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Let's open with a little fun. It's not every day you get a governor and his immediate predecessor in a little back-and-forth.

As it happens, the back-and-forth rather deftly frames much of the substance of today's column.

Gov. Asa Hutchinson was defending himself over the phone Tuesday against criticism that, after months of nobly holding out, he had ended up backing, in the now-defunct Graham-Cassidy bill, a proposed repeal-and-replacement of Obamacare that was inequitable to Arkansas and inadequate to the state's long-range need.

Hutchinson said his criteria all along had been that there could be no cost shift to the state and that the state had to be granted greater flexibility in continuing to serve its existing Medicaid and otherwise subsidized population.

Graham-Cassidy, starting out with a continuing-level block grant in 2020, met those criteria, he said.

But he also had taken the position, he reminded, that states should share responsibility with the federal government in "lowering the cost curve." A finite block grant forces the state to do that, he said.

Yes, by reducing services to fewer recipients, I said.

No, he said. He categorically rejected that efficiencies couldn't be found.

Here's just one example of the perils: Let's say an elderly low-income woman with early dementia was placed on a Medicaid waiver allowing her to receive in-home care for five hours each weekday. The idea would be for the state to be a partner in her care with her family members, who had their own workaday responsibilities and would arrange to attend to her 19 hours a day and on weekends.

Then the state could decide to find efficiencies in the program. It could declare that four hours a day is not so different from five hours a day, and that, henceforth, four hours, not five, would be compensated by Medicaid.

The state's efficiency would leave a 60-minute gap every weekday that would make an elderly woman marginally more vulnerable or her family members marginally more pressed for time.

One thing that might happen would be that the family would decide to place the elderly woman in a nursing home earlier than they would have otherwise. In that case, absent long-term-care insurance, Medicaid's cost would go from a couple of hundred dollars each month for a home sitter to thousands of dollars a month to a nursing home.

That aside, I remarked that the governor appeared to be saying that the Arkansas Works program, which is the Medicaid expansion started in Beebe's time and formerly called the private option, would have continued in Arkansas under Graham-Cassidy had that bill not met its blundering failure in the U.S. Senate.

And I remarked that the governor, then, probably didn't appreciate Beebe's public statement issued through the state Democratic Party the day before, when Graham-Cassidy was still alive if barely, that Medicaid expansion would be ended by Graham-Cassidy.

"Governor Beebe must not have been paying attention," Hutchinson replied.

Asa said Arkansas Works is the law. He said he had no intention of seeking to repeal or change that law. He said he was merely committed to running it with greater state latitude to find ways to make it work for less money.

Hesitant though I was to stir a pot, I texted Beebe to tell him that Asa had said he must not have been paying attention, and to invite him to call if he cared to respond. He texted, "It'll be a little later."

It turned out he was on the golf course in Searcy, and, I'd wager, pondering a clever retort between tee and green.

Soon Beebe called to say, "First, he shouldn't be so sensitive because I bragged on him in that very statement for having continued the program. Second, Graham-Cassidy would have redistributed Medicaid money, taking it from expansion states and redistributing it to non-expansion states, and doing so from the same-size pot. So, Arkansas is a loser in that. The Democrat-Gazette said so on the front page the other day.

"And, finally, I've been paying enough attention to know that, yeah, he's still got his car, but it only has three wheels."

All right, then. Fun had.

But this issue is serious, and I wondered if Hutchinson would now support bipartisan talks to accept that Obamacare is the law and is not working and can be made better with a few fixes, such as a re-insurance program to offset the costs of expensive conditions.

"We can hope, and those talks should take place," Hutchinson said. "But we should probably limit our expectations."

Republicans would have to accept Obamacare. Democrats would have to cede something of similar substance.

While the politicians themselves might be willing, their polarized bases would not be.

That's the distressing national reality. The best we can hope in Arkansas is that the immediately past Democratic governor and the current Republican one are no farther apart than they appear in today's little back-and-forth.


John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at Read his @johnbrummett Twitter feed.

Editorial on 09/28/2017

Print Headline: Health-care realities

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