Columns » Max Brantley

Decide on Medicaid already

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The Republican Party, newly in charge of the Arkansas legislature, isn't wearing the crown easily.

Oh, sure. It's easy to appease the gun nuts. The anti-abortion jihadists must and will be served. But after tossing chum to the single-issue sharks, then what?

The big question is Medicaid. The Congress, behind President Obama's leadership, has approved a significant expansion of the Medicaid program and provided the money to pay for most of it, meaning health care for a quarter-million Arkansans.

Arkansas Republicans tend toward Tea Baggery. They want to shrink government, even if it means depriving unemployed, underemployed and other struggling people access to health care.

Why won't Republicans just stand up and say no? It seems cruel, for one thing. More important, pressure is immense from virtually every sector of the economy to join Medicaid expansion. At least six other Republican-led states already have.

But Arkansas is in a race to the political bottom with Oklahoma and Mississippi. With a 75 percent constitutional vote requirement to pass spending bills, the odds are long on talking sense into a sufficient number of Arkansas legislators to do what's best for the state.

A handful of politically sensitive Republicans want cover. So they delay. They focus on obscure slices of the program. Should the state or the feds pay for that slice of the poor who make up to 138 percent of the poverty line? Shouldn't we study the program more? And isn't this program larded with waste, which could pay for expansion on its own?

That waste message is an oldie but evergreen. Arkansas Republicans even pushed Legislative Audit into a hurryup special audit of Medicaid, complete with some special advice on places to look, to build this case. The audit was set for a PR-style release to a mostly Republican audience two weeks ago. Republicans were madly leaking that the audit would show tens of millions in wasted money. Department of Human Services, which runs Medicaid, was informed of findings, but given no chance to respond.

DHS, however, saw enough of what was to come to see some of the methodology was flawed and said so. The Beebe administration noted the unusual procedures being followed. No chance for response? What was that about except a booby trap? The Republicans and Legislative Audit, controlled by Republicans, pulled back as the spin went against them. DHS and auditors talked further. When the audit finally was released Friday, there was, essentially, no there there.

A small sample of Medicaid recipients — notoriously hard to monitor as to assets in determining eligibility — was shown to have an error rate that might have cost the billion-dollar program $1 million. A doctor with a federal record related to possession of pornographic images hadn't filed proper paperwork on his conviction. But his past was no secret. Continuing publicity about him probably prompted Republicans to have him checked out. The doctor sees Medicaid patients in private practice, with full approval of the state Medical Board. House Republican Leader Bruce Westerman claims this bunch of trivia demonstrates Medicaid is "broken" and should be fixed, not expanded.

I've asked to see the original "show" audit. Legislative Audit won't release it. It hasn't been formally "presented," the Republican operative who's audit's legal counsel said. Republican Rep. Kim Hammer of Benton, co-chair of the Audit Committee, thought it sufficiently "presented" to post it on his website and speak of its "approval."

I'm betting the crooked path to this audit would reveal a whole lot more about Republican machinations than it would reveal about Medicaid.

Republicans don't want to expand Medicaid. People who want to save a foundering health care system, help more sick people and stimulate the Arkansas economy take the opposite view. It's a fair philosophical debate. Too bad most Republicans are afraid to wage it straight up. Which indicates they aren't so dumb.

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