Secret Knowledge or another pro-Obamacare Medicaid Expansion law? – PART II
When you are told about legislation, be a skeptic and check it out. Legislators may not like this advice, but Conduit for Action welcomes readers to check the facts.
Secret Sauce
2015 brought a new myth. Supposedly SB96 was going to be the way to end Obamacare Medicaid Expansion. “It ends it!” we were told.
But it was easy to see the legislation ended nothing because the supposed end date happened to be the exact date it would have ended anyway without the legislation. What SB96 actually did was give pro-Obamacare legislators almost two years to work on new Arkansas Obamacare legislation. SB96 set up a task force and didn’t hide the fact that its first duty was to recommend new legislation to continue Obamacare Medicaid Expansion.
When former opponents of Obamacare Medicaid Expansion were criticized for facilitating the extension of the program far into the future a new myth was created: “Trust legislators who voted for SB96. They have a secret plan to fight Obamacare Medicaid Expansion.” The secret sauce in this plan is apparently to merely change the name from “Private Option” to “Arkansas Works” and to make some tweaks that do not change the character of the program from one which discourages work and serves a population that is primarily able bodied working age adults with NO dependents, and 40% to 46% of those eligible do not work at all – not even part time or seasonal.
Where did SB96 come from?
In December 2014 Senator Jim Hendren circulated an outline for a bill. (The outline was dated Dec 12, 2014.) Under his outline, Arkansas’ Medicaid expansion (Private Option) would be phased out. No new enrollments would be allowed after June 30, 2015 and the whole program would have to end at the end of 2016. The outline also proposed to create a task force concerning Medicaid reform but its duties did NOT include finding a way to restart Medicaid Expansion.
Between the December 12, 2014 outline and January 9, 2015 there was a dramatic shift in what the Senator proposed to do.
A January 9, 2015 draft of what would become Senator Hendren’s SB96 was widely circulated. The draft took clear steps to assure Democrats and pro-Obamacare Republicans that SB96 would aid the continuation of Obamacare Medicaid Expansion – not end it.
- First, the draft assured Obamacare supporters the 2016 end date made NO CHANGE, because the program would end anyway when the Private Option waiver ended on that date. 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. This is the actual language from the bill to reassure Obamacare supporters: “WHEREAS, the Arkansas Health Care Independence Program and the federal waiver under which the state operates the Arkansas Health Care Independence Program will terminate on December 31, 2016, which will have the effect of ending eligibility for Medicaid expansion populations in the absence of legislative action by the General Assembly”.
- Second, a new duty was added for the proposed Heath Reform Legislative Task Force to show Obamacare supporters the intent was to continue Obamacare Medicaid Expansion beyond 2016 (whether called Private Option or under some other name). There is the first duty of the task force: “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”. Yes, this sounds like gobbledygook but we will explain what it says later in this article.
How did the idea completely flip between December and January? First, newly elected Governor Asa Hutchinson decided to work to keep Obamacare Medicaid Expansion and second the draft was written by the Governor’s Department of Human Services. The January 9, 2015 draft shows the document was created by DHS employee Mark White and edited by DHS Director John Selig. (Note: Director Selig was Governor’ Beebe’s point man for preparing the Private Option in 2013. Also note Governor Hutchinson, has already recommended continuation of Obamacare Medicaid Expansion under a new name.)
Task force duty to recommend how to continue Obamacare Medicaid Expansion
As mentioned above the Health Reform Legislative Task Force was given the duty to recommend how to continue Obamacare Medicaid Expansion. The duty reads as follows:
(d)(1)(A) 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, §§ 20-77-2401 et seq., upon program termination;
You may not be familiar with the jargon so let’s break it down:
- “Alternative healthcare coverage model” – A plan.
- “Legislative framework” – A law.
- “Health Care Independence Program established by the Health Care Independence Act of 2013, §§ 20-77-2401 et seq.,” – This is a reference to the Private Option law which is Arkansas’ version of Obamacare Medicaid Expansion.
- “Vulnerable populations” –The words “vulnerable populations” could have been left out because it adds nothing to the text, other than to confuse readers into thinking that only the neediest people in Medicaid Expansion would get coverage. “Vulnerable populations” in this context only means the person qualifies for Medicaid expansion based on income. SB96 makes sure low income people are called vulnerable. It twice uses “low income and other vulnerable populations”. Again, Medicaid Expansion is only about income, so the phrase is merely a way to say low income and includes everyone eligible for Medicaid Expansion. (See page 2 lines 20 and 25 of the bill)
The gobbledygook can be rewritten as “Recommend a plan and law to ensure the continued coverage for the Obamacare Medicaid expansion population.” With the federal match rate being lower in Medicaid expansion, the only way to accomplish this duty is through continuation of Obamacare Medicaid Expansion.
You cannot get any more pro-Obamacare than that.
Making sure the fix was in.
To clear the way to say SB96 was the only way to proceed the (majority Republican) Senate Committee on Public Health Welfare & Labor voted down a bill by Senator Linda Collins-Smith to end Arkansas’ Obamacare Medicaid Expansion. To keep the bill from being voted on by the full Senate meant Senator John Cooper, who campaigned against Obamacare, would vote against the Collins-Smith bill and Senator Missy Irving who voted against funding in 2014 refused to support the bill. Meanwhile, in the House Committee on Public Health Welfare & Labor, Representative Donnie Copeland’s bill to end the Obamacare program was also bottled up in committee.
Also, SB96 took no chances with the creation of the task force. Of the sixteen members to be appointed, fifteen were appointed by legislators who had voted for the Private Option. The only appointment not made by a previous supporter of the Private Option was by Senator Hendren in his role as Senate Majority Leader. But, remember, Senator Hendren is the sponsor of the SB96 which requires the task force to recommend the form of continued Medicaid expansion beyond 2016.
SB96 Accomplished Its Pro-Obamacare Goal
SB96 gave time for a new plan to be developed to keep Arkansas an Obamacare Medicaid Expansion state. Governor Asa Hutchinson has presented his plan with tweaks that do not change the character of Obamacare Medicaid Expansion. The myth of the secret legislative plan (to end Arkansas’ Obamacare Medicaid Expansion) is likely to fade after the Republican primary elections, when politicians no longer need to hide behind the myth.