COMMENTARY

Acceptance optional

The private option is on fire elsewhere—in the really backward states of the South, no less—even as it cools in the odd little state that created it.

I told you a couple of weeks ago that Utah’s Republican governor had proposed a form of Medicaid expansion styled after—copied from, actually—the Arkansas model.

I refer to the prototype by which Arkansas accepted Medicaid expansion dollars but got federal permission to use the money to buy private insurance for recipients and introduce personal responsibility elements.

Republican governors in Indiana and Wyoming have been working on similar ideas. Then, last week, the Republican governor of Alabama—a famously regressive place—declared himself open to some kind of Medicaid expansion availing itself of private insurance and finding a way to encourage if not force recipients to seek job training and work.

And on Monday, the Republican governor of Tennessee announced he had received federal authority to go forward with the idea of a two-pronged system giving recipients an option—basic Medicaid, but with new conservative elements, or vouchers for private insurance.

What’s motivating these Republican governors is that their hospitals need help and their state governments face short-term budget shortfalls. Using federal dollars for Medicaid saves state taxpayer dollars.

It’s similar to what happened in Arkansas. Democratic Gov. Mike Beebe favored basic Medicaid expansion in 2013. But, because of his budget worries, he was open to the alternative idea that percolated from his then-Medicaid director, Andy Allison, and Republican legislators like Sens. David Sanders of Little Rock and Jonathan Dismang of Beebe.

So Beebe went to Washington and got the waiver for the private option that is now a national trailblazer for nothing less than a new politics and a new solution.

I do not overstate.

The private option is a genuinely new idea because it uses expanded federal government spending toward universal health care, a liberal notion, as a basis for reforming health welfare in a more conservative fashion. It seeks to add personal responsibility. It could soon seek to tie publicly paid health insurance to job training and job seeking—a direct connection not currently permitted by the federal government.

The private option intends to transform Medicaid from a “destination,” as conservatives put it, into a foundation for upward mobility. And it wants to limit the breadth of coverage in government-paid insurance so that recipients won’t wind up with less health care if they move up into jobs and out of public assistance.

I’m all-in because the private option preserves vital government aid at a time of such conservative insurgence that vital government aid might otherwise be in great peril.

In fact, a Republican leader was saying the real fight is between conservatives and libertarians. Conservatives will use government programs to try to achieve reforms adding personal responsibility. Libertarians eschew government programs more generally.

Liberals and Democrats are left in this debate to say only that none of this could be happening without their new law and its new money.

In that regard, there is talk that the Obama administration may soon declare that any waivers it provides one state would be available to all states. That would mean as follows: Whatever Utah or Tennessee or Alabama got through a waiver could also be used by Arkansas to make its private option more conservative.

Beyond that, there also is talk that the new Republican Congress next year, while unable to repeal Obamacare, will pass legislation giving states more statutory flexibility on how to administer Medicaid.

In Arkansas, meanwhile, Republican Gov.-elect Asa Hutchinson continues to say nothing publicly about the private option.

That’s because anything he might say could irk somebody on the right and complicate what I believe to be his quiet work to try to save the private option if by another name and with new conservative provisions, including something tied to job training.

I wouldn’t be terribly surprised to hear Hutchinson declare next year that the private option had failed as a pilot project—that it had cost too much and not imposed enough conservative reforms. That wouldn’t be true, but that’s hardly the point.

And I wouldn’t be terribly surprised to hear Hutchinson then say that the concept could be saved, however, through his new and more conservative initiative that he might call … oh, the Arkansas Personal Responsibility Public Health Care to Work Act, or something like that. Something better than that.

No one told me that. I’m just thinking out loud, trying to put myself in the head of a conservative trying to deal with a libertarian.

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.

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