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OPINION | JOHN BRUMMETT: Not broken? We can fix it!

by John Brummett | March 3, 2021 at 3:59 a.m.

News item: The state Legislature is considering legislation to reapply for a federal waiver to keep Medicaid expansion alive by making changes in its nationally regarded program.

This is why Arkansas can't have nice things.

We had this marvelous creation of state government. Then we tried to break it, even kill it, and we damaged it.

But it survived, thanks to liberal federal judges, of which there are a few well-placed still robed and gaveled.

Now we intend to fix its unbrokenness.

Our prevailing mean-spirited conservatism renders us resentful of poor people and determined to punish them by whatever method is available, such as health care.

A decade ago, through the pragmatic compromising leadership of then-Gov. Mike Beebe and the pragmatic innovation of young Republican legislators at the time--Jonathan Dismang, David Sanders and John Burris, mainly--we devised our own way of accepting the Affordable Care Act's Medicaid expansion to extend health care to the working poor with household incomes falling below 138 percent of the poverty line.

Rather than simply giving these tens of thousands of poor people basic Medicaid, we'd take the federal billions and buy private health insurance for them.

It was called the private option, which is what it is and remains, though we've rebranded it to insult everyone's intelligence for political window-dressing.

The idea necessitated that the state seek a waiver of Medicaid rules from the Obama administration, which it got. The Obama administration was tickled that there was this rare Southern state willing to help its bountiful poor people.

The program has been demonstrably effective in extending health insurance to a quarter-million or more poor Arkansans, fortifying the state budget through the federal billions at a 90-10 match rate, keeping rural hospitals open by giving them reliable paying customers and holding down private premiums for everyone by depositing all those federally paid premiums into our private health-insurance marketplace.

But we struggled every two years to get the requisite three-fourths majorities of our Legislature to appropriate the money to keep the program alive. The right wing can hardly abide good government. Its lifeblood is complaining about bad government.

To get the 27th vote in the 35-member Senate, we did tricks.

We let one right-winger vote for the appropriation bill because it contained a phrase that none of the money could be used for Medicaid expansion, this on the open scam that Gov. Asa Hutchinson would use his line-item veto take out those words. That scheme offended the inimitable Sen. Stephanie Flowers, but, in the end, she saved Medicaid expansion because, even with silly right-wing trickery, she knew that the program was the right thing.

To keep right-wingers voting for it, Hutchinson came up with a work requirement that really was a computer click requirement that discriminated against the disadvantaged.

The work requirement got sued because federal law doesn't permit Medicaid to be used as a work-leverage hammer. It got thrown out in federal court. Studies showed that it managed to kick tens of thousands of people off Medicaid and find not one job for any of them.

The work requirement is pending at the U.S. Supreme Court, but the Biden administration is ending all such waivers because Medicaid is for health care, not denying health care for an absence of mouse-clicking.

Now the 10 years will soon be up on the federal waiver permitting us to do the private option.

So, obviously, the state will simply apply to re-up the program as is, right?

Why, of course not.

Since we can't do a work requirement, we'll do a "work incentive" program. People working or somehow demonstrating that they are jumping through our work-seeking hoops would keep their private health insurance. But people not able to so verify would be booted off their private plans and demoted to basic Medicaid, which is simple fee for service, and which pays less and more slowly. That would hurt our rural health-care infrastructure's nose to spite our scowling right-wing faces.

Fortunately, most Medicaid expansion recipients are working. That's why they're on Medicaid expansion rather that basic Medicaid.

Still, those folks will need to provide administrative verification or face the consequence of having a reimbursement system less helpful to their providers, which is more their providers' consequence than theirs.

Meantime, legislators and bureaucrats have come up with play-pretties to adorn on the proposed new program.

They're going to change the window-dressed name of Arkansas Works to the new name of Arkansas Coat of Paint, or something.

They've added special coverage for pregnant women, which is nice, because, as you know, this Legislature so loves and protects pregnant women that it passed a bill saying they couldn't end pregnancies resulting from rape or incest.

Through it all, here is the ultimate issue: Either we keep Medicaid expansion or we see boarded-up rural hospitals, lose billions for the state budget, and watch private premiums rise even more than they're rising.

More basically: Either we keep Medicaid expansion or we pay the price of mean-spirited conservatism.

Let's call the roll. All this chipping away at the unbroken is getting tiresome.

John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at [email protected] Read his @johnbrummett Twitter feed.

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