I’ll have a detailed post later in the week about what the new Medicaid expansion alternative in Arkansas means for the quality of care that folks in the expansion pool will receive, but thought I’d quickly note a point raised by Rep. John Burris on Twitter.
Burris tweets to highlight "how different private option can be. Those who say it's basically the same don't understand the issue." Unfortunately he links to a flimsy article by a hyper-partisan group funded by insurance companies. Nevertheless, there's a good underlying point here: The new “private option” may well lead to better health outcomes than the original Medicaid expansion plan would have. Burris is correct to point out that people like me that have been using “just as good” as quickie shorthand to describe what the new deal means for low-income uninsured folks should really say “possibly better.”
While concerns about access may be overblown, it's certainly the case that the pool of folks we're talking about — adults in Arkansas — should have more options and access for care. And there is evidence that we'd expect folks on private insurance to get better health outcomes than if they were on Medicaid.
Now there are lots of caveats here. Is this the magic of the free market or simply the fact that Medicaid is chronically underfunded? The main advantage that private insurance has is higher reimbursements and if you've finally gotten around to finishing that article in Time, you might rightly interject here that there are systematic overpayment issues in the private healthcare market. Fierce debate remains over whether spending on Medicaid or private insurance is more efficient. And many would argue that if we compare the U.S. to other nations, we find that a system relying on private insurance produces worse health outcomes than single-payer. We'll leave that argument for another day. But if we simply look at the expansion pool in Arkansas in a vacuum, could the new "private option" be even better for them than Medicaid expansion would have been? Yes.
For a clear and well-reasoned conservative argument that the "private option" is better than Medicaid expansion even though it costs more, see former Romney healthcare adviser Avik Roy (UPDATE: based on reader comments, I guess I should note that I'm not agreeing with Roy that private is better, just pointing out that he acknowledges it's costlier). But let's be clear about what's happening. If the new approach manages to achieve better outcomes and better access, it is almost certainly going to do so via higher spending.
This has left-of-center healthcare wonks, used to hearing conservatives scream about cost concerns, baffled. Aaron Carroll, director of the Center for Health Policy at Indiana University, put it well:
I guess some people assume progressives love Medicaid just because it’s government run. I support the expansion not because it’s un-private, but because it’s a cost-effective way to expand insurance coverage to the poor. Since so many conservatives think we can’t afford the cost of the Medicaid expansion, it seems odd to me that they’d be willing to spend more money to give them private insurance. I assumed that when they said we didn’t have the money for Obamacare, they meant we needed to spend less. I assumed that fiscal conservatives were worried about health care spending.
I can understand why liberals may rail against the hypocrisy of conservatives who angrily protested the cost of Obamacare but are now eager to throw extra taxpayer money to private companies. It's a fair point, but it strikes me as misplaced if one is concerned about the immediate welfare of low-income folks in this state.
On this clear-sky morning in Arkansas, I am content to simply marvel — and give thanks — that local Republicans are pushing the idea of spending more money to give more help to the poor.