The Supreme Court ruling on federal health care law set the stage at the Arkansas Capitol today for more health discussions.
A group of Republicans — legislators and Lt. Gov. Mark Darr, who'd personally intervened in the case —called an afternoon news conference to blast the decision and promise all possible resistance.
Elsewhere, officials of the Beebe administration held a session to explain their plans to reshape Medicaid in a way that they hope will save money in the billion-dollar program about 70 percent paid in federal dollars.
Darr led the way at the Republican news conference. He said the state should hold off on implementing any part of Obamacare for as long as possible. Nor does he think Arkansas should expand Medicaid, as the law anticipates.
Both Darr and Sen. Jeremy Hutchinson asked what will happen to uninsured citizens in states that choose not to expand Medicaid. “I know there are reports from governors all over the country that say they’re not going to voluntarily expand their Medicaid program. What happens if the majority of the states don’t do it? Are those people taxed because they don’t have insurance? Are they given a rebate? Where does the money come from to rebate all these people? It opens up a whole lot of questions that we as legislators need to get the answer to before we move forward. I know we’ve had reports from state agency heads that say onward and forward, but I think that’s the wrong approach. I think there are more questions to be answered now than before today’s rulings…I think it’s important to wait and see what other states do. We don’t want to be the only state that voluntarily agrees to Medicaid expansion," Hutchinson said.
Hutchinson joined a Republican messaging point that became ubquitous as the day wore on. Obama had campaigned against raising any sort of tax on lower income Americans, but carried the day in the Supreme Court because the mandate was construed to be a tax.
"Despite the Administration campaigning for this legislation on the grounds that it’s not a tax, today they embrace it as a tax…the frustrating thing is, this tax, unlike any other tax in American history, most taxes, you’re taxed because of income, or because you decide to purchase something…this tax is not broadbased. It is not spread out across the population as a whole. It selects a few people and taxes them for their mere existence. They’ve done nothing, they chose to participate in nothing, they’re not participating in a commerce, they’re taxed because they exist," he added.
Talking Points Memo offers a more nuanced discussion of this. It's not as simple as Hutchinson suggests. The mandate, plus a variety of health insurance options, exists regardless of how far states go in expanding Medicaid for the poor.
TPM also notes that the call by Republicans to refuse to set up state health exchanges — nullification in other words — is empty talk because the feds will do it if the states won't.
Darr's full statement and some video after the jump. But first, Leslie Newell Peacock's coverage of the state's explanation of coming Medicaid changes:
The state is going to change the way it reimburses medical providers with a “medical home” strategy that substitutes for the fee-for-service model by gearing payments to episodes of illness, rather than doctor visits. The system also appoints a “principal accountable provider” to coordinate patient care between hospital and doctor’s office.
State Department of Human Services Director John Selig, Medicaid director Andy Allison, Medicaid medical director Dr. William Golden and the medical directors and administrators of insurers Qual Choice and Blue Cross and Blue Shield talked about the changes, which go into effect Oct. 12, in a press briefing today.
Selig also fielded questions about the Supreme Court decision on the Affordable Health Care Act, which would allow states to opt out of Medicaid expansion. “We’ve been planning to do the expansion all along,” Selig said. It will cost along the lines of $1 billion a year; the federal government will pay the first three years.
“The health care system in the United States doesn’t work particularly well,” Selig said understatedly. Americans pay twice as much for care than other wealthy nations and outcomes are worse. “We’ve got to get a handle on that,” he said. Rather than serve fewer people, pay providers less or cut down on access — solutions in other states, he said — Arkansas will avoid such “slash and burn” options in favor of going to a more efficient system (though he added that doesn’t mean the future doesn’t mean reduced care). Fee for service encourages volume; paying by episode will encourage efficiencies, cutting down on doctor visits, unneeded procedures and what Blue Cross medical officer Robert Griffin called “therapeutic misadventures.” One example: Nearly half of Arkansas patients who are treated for upper respiratory tract infections are written a prescription for an antibiotic, though medical standards recommend them in less than 5 percent of such cases.
