by Max Brantley
I quibbled with some Republican shills last night on Twitter about their bodacious spinning on the growing Republican support for taking federal Medicaid expansion dollars for Arkansas, but doing so through private insurance rather than a government-run program. Bottom line is the same: It will mean a huge increase in government spending on health care for the working poor. That's good. But I was just a bit rankled when a Republican convert to a plan wholly created by Obamacare sent out a Twitter last night again talking about the evils of Obamacare.
The Stateline news outfit has an instructive piece on the growing interest among previously dug-in Republicans about so-called "private option" Medicaid expansion. It addresses directly the semantic question.
Is it still Medicaid?
To beneficiaries and health care providers, the strategy that Arkansas and Ohio are pursuing would look exactly like private insurance. Instead of a Medicaid card, the newly eligible adults would get a private insurance card. They also would be responsible for certain co-pays, just like private insurance subscribers. The difference is that the state Medicaid program would pay their premiums with federal dollars.
The Medicaid agency would maintain control over enrollment and could determine that certain people in the expansion group, such as those with severe chronic illnesses, should receive traditional Medicaid benefits, including home health services and long-term care.
In fact, the private option already is allowed under the federal Medicaid law, although it is rarely used. Called “premium assistance,” it is considered cumbersome by Medicaid officials because it requires the agency to find a policy with roughly the same set of benefits that Medicaid offers—or provide additional benefits separately—and it must cost enrollees no more in copays than other Medicaid subscribers pay. If it does, Medicaid must reimburse the beneficiary.
But using the premium assistance option should be less of an administrative burden in 2014, when the federal health law takes effect. That’s because insurance companies should be eager to create plans that fit the state’s existing Medicaid benefits, because it will give them the opportunity to sell policies to hundreds of thousands of newly eligible beneficiaries.
Quacks like Medicaid to me. If it makes Republicans happy to call it something else — and gets Obamacare done — fine. But, as with Michael Cook's earlier on the cell phone tax increase, the hypocrisy is a little galling. An honest Republican would admit Obamacare was too good a deal to pass up and so they've decided to go along with implementation, but under a plan that he or she thinks is superior on grounds of benefit and efficiency. (For now, it seems likely to be less efficient and thus marginally more costly, but the real experience will ultimately decide that and possible changes in the future.)
PS — Note, too, that House Republican Leader Bruce Westerman is calling again for (AP) (and Gov. Beebe is rejecting) a special session to deal with Medicaid. More time to answer questions, see. More delay. Delay is defeat. Despite the growing warmth of Republicans toward an insurance industry-fattening "private option" approach, it seems clear some resistance in the ranks remains.