Act 46 (SB96) created the Arkansas Health Reform Legislative Task Force. (By the way, it continued Obamacare Medicaid Expansion until it would need new Arkansas legislation anyway.)
What legislation will come out of the task force recommendations? Let’s look into a crystal ball to see into the future to unwrap this mystery. Actually, I don’t need a crystal ball and you don’t need one either. We can make a pretty good prediction just by reading Act 46 and listening to public statements of politicians.
Much of the results of the task force recommendations have already been scripted out by the legislation setting up the task force. Add to that the fact that Governor Asa Hutchinson is already talking up a special session despite the task force only being in the early stages of its deliberations.
Conservatives were told to “trust us” SB96 is the only way to wind down the “Private Option”; however, opponents of the Private Option never focused on the narrow goal of ending just one version of Obamacare Medicaid Expansion. The goal of opponents is to end Obamacare Medicaid Expansion in Arkansas, and to join the other 22 states that refuse to adopt Medicaid Expansion.
We hear about what will not be included in new legislation:. (1) Not likely to be a continuation of the Private Option; (2) Not minor changes with a new name; and (3) Not the traditional Medicaid delivery system. What is not being said is that no matter what kind of program or blended program is proposed, coverage of the expansion population will be based on the authority of Obamacare.
What is likely to come out of the task force? More Obamacare. If you are liberal you are going to love it. If you are conservative and are concerned about Arkansas’ budget and Arkansas programs, prepare to be disappointed.
PREDICTION 1. The legislation will be presented as ending the “Private Option” but the Private Option is merely one version Obamacare Medicaid Expansion. Legislation will be prepared to continue coverage for the Obamacare Medicaid Expansion population.
I expect Obamacare supporters to try to confuse voters by bragging on ending the Private Option program while keeping Obamacare Medicaid Expansion. As stated above, opponents of the Private Option have never sought to merely end the current version (Private Option), but sought to end Obamacare Medicaid Expansion in Arkansas.
Act 46 (SB96) lists the first duty the task force as being to:
Recommend an alternative healthcare coverage model and legislative framework to ensure the continued availability of healthcare services for vulnerable populations covered by the Health Care Independence Program established by the Health Care Independence Act of 2013, §§ 20-77- 28 2401 et seq., upon program termination.
This is the duty to recommend coverage of the full Private Option/Obamacare Medicaid Expansion population.
PREDICTION 2. The Obamacare Medicaid Expansion program and the regular Medicaid program will be blended together, perhaps by a block grant, and the change will be used to claim that Arkansas is not an Obamacare Medicaid Expansion state. Even with the changes, the federal government will continue to recognize that Arkansas is an Obamacare Medicaid Expansion state.
- Governor Hutchinson in his health care speech on January 22, 2015 emphasized the desire to obtain block-grant type waivers for government health care.[i]
- Senator David Sanders, one of the architects of the Private Option, in an interview with John Brummett sought to move the conversation from a narrow focus on the Private Option to a transformation of the system.[ii]
Blending the populations together will be called innovation, but the blending will also help Obamacare supporters by making it harder to identify and separately track the costs of covering the Obamacare Medicaid Expansion population.
The blending together of the populations may be used to claim that Arkansas is not an Obamacare Medicaid Expansion state, but don’t expect the federal government to take Arkansas off the list of Obamacare Medicaid Expansion states. This would be the same pattern as with the original passage of the Private Option – when supporters claimed it was a “conservative alternative’ to Obamacare Medicaid Expansion, while federal agencies accurately stated that it was expansion.
PREDICTION 3. The legislation will include reforms in the State Medicaid and Welfare programs but instead of using the savings to shore up traditional Medicaid or returning some of the money to the people in the form of much needed tax relief, Obamacare supporters will declare the savings to be “free money” to be used to spend on the Obamacare Medicaid Expansion population.
Act 46 includes this duty of the task force:
Identify resources and funding necessary to ensure an effective and efficient transition from the Health Care Independence Program, while minimizing or eliminating any need for the General Assembly to raise additional state general revenue;
While I completely agree with this duty, it would be disingenuous if they claim long overdue reforms as a source of “free money” to support the continuation of expansion.