The state rejected bundling — which would have created a reimbursement standard up front to control costs of procedures — and has consulted with doctors around the state to come up with standards of care for the best outcomes at the best price. Medicaid office will look at charges for various procedures — hip and knee replacements, perinatal care, simple upper respiratory tract infections, acute congestive heart failure and attention deficit hyperactivity disorder — and reward doctors whose outcomes are good and charges fall below “acceptable costs” and penalize those whose charges are above “acceptable costs.” Reports from the doctors themselves will create the measure by which Medicaid determines what’s acceptable. Providers will receive performance reports based on what they report to Medicaid on where the stand in relation to their colleagues. “We’re not talking about reducing rates” of reimbursement, Selig said, but ending “over-utilization.”
Allison stressed that Medicaid is not relying on simple averages to create acceptable reimbursement levels, but is looking at “outlier” cases as well. The team said it expected to see change in the first three months of implementation.
Selig said the new payment plan won’t eliminate the predicted $250 million to $400 million shortfall the state Medicaid program faces next year. An accumulating surplus might offset some of it, however.
The commercial insurers said they will implement the model for private pay patients at a later time. Qual Choice president Michael Stock believes the “medical home” system will slow “the inflation factor” in the cost of health care, which has tremendously outpaced other cost increases. Steve Spaulding, vice president of Enterprise Networks for Blue Cross and Blue Shield, said he believes a more efficient medical system will help attract business, offering a conversation he had with a businessman who said the efficiency of an area’s health care system has become as important as tax incentives in deciding where to put in a factory.
The website www.paymentinitiative.org has more details on the “medical home” plan.
MARK DARR STATEMENT
"For months now some of us hoped the U.S. Supreme Court would rescue us from the political process. Today’s decision is a wake up call. It shows that political decisions must be made not by courts but by legislators and executives. As you know, I joined the lawsuit challenging Obamacare a year and a half ago. Like most Arkansas I take issue with the government overtaxing us and over-regulating our lives. Today’s decision shows that I was right. Our counsel is right to have said that the Law of Interstate Commerce did permit the mandate. However, most of us never dreamed that the Supreme Court would interpret Congress’s power to tax in such a broad way. Like 70% of the citizens in our state, I remain concerned about the prospects for the people of Arkansas. The White House healthcare plan encourages employers to dump their employees into health exchanges. It significantly expands abortion funding and it puts federal bureaucrats in charge of literally millions of decisions that should be confined to doctors and patients. Its immense cost endangers our economic health. The advocates of Obamacare believe they prevailed today. But efforts were made in our state legislature last year to approve Obamacare. Our attorney general and other democratic legislatures were tireless advocates of leaving Obamacare alone. Today I tell you the fight over this issue has only begun. In case the will of the people hasn’t been clear, their message will be solidified in November. My desire is for a new president and Congress who will repeal and replace this law and state legislatures who will stand firm against it at their level. One ray of hope is that the federal government cannot punish the states if they chose not to participate in this Medicaid expansion program. This decision underscores the fact that when Arkansas’s political establishment said we had to grow government, they were wrong. What conservative legislatures were saying was right. We unnecessarily wasted millions of dollars starting these exchanges when we didn’t have to. In addition, Arkansans were promised their taxes would not go up. Because of this law, clearly Obamacare is nothing but a tax, forcing people into decision against their will. President Obama promised us that he would not raise taxes on the middle class. The Supreme Court has now revealed that our president is responsible for one of the largest middle class tax increases in history. My first reaction this morning was disappointment. In fact, however, the court has put this issue back where it belongs – in the hands of the states. I pledge to continue to stand up for Arkansas, and together we can and will get government out of our lives and will bring real reform to our healthcare system. Today I call on every elected official who served in this Capital, whether they’re a Democrat or Republican, to publicly take a stand. While your vote on this issue will be recorded next session, Arkansans deserve to know where you stand right now. Will you stand with President Obama and continue to burden Arkansans or will you join me and others in bringing real healthcare reform to our state? The line in the sand has been drawn, and now is the time to let real conservatives know what we plan to do. Conservatives in Arkansas, now is the time to reform the Patient Protection Act, so that its better for patients, for doctors, for our country, and we encourage them to do so. There is no doubt that our current healthcare system is sick and needs reform. At the federal level, we need to encourage our lawmakers to repeal and replace this bill. At the state level, we need to work to expand the choice in insurance providers, give medical professionals more freedom to practice medicine, and make sure we provide for the truly needy and deter frivolous healthcare lawsuits. To the people of Arkansas, I say this – I heard your concerns and I stood with you. And today, I continue standing with you. And together, we will win the battle."
Rep. Dave Sanders answers some questions after the press conference: