As Cass Sunstein has pointed out, for some Obamacare critics, “the real lesson of essentially every development in health-care reform” is “OBAMACARE IS A DEBACLE.” So it should come as no surprise that groups like Americans for Prosperity are busy twisting the facts on the “private option” policy for Medicaid expansion passed by super-majority in the legislature last April.
The AFP Foundation Arkansas Twitter account sent out these messages earlier this week: “Automatic assignment into #privateoption (aka the gov't knows what's best for you)” and “If ur eligible for enrollment in #Medicaid expansion u really don't have a choice of whether or not to enroll. It's automatic.”
Sounds scary! Unfortunately it’s divorced from reality. The first tweet references auto-assignment. If people eligible for insurance under the “private option” fill out an application but don’t select a plan, the Department of Human Services will still give them a plan via auto-assignment. This is simply a backup against inevitable signup glitches, likely to be an issue in Year One because there will be two separate portals for the exchange and the “private option.” DHS will then inform the consumer of the plan they’ve been auto-assigned; the consumer is free to pick a different plan instead if they like. No one will be forced into a particular plan — auto-assignment only happens if the consumer doesn’t pick a plan themselves, and the consumer can then opt out and pick a new one.
The other point to keep in mind is that auto-assignment only impacts people that enroll — it’s not as if DHS is automatically signing up random people up against their will. Which brings us to the second AFP tweet, which suggests that eligible people will be forced to enroll. That’s ridiculous. DHS has no authority to mandate anyone to sign up. Low-income folks can refuse to enroll if they so choose. They can even buy their own insurance instead if they can somehow afford it. Of course, many eligible people will probably choose to sign up, since they’re being offered health insurance with free premiums. But it’s their choice. (It’s true that there is an individual mandate as part of Obamacare, but most of the “private option” people are too low-income to fall under the mandate — and that’s a feature of the federal healthcare law that has nothing to do with Medicaid expansion, DHS, or the “private option.”)
When I noted this on Twitter, AFP State Director Jason Cline chimed in, “yeah. Until a friendly taxpayer funded ‘navigator’ comes along. And the waiver reads mandatory enrollment for those eligible.” First of all, the Obamacare guides can inform someone they're eligible and help them enroll; they have no power to force anyone to do anything. But Cline’s comment reveals what AFP is getting wrong. The draft of the federal waiver to proceed with the “private option” makes multiple references to the “private option” being “mandatory” for qualified individuals, which Cline continually harped on. But this refers to Medicaid beneficiaries, not the general public! If a private-option-eligible person enrolls in Medicaid, they must use a private plan via the private option — they can’t opt for traditional Medicaid instead. DHS is not (and cannot!) mandating someone to enroll in Medicaid; they’re mandating the “private option” if they enroll.
Now, I’d personally be open to experimenting with a system that gave beneficiaries the option of choosing Medicaid or another public program instead of one of the private plans. But I would be very surprised if that’s AFP’s position. It’s almost as if they’re willing to toss out any argument against the “private option” they can come up with, even if it bears no coherent relationship to the facts or their ideological position.