Of the two big state budgets that have grown apace the past few years, prisons and medical services for the poor, Gov. Huckabee proposes that one grow next year by 20 percent and the other by 3 percent.
You know which is which. Prisons are in vogue, the poor are not.
It would be uncharitable to say that the governor cares more about the welfare of criminals than of the poor, though that is the kind of analogy he might draw if he were on the other side. Huckabee doesn't consider hiring a small army of prison workers to be coddling inmates, and let's all stipulate that it isn't. The public has come around to accepting that.
Spending a great deal more on prisons is a way to show that you're tough on crime, not soft on it, though there is no evidence suggesting that bigger prisons make society measurably safer.
Holding the Medicaid budget to 3 percent, the rate of general inflation, while medical inflation is more than twice that level, is grandstanding of a different sort and potentially more harmful. People will be hurt.
Cutting the Medicaid budget and holding down the pay of public employees are the linchpins of Huckabee's austere budget, the way he proposes to stem the wild, "uncontrolled" growth of government under his predecessors, Jim Guy Tucker and Bill Clinton. It was Tucker's own extraordinarily tight budgeting, in fact, that checked government operations and produced slightly more than $200 million in surpluses in his three years at the reins. Huckabee is getting to spend a lot of that money.
The governor didn't spell out how he wanted the Medicaid program reduced to the rate of general inflation the next two fiscal years, leaving that to the professionals in the Department of Human Services. He seemed to bless one option mentioned by Tom Dalton, the director: Require the poor to pay a larger share of medical bills as a condition of getting help.
Huckabee suggested that the 3 percent budget could be reached without denying benefits to the needy or hurting anyone. You merely cut out the proverbial waste and fraud.
Humane words don't constitute policy. If the state cuts Medicaid spending far below the medical inflation rate, it will do so at the expense of the health of poor people. Requiring large copayments from people who cannot pay them in order to get prescriptions or to obtain medical care will keep thousands away from the clinic door. Medical professionals on the task force assembled to find Medicaid savings found it an unacceptable way to meet the governor's target.
Not many other ways present themselves.
¥ The state can slash reimbursement to nursing homes politically undoable.
¥ It can reduce the number of prescriptions that poor people can get filled each month. Studies have shown people get critically sick and wind up in the hospital. The state doesn't save anything.
¥ The state can reduce the number of reimbursed days in the hospital, dumping critically sick people or driving up charitable care.
¥ The state can raise eligibility requirements, ending coverage for tens of thousands of women.
The crusade is based on another popular myth that the Medicaid program in Arkansas is spiraling out of control, bloated by administrative costs. The governor said not long ago that only some 14 percent was dispersed in benefits to poor people.
Actually, administrative costs run about 4 percent of the program, one of the best ratios in the country and low by even private standards.
Arkansas ranks ninth in the nation in the high percentage of its people who live below the poverty line (17.3 percent), but unusually high shares of those do not receive any government medical benefits. One in every five Arkansans has no health insurance, government or private.
Out of control? Arkansas ranks near the bottom even among the low-benefit states of the South in the per-capita money spent on Medicaid. Only Alabama, Florida, Oklahoma and Virginia are lower. And of the money spent on Medicaid in Arkansas, the share covered by the state government, 26.4 percent, is one of the lowest in the country.
David Wroten, a lobbyist for the conservative Arkansas Medical Society, ordinarily not a cheerleader for government programs, told the government task force last month: "Our Medicaid program is one of the best in the country. It is run by some of the best in the country. Don't do anything to destroy that."
The governor's not. He's just going to make it more exclusive.
Print headline: "Medicaid plan will hurt people" December 20, 1996.