Private-option progress

Sunday, August 10, 2014

What I'm getting ready to do is something Democrats won't appreciate and that I know better than to do.

John Brummett is blogging daily online.

That is to assume Asa Hutchinson's victory in the governor's race. It is to underestimate Mike Ross, which I've done before to my peril.

But two credible polls have installed Hutchinson in a five-point lead in the governor's race. Meantime, his nephew, state Sen. Jim Hendren of Gravette, got elected last week to be Senate Republican leader--meaning majority leader--for the 2015 session.


In a not-unrelated matter, a national study said that Arkansas, mostly thanks to the unique private-option form of Medicaid expansion, has made more progress than any other state in providing health insurance to its citizens.

Arkansas has, in fact, moved in less than a year from next-to-last to 22nd in the percentage of its population with health insurance, according to a Gallup survey.

So the state that hates Obamacare most reaps more benefit from it than any other, largely by adapting it. And the state with the most restrictive legislative term limits in the country produces the most substantively promising health-care policy in the country.

I must therefore repeat a frequent theme in this space. It is that Arkansas, politically speaking, is a wonderfully weird place--sometimes more wonderful than weird, and sometimes the other way around.

And now a single Republican family in that state may well lead the way in saving and advancing that ballyhooed adapted element of Obamacare.

You call that irony.

In interviews attending his election as majority leader, Hendren, previously a fairly firm private-option foe, talked about how we need compromise.

He spoke, as Uncle Asa has spoken, of emphasizing job-creation and job-improvement efforts as part of any continued authorization of private-option funding.

Remember, too, that I have written several times in this space that, as governor, Hutchinson would more easily pass the private option than Ross. (After all, his nephew will be majority leader in the Senate).

And I've written that, though he vacillates as a candidate, Hutchinson would put conservative window-dressing on the private option and save it because his biennial budget will require it.

So here's a digital conversation I had Thursday with Hendren:

Me: "It's a (family) dynasty to save private option by some kind of health care-to-work tie-in to Sen. (Jane) English's work-force education and training reforms."

Hendren: "Got any friends in D.C. who will go along with such good ideas? They're not always as reasonable as you and they're our boss, unfortunately."

Me: "Arkansas has become national model for Obamacare, so, sure, we can call a shot like that. (Sen. David) Sanders working on full ACA waiver."

Hendren: "We'll see. You know me. I just want everyone to be happy."

I do not know exactly how we would establish a direct link between private-option health insurance and job training. In fact, we probably can't actually relate one to the other under existing Title XIX, which defines all of Medicaid as a disability.

I know, though, that the concept is not distantly removed from the welfare-to-work reforms of a certain Democratic president from a certain weird, wonderful state.

The compromise probably lies in the longer-term waiver from the Affordable Care Act itself that David Sanders and Sen. Jonathan Dismang have been angling since 2012 for the state to seek for 2017.

Yes, Obamacare contained a provision allowing states to seek permission to do it differently starting in 2017.

Sanders and Dismang believe the private option is proving that not all people below 138 percent of poverty are disabled or possessed of what I would loosely and uncomfortably call an entitlement mentality.

They believe we can work toward asking the federal government for a full Obamacare waiver to define our state's Medicaid population as only the aged, disabled and medically frail. That would leave everyone else now in the private-option population--all the able-bodied--to the private insurance market.

Sanders believes we would not need to require those people to work or seek work or enroll in job-training. He believes they are naturally so-inclined.

He believes we merely need to assign them personal responsibilities while enhancing their opportunities with better training services and growth-driven economic policies.

So you take a circle representing Reaganism and a circle representing Clintonism and a circle representing Obamaism. There's a tiny sliver of overlap. You gather in that tiny sliver and you call it Arkansas.

What I'm saying is that Sanders and Dismang and a few others are planning something longer-term. And I'm saying it's something a Governor Hutchinson and his nephew could embrace--in fact, will embrace--as a means of saving the private option.

For that matter, a Governor Ross, still a distinct possibility, could embrace it as well if it provided the only path to keeping the private option alive.

------------v------------

John Brummett's column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.

Editorial on 08/10/2014