In 2013 the legislature hired a consultant to look for reforms in Medicaid and Welfare programs. The report proposed reforms that were projected at that time to save between about $66 million and $98 million. The report was filed with the legislature during the first week of July 2013. But, ignored until November 18, 2013, when the legislature was heavily involved in preparing for the new session with many new legislators. Saving that could have been realized then would have worked counter to the narrative that continuation of Medicaid Expansion was needed for budget reasons. Now that savings from reform fits the needs of Obamacare supporters, reforms will be examined. We need the reforms but the savings from reforms does not belong to Obamacare Medicaid Expansion.
PREDICTION 4. The legislation will include a request to the federal government to be allowed to require recipients to seek employment or be a part of job training or education. However, the federal government has denied such requests by other states for the Obamacare Medicaid Expansion population and is unlikely to approve such a request.
Act 46 says the task force is to seek to:
(v) Increased employment of able-bodied recipients of taxpayer-funded healthcare services;
Sounds GREAT…. but the federal government has been adamant that they will not let states require work for Medicaid Expansion recipients. The federal government has even denied Pennsylvania’s request to require recipients to merely look for work. Before you buy this line you better see it in writing from the federal government before legislation is proposed.
PREDICTION 5. The legislation will propose turning over broad authority to bureaucrats and the Governor to seek program changes through waivers authorized by Obamacare. This will be same or similar to SB828 which fortunately stalled in a Senate committee.
This is what SB828 of 2015 tried to do, but it stalled in committee after it got much public attention. Incorporation elements of SB828 into new legislation is likely to be part of the strategy of Obamacare supporters because it has two advantages for them. First, they will want to include as little detail as possible. The more detail that comes out about the particular waivers to be sought pursuant to authorization in the Obamacare law, the more likely it is that the details will cause more concerns by Republican legislators who are sitting on the fence on Obamacare. Second, Obamacare supporters do not want to have to keep dealing with the issues in the legislature and the grant of broad authority to bureaucrats and the governor would keep the legislature from having to deal with these issues in the future. Shifting power to the governor and the bureaucrats would help them guarantee that Arkansas remains an Obamacare Medicaid Expansion state.
SUMMARY OF PREDICTIONS: As scripted out in the duties of the task force, legislation will be introduced to keep Arkansas as an Obamacare Medicaid Expansion state. The new legislation will be supported by the governor, Democrat legislators and big government establishment Republicans. The Republicans who vote for this legislation will claim the new legislation is somehow conservative, but the result will be that Arkansas will have to commit substantial state revenues to continue the coverage.
Maybe I will be wrong about every prediction. The point is don’t just accept what supporters of Act 46 are telling you and don’t just accept my predictions. Read the actual duties of task force in Act 46 (SB96) and listen to what politicians are saying and NOT saying.
(Note task force duties begin on page 4, line 23 of Act 46)
Cost of Obamacare Medicaid Expansion
The state budget is under constant pressure for funds to support various programs. The state budget is especially at risk from fluctuations in the Medicaid matching rate imposed on Arkansas. As recently as 2012 the Department of Human Services was warning of a $460 million shortfall in Medicaid funds and there was concern that grandma might be thrown out of the nursing home. (As a comparison consider that the entire budget for the State Police is $68 million.)
Obamacare Medicaid Expansion adds hundreds of thousands of people to state assistance. The state has not had to pay for that coverage but 2017 brings a requirement that Arkansas pay 5% of the costs and the percentage rapidly increases to 10%. The state’s own consultants projected Arkansas’ costs for Obamacare Medicaid Expansion to increase to $330 million in 2020 and keep on increasing.
The competition for dollars is not just between Obamacare Medicaid Expansion and other kinds of state programs. The competition for dollars is also between Obamacare Medicaid Expansion and our most vulnerable citizens who rely on traditional Medicaid.
Unlike traditional Medicaid, Obamacare Medicaid Expansion targets a population that is primarily able bodied working age adults with no dependents, and about 40% percent do not work. Twenty-two states still refuse to adopt Obamacare Medicaid Expansion.