So the "private option" will survive. We might not even change the name.
Our very conservative governor sees budget facts clearly. This should surprise no one. He's demonstrated that ability before. What matters is what followed his statements Wednesday. To be precise, what matters is what didn't follow.
We're keeping more than a billion dollars of federal health care spending, Gov. Asa Hutchinson declared. A nearly complete silence followed as most of us thought, "Well, duh." But there was also an eerie lack of private option foes competing with each other in wailing and rending their clothes. Nobody's making any "Judas" comments now, at least not very loudly.
This calm is nationally significant. There are groups all over the country who exist solely to wail and rend their clothes. They heap discredit on anyone who finds any use for any part of Obamacare. The 2016 presidential election is already going. Yet the strident attacks we used to see on any governor who touched "unclean" Obamacare didn't happen this time. There's been some candid admissions of defeat on the websites of usual suspects. That's all.
Suppose you plan on entering our GOP primary. Suppose you expect to ride the tide of anti-private option anger. You might want to rethink that.
Certainly there's much quiet disappointment among private option foes. Those foes have the cold consolation of being right. Think back on when private option passed. Foes warned that once we took the money, we'd never let it go. Not all of us replied, "Why would we ever want to let it go?"
Consider a couple of the governor's proposed changes. Private option subsidizes private insurance policies for the poor. Hutchinson points are clearly designed to make the thing politically more palatable for conservatives. So there's the clear whiff of "change for change's sake" from some points. Others seem designed as bargaining chips he intends to give up. "Sometimes, as governor, you need to put some ideas out there that can be shot at," he said. You have to admire his candor.
At least one of those ideas is getting some hasty criticism. It deserves a good look instead. The governor wants to require people who have a health plan available at work to take that coverage. Then private option would not help workers buy their own insurance. It would help those workers cover premiums, deductibles and co-pays the employer's insurance doesn't pay.
This idea was quickly dismissed by an expert quoted in the New York Times, no less. Workers receiving benefits from private option tend to be low-wage workers who aren't often offered company insurance. The immediate effect would be tiny. That's true -- but doesn't consider that Hutchinson's plan might change the market.
Why should a company offer insurance its employees won't buy, a plan with high deductibles and such? But if those employees can get help meeting those deductibles, they might buy such a plan. This would be a much better deal for such workers than private option alone. Therefore, a company might get an incentive to offer insurance. That would help businesses that keep losing workers to other companies that already offer health benefits.
I can picture an insurance company making such a pitch to small commercial customers. This idea also neatly addresses the criticism that private option might cause small employers to drop their private, non-subsidized plans and tell their workers to go buy their own.
People think of the private option as just a government program. It's not. It has profoundly changed the private insurance market in this state. That is its great strength compared to the simple Medicaid expansion of pure Obamacare. Private option keeps more people in the private (albeit subsidized) insurance market. That means a bigger pool of shared risk for all of us. That matters -- a lot.
So I'm more than a little surprised at the governor's point to require the unemployed to get out of private option and join Medicaid. If they have the income from other sources, why not keep them in the private pool? That's the idea of his I expect to get shot at the most.
In closing, give conservative critics of private option some credit. Supporters of the plan keep saying that more federal spending on health in Arkansas benefits the state treasury. That spending generates income and taxes. That's true -- income and taxes derived from borrowed money. Peter was robbed to pay Paul. Yes, the state is collecting some taxes on Paul's new income.
Commentary on 08/22/2015