For anyone who monitors state legislation or is interested in state legislation, the tale of SB96 of 2015 is a worth reviewing. Whether you are against Obamacare Medicaid expansion, for it, or have no strong view, the lessons of SB96 will give you a healthy skepticism of Arkansas legislation. That skepticism will serve you well in the future when you look at other legislation and are told it favors your side of the issue.
SB96 became Act 46 of 2015 and created a task force to make recommendations concerning how to continue Arkansas’ Obamacare Medicaid Expansion. SB96 has been a problem for Republicans who vowed to fight Medicaid expansion.
Over nine months have passed since SB96 was signed into law, but some Republican legislators are still trying to convince the public that somehow the law is really not pro-Obamacare legislation. One legislator has adopted the strategy of emphasizing a few words in the legislation while omitting the actual context of the words and omitting pro-Obamacare provisions in other parts of the legislation.
Another Republican has adopted the mantra “trust us” and claims conservative legislators have a secret plan to end the Arkansas Obamacare Medicaid Expansion. The idea that the pro-Medicaid Expansion bill, SB96, is somehow part of a secret plan to end Medicaid expansion is so out-there that proponents of the “secret knowledge” idea sound like they must be forming the Gnostic Wing of the Arkansas Republican Party.
Social media has been used to push the ”trust us we have secret knowledge” idea and was the subject of a recent Facebook fight November 29 and 30 between a state Senator and members of the Faulkner County T.E.A. Party. As with most social media fights, it got out of hand with the first comment in which the senator demeaned any conservatives who would criticize SB96 supporters. The conversation then became about whether those who promised to oppose Medicaid expansion but voted for SB96 are liars.
CFA will not venture a guess on whether anyone “lied” and sees no need to speculate about any legislator’s intent. What CFA can say is: SB96 is clearly a pro-Obamacare Medicaid expansion bill and it is completely contrary to promises to oppose Obamacare Medicaid Expansion (Private Option or whatever it will be called in the future).
In 2015 Arkansas swore in a new Republican Governor, Asa Hutchinson. On January 22, 2015, Governor Hutchinson announced he wanted to continue the Medicaid Expansion (Private Option) through 2016 and urged the legislature to create a task force to develop an “alternative health coverage model” for “vulnerable populations” now covered under the program.[i] The same day the governor’s nephew, Senator Jim Hendren, filed SB96 to do just that. “Vulnerable populations” is defined by the legislation to include qualification based on income and, in fact, income is the only qualification for Obamacare Medicaid Expansion. In other words, Governor Hutchinson and Senator Hendren were asking to continue to cover ALL Obamacare Medicaid Expansion enrollees even beyond 2016. (The Medicaid Expansion population is substantially able bodied working age adults with no dependents and nearly half do not work at all.)
Supporters of SB96 claimed the only way to end Medicaid Expansion was to continue it until 2016. That is not true, but worse is that they failed to admit the clear intent was to propose tweaks to the program but to continue it beyond 2016. The task force was given the duty to recommend how to continue Medicaid Expansion after 2016.
The deception of ending Medicaid Expansion is not supported by the legislation. Some provisions are so obviously pro-Obamacare that it appears they were included in order to assure Democrats and Establishment Republicans that the optional Obamacare program was safe. Here are two examples of that assurance:
- SB96 which was being touted as ending Medicaid Expansion at the end of 2016, took the odd step of undermining the narrative by emphasizing that the 2016 end date in the bill was when the Private Option waiver ended anyway. (see page 2, lines 13-17 of SB96) Democrats and pro-Obamacare Republicans would understand they would lose nothing in the bill because new legislation would need to be submitted anyway to continue on into 2017.
- The duties of the task force could have been left as a generic study of Medicaid and they still could have used the task force to further Medicaid Expansion. Instead of doing that the very first duty listed for the task force was written to assure Democrats and Establishment Republicans that the task force was to recommend how to continue coverage of the Obamacare Medicaid Expansion population beyond 2016 (whether called Private Option or some other name).
If any Obamacare supporter still needed assurance they merely needed to confer with Department of Human Services officials, since SB96 was written or revised by DHS.
Were some legislators fooled by SB96?
If some legislators were fooled by representations about SB96 being a way to end Arkansas’ Obamacare Medicaid expansion (despite the clear purpose of the bill to find a way to continue Medicaid expansion) it must have been disheartening for them to see how things have played out over the past nine months:
- March 2, 2015 – The membership of the Health Reform Legislative Task Force was announced and a majority of the members had voted for Medicaid expansion in 2013 or 2014. Only two members of the task force had voted against SB96.
- April 20, 2015 – Senator Hendren urged task force members not to re-litigate or rehash decisions concerning the Private Option.
- May 6, 2015 – The Health Reform Legislative Task Force discussed the final Request for Proposal (RFP) for the consulting contract. The RFP did not allow for a wide open study of Medicaid expansion in Arkansas, instead it limited the consultant to making recommendations on how to continue Medicaid expansion coverage after 2016.[ii]
- August 19, 2015 – Governor Asa Hutchinson announced a seven-point plan to keep Arkansas as an Obamacare Medicaid Expansion state.[iii] The new plan is more of the same, with a few tweaks to the program and a new and misleading name.
- October 7, 2015 – The Stephen Group (TSG) report is released to the public. TSG makes sure the public knows its study has been limited by the task force to making recommendations on how to continue Medicaid expansion. On page 4 of “The Stephen Group Volume II: Recommendations” TSG states: “TSG’s contracted responsibility calls for recommendations to improve the quality and efficiency of the traditional Medicaid program while offering a solution for the future of the Private Option, while maintaining coverage for the nearly 250,000 participants in the program.”[iv] (emphasis added)
- December 4, 2015 – Arkansas Medicaid Director Dawn Stehle stated Arkansas will apply by the end of the year for an extension of the federal waiver that authorized the state’s private-option health insurance program to continue beyond 2016.[v] Apparently there was no need to wait for the task force to rubber stamp the decision.
Even if a legislator was initially fooled by SB96 it is long past the time that the notion can be claimed with a straight face.
Sadly, the charade is likely to continue at least until after the Republican primary.
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What to expect in PART II of this article?
In Part II of this article CFA will discuss how Senator Hendren’s proposal changed dramatically in less than a month (December 2014 to January 2015) and will go into detail to explain the pro-Obama provisions of SB96. We don’t want you to take our word for it. We want you to see for yourself!
[v] State seeks private-option waiver extension, Arkansas Democrat-Gazette, 12/4/2015