Pitching the Medicaid deal: e-mails hint at strategy | Arkansas Blog

Pitching the Medicaid deal: e-mails hint at strategy

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For those interested in the political ins and outs of the Medicaid deal, don't miss Charlie Frago's juicy story (paywall) in the D-G this morning. Based on FOIA requests of emails from the Arkansas Department of Human Services, Frago pieces together fragments of the narrative leading up to the deal and suggests some coordination between leading Republicans and administration officials.

As we've speculated, Rep. John Burris appears to be the point man, he's making the hard sell to Republicans, and he has allied with administration officials — including at DHS — that he previously sparred with.

• A good chunk of what Burris refers to as "cuts" are really reductions in cost that are part and parcel of expanding, whether through Medicaid expansion or through the "private option." For example, there will inevitably be reductions in state expenditures on uncompensated care; there will also be certain populations temporarily eligible for Medicaid that will move to the expansion population at higher match rates. (I'll note for the umpteenth time that Republicans used to not believe in these offsets. Times change.)

• That said, there may be fights to come if Burris is looking to cut further, though I'll note that House Speaker Davy Carter explicitly promised that there would be no further service cuts to the existing Medicaid program over the next two years: "not going to happen."

• Medicaid Director Andy Allison confronts the cost question. My reading is that this confirms what we've said: this approach to providing coverage will likely be costlier; it will be a lot costlier to the feds; because of various savings and revenues, it will still likely be a net fiscal positive for the state. Here's Allison: "We do expect the gross costs to be higher than expanding traditional Medicaid in the first years of the expansion. However, it isn’t clear that those higher costs mean that expansion turns from being a net saver to a net coster for the state in the out years (2017 and beyond)...In any event, I don’t view this option as committing the state to a more costly expansion."

• Sounds like the 3-percent rate cut to Medicaid providers to address the shortfall will no longer be needed (good news for providers of course, but also for Medicaid recipients, whose access tends to suffer when reimbursements are slashed).

• I'm burying the insider-gossip lede. Lots of administration officials really enjoy referring to the governor as "Beebelieber."

We'll have more on policy, fiscal and legal implications of the new expansion deal in the coming days, but at the risk of going too inside baseball, I'll quickly point out that Burris is looking like a sharp political operator at this point.

1) He was widely seen as the man behind the scenes of Carter's surprise maneuver to grab the Speakership.

2) Carter gave him a plum gig as Chair of Public Health.

3) He led the charge for an alternative plan that could be sold as not-Obamacare (even though it relies on the central tenets of Obamacare).

4) As a rabidly anti-Obamacare crusader who always looks like he wants to punch someone during committee meetings, he was uniquely positioned to sell the plan "Nixon to China" style to Arkansas Republicans.

5) So if he leads the way on passing a bipartisan plan to expand health coverage to the poor, save hospitals, and bring economic stimulus...

What's next? Boy Governor? Folks think of him as more Angry John than Slick Willie, but seems like he's pretty slick.


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