It was 1968, and the Vietnam War was at its bloody apex. The regional capitol of Ben Tre, once a Viet Cong stronghold, was now in American hands but the struggle had reduced it to rubble. A reporter surveying the ruin questioned a U.S. military officer about the tactic and was rewarded with a quote heard round the world: “We had to destroy the village in order to save it.”
The episode sprang to mind when it became clear why some of the most ferocious opponents of Arkansas’s Private Option health insurance program rather abruptly announced plans to continue it, in this current fiscal session of the General Assembly, rather than deny it funding.
They would save the Private Option in order to kill it.
A reverse analogy. An inexact one, yes, in that the amendments added to the legislation by the House, at the insistence of the Private Option’s enemies, are intended to tighten the ligature around the program’s neck, preparation for the final twist of the twine in the regular session next year. The slow strangulation, as would be inflicted by Rep. Nate Bell (R- Mena) and his allies, would refuse the state Human Services Department any money for “outreach”: advertising, marketing, promotion, consumer assistance — the oxygen required by any product, new or established. The Private Option outreach is designed to educate and enroll, to the greatest extent possible, the currently uninsured, whose health care expenses are now being absorbed by one or another provider, often hospital emergency rooms, which drives up the cost of care to everyone who does have medical coverage. (Those with especially egregious ailments or essentially no disposable incomes are routed to the Medicaid program).
Put simply, the state is offering to consumers a product — health care, or a method of paying for it — yet under the Bell amendment it doesn’t want consumers to know the product is available. And in so doing it would jeopardize hundreds of millions of federal dollars — $915 million this year — in annual federal subsidies to Arkansas. The strategy is not likely to be studied at Harvard Business School, nor is it a textbook example of running government like a business. Yet neither will it necessarily — necessarily — send the Private Option to the undertaker next year.
The $18 million the state thus far has spent on outreach, including 500 temporary workers whose job is to help “navigate” those eligible for the assistance to the appropriate destination, has helped sign up approximately 100,000 previously uninsured individuals whose medical expenses would otherwise be distributed among the more fortunate. Significantly, enrollment among younger citizens, whose clinical requirements usually pale against those of their elders, has heartened state health officials. The broader the risk pool and the healthier its participants, the fewer demands on its resources, the smaller the cost to the individual, to the taxpayer.
These same managers cringe at the prospect that any aspect of Private Option marketing could be eliminated, as do Arkansas hospital administrators, many of whose facilities are hemorrhaging dollars because of uncompensated care (“It’s running on fumes,” one state senator described his local hospital). Yet they acknowledge that terminating the enrollment campaign, while hurtful, would not automatically doom the program. To build broader public support for continuing the Private Option there would come into play, of necessity, a second private option — the private sector.
Non-profit organizations including churches and such civic groups as could be recruited to the mission, presumably encouraged and assisted by supportive state and local government officials as well as sympathetic health care providers, could put their shoulders behind the wheel and take up the outreach. (Their shoulders should have been there from the start). One possible sales pitch by hospital administrators: “Do you think we like charging you five bucks for an aspirin tablet? Do you know why we have to?”
Leaders of both chambers say they are newly confident that the Private Option will continue at least through the fiscal year beginning in June, that the initial refusal of a bloc of House arch-conservatives to prolong it will be overcome. Whether the political climate will have changed by the January meeting of the legislature, when a new governor will be in office, is anyone’s guess.
Enrollment in the Private Option and whatever impact, presumably favorable, it will have on the ledgers of public and private accounts may diminish sentiment in the General Assembly for terminating the program next year but almost certainly not eliminate it. But in renewing it the lawmakers would give it a chance to succeed if not necessarily reach its potential, which should not be measured solely in tax dollars, state or federal, saved or expended.
Put another way, the Ben Tre analogy may not hold water. Or so we should hope.
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Steve Barnes is a native of Pine Bluff and host of Arkansas Week.