Tuesday, April 05, 2016

EDITORIAL >> Much ado about little

Today’s vaunted special session of the Arkansas General Assembly is looking more and more like much ado about very little. Gov. Hutchinson yesterday dropped his ballyhooed managed-care act from the call for the session, which is supposed to consume three or four days this week.

All that is left for legislators to do, besides the Senate routinely confirming a bunch of the governor’s Republican appointees to innumerable little state boards, is approve a reauthorization of the Medicaid portion of the Affordable Care Act, which you know as Obamacare.

That reauthorization would have been routine without the governor’s fumbling with some largely cosmetic changes to the Obamacare program so that legislators can claim never to have voted for any part of President Obama’s health reforms and also without the disaster of his managed-care campaign, which left legislators, mainly the governor’s own Republican acolytes, vexed or confused. More about that in a moment, and much later.

Hutchinson yesterday morning punted the managed-care issue to a later—perhaps a third or fourth—legislative session in late spring, summer or fall. But Hutchinson is absolutely right. Legislators must reauthorize Medicaid insurance for poor working adults and then fund it. If he and they fail, Arkansas will find itself, like Kansas and Louisiana, in a budget crisis of biblical proportions: a quarter-million people without medical insurance, shuttered hospitals and clinics around the state, Arkansas’ great university medical system reduced to a shadow of itself, state services slashed across the board, the state’s economy shorn of nearly a billion dollars a year in capital, the burgeoning job market badly afflicted.

All the legislature has to do this week is rubber-stamp the governor’s minor revisions of the “private option,” the name Republican legislators attached to the Medicaid expansion in 2013 so that people would not see it as Obamacare. The Affordable Care Act of 2010 called for states to expand Medicaid, the 1965 program for indigents with medical problems, to cover poor working adults, but in a split decision the U.S. Supreme Court said states had to be given the option of approving or rejecting the program. Arkansas and 30 other states took it, but Republican legislators who voted for it have been catching hell from conservative groups like the Club for Growth and Americans for Prosperity for embracing the dastardly Obama.

Gov. Hutchinson is trying to give them some cover by tweaking it and calling it “Arkansas Works” instead of “Private Option,” which foes have persuaded the public is actually Obamacare. Hutchinson may not have known what he was doing when he affixed the name, which must remind TV addicts of “House of Cards” of the villainous and conniving President Frank Underwood. President Underwood began a program called America Works, which was to replace Social Security and the rest of the country’s social safety net with a mandatory work program. Hutchinson named his Medicaid switch Arkansas Works to suggest to conservatives that it would encourage slackers on the medical rolls to find a job. The new tag serves the governor poorly, at least with the TV crowd.

Although many Democratic legislators he needs to pass the bill are unhappy with some of the tweaks, which might cut off many needy people from medical help, in the end they will give him the simple majority he needs to pass the bill. Everyone will go home and come back to the Capitol in a week for the annual fiscal session, where the really critical decisions will be made. An appropriation of funds for Arkansas Works and the entire Medicaid program for the aged, blind, disabled, poor and disabled children, the mentally ill and all the rest will require a nearly impossible three-fourths vote in each house, at least according to the common interpretation of the Constitution (we think a simple majority would and should suffice). If it fails of passage, everything collapses this fall and the governor will find himself in an impossible jam. All of us will be there with him.

A word about the governor’s (presumably) temporarily abandoned managed-care program. To claim conservative credentials in this whole fight, Hutchinson said he would like to take a few parts of the huge Arkansas Medicaid program, much of it the work of Gov. Mike Huckabee nearly 20 years ago, and turn patients in those programs—mentally ill and disabled people—over to managed-care insurance companies and see if they couldn’t chop the costs dramatically. Managed-care companies do that by reducing payments and services for which they will pay enough that they can still make a good profit from the government payments.

Sometimes that doesn’t have the desired effect. When the Bush administration in 2003 changed the Medicare law to encourage people to buy managed-care policies instead of getting simple Medicare coverage, rather than less, it wound up costing taxpayers 17 percent more, and the federal deficit soared. Obamacare reduces that giant loss by shaving the managed-care subsidy a little.

Many Republicans and Democrats thought the governor’s managed-care plan was risky or else too bewildering, and party leaders urged him Monday to take it out of the session and leave it for another day when he could sell it or abandon it. It was jeopardizing Arkansas Works. Yesterday, he did. Hutchinson admirably has tended to yield to such political prudence.

Get the little job of reauthorization done this week and get out of town. Gov. Hutchinson needs to be at his political best next week, when truly desperate decisions have to be made. — Ernie Dumas