suggested so far are mere tinkering. They tend to make it harder for the very poor, particularly those who do not have full-time jobs, to get medical care or else force them to jump through hoops like getting into job-retraining programs or performing community service. A few proposals would hew more closely to the original Obamacare that is implemented in most other states, by requiring more of the 250,000 to be insured in the old Medicaid program, where the government, not private insurers, insure them and where the payments to medical providers are much lower.

Now, only those in very poor health who require almost perpetual care are on straight Medicaid. Another proposal will require several thousand workers who are below 138 percent of poverty to enroll, still with government aid, in the small-business group plans set up by Obamacare.

When Hutchinson finally outlines all the modifications, they will no doubt lower the overall cost of the Medicaid expansion by a few million dollars a year, although not enough to bring the costs down to where they would have been if the state had merely followed Obamacare’s original directives to the state.

The governor notified Obama’s secretary of health and human services that the state probably would just stay in the federal insurance exchange rather than set up its own exchange, which is a sensible move and one that reduces future confusion. All Hutchinson’s changes, of course, will have to comply with the law and get the approval of the Obama administration.

But please remember, whatever you do, do NOT call it Obamacare or the private option. Governor Hutchinson, 250,000 of your fellow Arkansans and the hospitals and physicians of Arkansas will thank you.
 — Ernie Dumas