by Max Brantley
In case you missed it, the message at yesterday's budget hearing on the state Medicaid program was simple:
Arkansas can lay out an additional half-billion in state and federal dollars and still be forced to slash important services to 75,000 people. Or it can join the federal health care law's expansion of Medicaid at no cost to the state for three years and expand help for hundreds of thousands of Arkansan living without a health safety net and, in the process, incurring immense unseen costs for us all. Not to mention dying.
Rational people would take the money. Many Republican legislators simply won't. These include many legislators braying about forcing poor people to put "skin in the game" who are happy to get taxpayer-financed health insurance for themselves. And when this same crowd starts talking about waste and fraud, ask them for some figures on the relative cost of fraud by people seeking medical services against fraud by pharmaceutical companies, hospitals, doctors, insurance companies and others getting rich off the system. The problem isn't a sick old lady seeing a doctor too often. Nor is it lack of co-pays.
Arkansas Advocates for Children and Families has produced a good explainer and graphic material on what the legislature faces. It outlines the dimension of a problem that extends far beyond the presumed moochers to working people who serve them:
Medicaid works for Arkansas. It helps our disabled neighbors, elderly Arkansans, and thousands of children in low-income homes get care when they need it most. According to DHS officials, Medicaid will face a $138 million state budget shortfall in 2014 after help from $160 million in new state dollars ($70 million of which will be one-time funding. The potential impact of the shortfall on services is $460 million in total state and federal funding.
Thankfully, Arkansas has a chance to help solve that problem while offering health coverage to more than 250,000 of our fellow citizens. This coming session, legislators will decide whether or not to extend Medicaid services to folks in Arkansas who currently have no other option for health care. It’s a move that would save the state $372 million over the first eight years, according to the state’s Medicaid director, Andy Allison. Extending Medicaid is a good deal for Arkansas.
Members of the newly-elected legislature have said Medicaid will be one of the biggest issues of the upcoming legislative session. So far they’re right. In budget hearings yesterday, legislators and Department of Human Services officials discussed ways the program will change in the coming years. Due to the budget shortfall and lack of new revenue, officials were forced to suggest cuts to Medicaid.
To save $130 million, new “efficiencies” were suggested, including prior authorizations for dental care and some ARKids First services, accounting changes for school-based Medicaid programs, and new audits for outpatient therapies. Other measures, including a three percent cut to provider payments, are designed to save millions, but they may also restrict access to care by impacting provider participation. Actual service cuts include:
* Eliminating adult dental care (40,000 adults affected)
* Dropping ARHealthNetworks coverage for working adults (20,000 adults affected)
* Restricting new enrollees for home and community based waivers for those with disabilities
* Cutting “level 3” nursing care for those not wholly dependent on help for daily living (up to 15,000 adults affected).
We know these services are important to families across the state.
Luckily, children were spared, for the most part, from direct cuts. However, 75,000 parents, grandparents, and other adults may not be so lucky. The state cannot afford to make the penny-wise but pound-foolish decision to cut back on current Medicaid services. Nor can we miss the opportunity to guarantee coverage to all eligible Arkansans. Not only will strengthening Medicaid give Arkansans more health coverage options, it will help some of the state’s fiscal problems by making sure rural hospitals stay in business, generating tax dollars that will stimulate the economy, and cutting down on the cost of uncompensated care all at a cost of $0 over the first three years. In fact, DHS’s revised savings from extending Medicaid total $159 million in 2014-15.