What we’re seeing, at least on the Medicaid expansion issue, is how Republicans and Democrats can work together in Little Rock on their good days, and how they ought to work together in Washington at least some of the time.
Let’s bring those who haven’t been following the issue closely up to speed. You know about Obamacare. You know that Republicans, and a lot of other people, don’t like it. You know that doesn’t matter because President Obama won the election.
You may or may not know that one of Obamacare’s provisions gives states the choice of expanding Medicaid – the government program that provides health care to poor people – to those who earn up to $15,415 annually. In Arkansas, an expansion could bring an additional 250,000 people onto the rolls. The federal government says it will pay 100 percent of the cost for three years and reduce that amount over time to 90 percent.
You could probably guess that a lot of people would see all that free money coming from the feds as a pretty good deal – particularly hospitals. They treat a lot of poor people who make too much money to qualify for Medicaid but not enough to pay for their health care.
Businesses can’t stay in business for long providing their services for free. If Arkansas doesn’t take this money, other states will, so we’ll be paying tax dollars here to take care of people in California and Massachusetts but won’t be getting the same deal in return.
You could probably guess, however, that Republicans in the state Legislature still aren’t excited about it. It’s an expansion of government. They don’t want the state to get trapped into providing a service it can’t afford. There’s always a chance – a pretty foreseeable one, actually – that the debt-ridden federal government will change the terms and make states pay more than 10 percent. For these reasons, some states have said no.
On the other hand, there’s a hospital or health care provider in just about every district represented by Republicans. Plus, this part of Obamacare benefits the working poor who have jobs and are trying to do the right thing. It’s not a handout to the undeserving.
This is the toughest issue facing state legislators this year. Because Medicaid is running deficits, this is seen as a fix by some and a trap by others. So much money is involved that a lot of tax and spending issues are sort of hovering around it.
A group of Republicans have been working with Gov. Beebe to try to come up with a solution. They include Sen. Jonathan Dismang, R-Searcy, and the guy who used to write this column, Sen. David Sanders, R-Little Rock.
Earlier this year, they asked Beebe to pose an almost hypothetical question to Kathleen Sebelius, Obama’s secretary of Health and Human Services: What if, instead of expanding Medicaid, those federal dollars were used to buy private health insurance for the working poor? This would be done through the state’s insurance exchange, a soon-to-be-created menu of insurance plans that will be subsidized by the government. To everyone’s surprise, Sebelius said yes.
So now Arkansas is trying to figure out how to do that, and a lot of states are watching.
The Congressional Budget Office says this solution will cost a lot more tax dollars than just enrolling those people in Medicaid. The state Department of Human Services disagrees, saying it probably will cost a little more but maybe none at all.
Looking ahead, there’s a lot more flexibility working with a variety of private insurers than being forced into Medicaid’s one-size-fits-all approach.
Three-fourths of the Legislature must agree to the expansion, which wasn’t going to happen before this deal emerged. Expansion still might get killed by those Republicans who are opposed to anything that even smells like Obamacare. This may not be government health care, but it’s still government-funded health care.
But the process does demonstrate the creativity that can emerge when diverse officeholders at least try to work together. If Democrats had controlled the Legislature and the governor’s office, they probably would have just expanded Medicaid. If Republicans had controlled the Legislature and the governor’s office, then who would have talked to Sebelius?
Think what could have happened had Washington operated like this while Obamacare was being created. What if Democrats and Republicans had worked together over a period of several years, incorporated ideas from both sides and then passed a reasonable compromise?
Obamacare might have included tort reforms to protect good doctors and hospitals from predatory lawyers. It might have encouraged more personal responsibility. It might have mandated fewer coverages. It never would have forced private religious organizations to cover contraception.
It might have been much better. It would have been completely different. It wouldn’t even now be called Obamacare.
Oh, well. Let’s see what we can do in Arkansas.
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Steve Brawner is an independent journalist in Arkansas. His blog — Independent Arkansas — is linked at arkansasnews.com. His e-mail address is firstname.lastname@example.org