Former Mitt Romney healthcare advisor Avik Roy, who went from excited to cool about the "private option," has a new post up this morning advising Arkansas Republicans to vote against it. You might be wondering why we should care what a writer at Forbes says about Arkansas, but keep in mind that Roy is an influential writer among local Republicans and his posts generally get passed around.
Unfortunately, Roy made two major factual errors in this post. After the jump: what he got wrong, which I have confirmed with DHS.
1) Roy says that the plans under the "private option" would have to follow Medicaid's "any willing provider" rules which would force them to include any provider that accepts Medicaid patients in to the network. Not so. Here's Arkansas Medicaid director Andy Allison: "Medicaid's open provider network rules wouldn't apply in the exchange any more than they apply to Medicaid managed care plans in states that have gone that route."
2) Roy says that people that make between 100 to 138 percent of the federal poverty level would have the strict cost-sharing protections in place for Medicaid below 100. Nope. The allowable cost-sharing for this group would be comparable to the allowable cost-sharing for the same population on the exchange. That happens to be what Roy says he was hoping for with the "private option." This is not an insignificant group: the Urban Institute estimates there are more than 50,000 people between 100 and 138, almost a fourth of the total pool of new eligibles. Some argue that it's even larger. Low-income recipients below 100 percent of the federal poverty level would indeed get the same protections as they would have under Medicaid. Here's Allison: "he advocates in his piece for exactly what this plan would accomplish — income-related sliding scale financial obligations that are consistent with...those in the exchange, with the addition of what amounts to the bottom end of that sliding scale in the form of the adult population below 100% of the poverty level."
I brought up both of these points with Roy in our conversation yesterday so it's surprising that he didn't check. It's also possible that he doesn't realize that Arkansas will be doing the "private option" via a waiver (the portions of the CMS memo he quotes apply to premium assistance without a waiver).
Hopefully he will correct. In any case, keep in mind that his initial enthusiasm for the "private option" was based on a misunderstanding about the cost-sharing rules, despite local reporting that explained the rules and firm understanding from all the relevant local players.
Roy is a sharp guy with a sincere interest in conservative healthcare reforms, and he's a good person for local Republicans to turn to for big-picture policy ideas. But his post this morning is specifically about how they should vote on the Arkansas plan. Given his confusion about the facts on the ground and the actual policy, lawmakers should be hesitant to take his advice on local matters.
*UPDATE: Roy has issued a correction on point 1. Addressing point 2, Roy argues that it's encouraging, but not sufficient given the Medicaid cost-sharing rules for people below 100 percent of FPL. He also notes fairly that what I describe about cost-sharing above is not clearly spelled out in the legislation. It is the plan that has been articulated to me by DHS and key lawmakers, and is part of the framework that the feds have given Arkansas permission to pursue. The legislation does need to be more clear on this point.