Anti-Medicaid expansion dead enders offer phony "compromise" proposal | Arkansas Blog

Anti-Medicaid expansion dead enders offer phony "compromise" proposal

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CLARK AND BALLINGER: Picture me trollin'.
  • CLARK AND BALLINGER: Picture me trollin'.

Sen. Alan Clark
and Rep. Bob Ballinger today presented their "compromise" on Medicaid expansion. It's baloney. 

Clark opened by griping about Medicaid expansion with the long list of complaints that are by now as stale as a box of crackers you opened and forgot about three long years ago. He complained that they are called obstructionists just because they are threatening to shut down the entire Medicaid program if the majority doesn't cave to their demands. He said that they have already offered generous compromises (what he means is that they have offered to kill the Medicaid expansion a bit later instead of immediately, which Medicaid expansion proponents unsurprisingly don't view as a compromise at all). 

Their latest pitch has the novel feature of trolling the governor by suggesting that the private option move beneficiaries to traditional Medicaid instead of private plans. That's what many Democrats would have preferred in the first place (as a reminder, the private option purchases private plans for low-income Arkansans instead of covering them via the regular old Medicaid program). Otherwise, the Clark-Ballinger proposal is filled with poison pills and reductions in coverage that make it a complete non-starter. It's DOA. No "Arkansas Works" backer would ever consider it for a moment. 

The proposal would do five things:

1) It would end the Medicaid expansion for people who make more than the federal poverty level. Currently, Medicaid expansion covers adults who make less than 138 percent of the poverty level. The Clark-Ballinger plan would kick those above 100 percent of the poverty line off of the private option. The federal government has been crystal clear that they will never accept this arrangement under any circumstances. Even aside from the fact that Democrats aren't going to agree to a reduction in coverage, in other words, this is a pure poison pill. Dozens of states  — including Arkansas in the original negotiations — have asked the federal government whether they can do "partial expansion" — take the Medicaid expansion funds for folks below the poverty line but send the folks above the poverty line to the subsidized exchange (in states that do not expand Medicaid, those in this 100-138 FPL group are eligible for the exchange). The federal government has said over and over and over again that the ACA does not allow partial expansion. If a state wants to expand Medicaid only up to the poverty line, they lose the Medicaid expansion match rates. The state could do what Ballinger and Clark suggest, but they would have to pay three times as much, prohibitively expensive. This Ballinger-Clark ask is simply impossible — it is an ask that would only be made by people intentionally trying to derail the expansion or people who simply haven't done much research on Medicaid policy. 

2) It would move the remaining beneficiaries from private plans to the traditional Medicaid program. This is a kind of trolling effort that is ostensibly meant to excite Democrats. Many Democrats argued that traditional Medicaid would be less costly than the "private option" approach, which uses Medicaid funds to purchase private health insurance for beneficiaries. The aginners here are suggesting that traditional Medicaid expansion would be better than the private option. That's an interesting policy question that will be a key issue in evaluating the private option experiment, but the governor and pro-"Arkansas Works" Republicans are not going to switch course now and go with regular Medicaid expansion as originally envisioned by Obamacare. 

Clark argued that beneficiaries were getting "preferential treatment" by getting private insurance coverage instead of regular old Medicaid. Putting on his Bernie Sanders hat, Clark also said that the private option was "corporate welfare for insurance companies." And he said that medical providers were also getting "corporate welfare" via the better reimbursement rates from the PO as opposed to traditional Medicaid. This is an argument that might be convincing to Democrats if not for every other part of the Ballinger-Clark proposal (and let's just say that the chances of a massive overhaul from the PO to old-fashioned Medicaid expansion at this point in the political and policy debate is...unlikely). 

3) No coverage for emergency contraception (and likely no coverage for abortion in the case of rape, incest). "No abortion funding," Clark said. "The funds should not go to any abortion services or abortifacient prescriptions [he means the morning after pill]." The private option is subject to the Hyde amendment and doesn't cover abortion services except in cases of rape, incest, and life of the mother. Would their proposal eliminate the rape, incest, and life of mother exceptions? "Life of the mother would be an exception I would support," Ballinger said. Clark went further: "No public funding of abortion." No exceptions. 

The other point that Clark and Ballinger are pressing here is emergency contraception, which they believe is abortion, against medical evidence. Currently the private option covers the morning after pill. Federal law mandates that all private plans offer this coverage with a prescription. We just went through this charade just last week! All that said, the Clark-Ballinger plan envisions switching everyone from PO plans to regular old Medicaid and states do have more flexibility on the issue when it comes to the Medicaid program itself (as opposed to the private plans used by the PO) — although even there it's unlikely the feds would be kosher with all of Clark and Ballinger's demands. 

Another issue: Some anti-abortion activists also argue that certain types of the IUD (the most effective form of long-acting reversible contraception) are abortion. Asked about IUDs, Clark and Ballinger said they were not familiar enough with them to have a position, so unclear whether they would ban IUDs too. 

If the Obama administration didn't agree to the relevant waiver requests, the private option would end, Ballinger and Clark said. Since that's what would happen, that's what would happen. Ladies and gentlemen, a poison pill! 

4) No dental coverage. The governor's "Arkansas Works" plan would offer dental coverage as an incentive for beneficiaries to comply with best wellness practices (visiting a primary care doc once they sign up). Ballinger and Clark do not want to offer dental coverage under any circumstance and they would nix this aspect of "Arkansas Works."

5) Funding cap. If the Arkansas share rose above $200 million per year, the program would end. Clark and Ballinger are already offering a proposal that would de facto kill the private option via poison pills. Now we arrive at the familiar part of the proposal where Clark and Ballinger suggest that we kill the PO, just later instead of right now. Most projections have the total spend at around $2 billion per year once we get five or six years down the road; with a ten percent state match, that means Clark-Ballinger have a de facto proposal to end the private option around 2021. 

Some odds and ends: Clark also suggested hand-waving talking points on unspecified waste, fraud and abuse, proposing "a massive overhaul of DHS and Medicaid." The governor is already proposing something along these lines with his managed care proposal and related reforms, so unclear what Ballinger-Clark want instead.

Clark also complained that the current private option ends up generating net revenues for the state, which he considered a bad thing because it's all funded by the federal government. I'm unclear on how, logistically, the Ballinger-Clark plan would avoid the "problem" of helping the state bottom line and instead deliver a worse outcome for the state. 

In case there was any confusion about the poison-pill plot, Clark said that if the Obama administration didn't agree to Clark-Ballinger's terms, that would mean the end of Medicaid expansion. "As far my vote, yes," Clark said. "I'm being very generous here. I said, 'when Hell freezes over' and when the Obama administration bends, Hell may freeze over." 

The governor's staff was on hand, hearing the proposal for the first time. "I didn't want [the media] to know about it until now," Clark said, explaining why he had not sent the proposal to anyone before the presser. 

Only one other senator from the Tea Party Ten showed up (Sen. Gary Stubblefield). 

Clark and Ballinger want a fair hearing, so I have tried to provide a thorough analysis above despite my suspicion that this is an elaborate trolling exercise. This is the last gasp of Lost Causers who know that they have been thoroughly defeated. 

TL;DR version: LOL, DOA. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.


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