***UPDATE: Just now, Sen. Dismang was grilling Surgeon General Joe Thompson in the Public Health committee meeting on the 100-138 group. He didn’t explicitly mention the idea outlined below, but focused on the 100-138 group for the same reasons: if we expand, they will be covered by Medicaid; if we don’t, they’ll go to the exchange. Dismang arguing that the exchange will mean higher reimbursements for hospitals and, more dubiously, that people would prefer to be able to buy subsidized insurance on exchange. (He didn’t say this, but would also be more profits for insurance companies.) He said people should be able to buy subsidized private insurance (hmmm…what was his position on Obamacare?) but by moving the 100-138 group to Medicaid we “take that right away.” Dr. Thompson’s response: whatever you think the optimal policy for the 100 to 138 group is, feds say it’s all or nothing.***
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Despite the fact that the feds have said no, “partial expansion” remains an idea we keep hearing from Republican lawmakers as the legislature considers the Medicaid expansion question.
When I spoke with Sen. Jonathan Dismang (R-Beebe) earlier this week, he reiterated that there was no way that he could support full expansion, but said that partial expansion—establishing a lower eligibility threshold for Medicaid expansion than 138 percent of the federal poverty level (FPL), the line established by the Affordable Care Act—was “definitely something that needs to be considered.” He was at pains to make clear that he wasn’t ready to support a partial expansion outright, but said it was “an idea that seems more reasonable than the full expansion being pushed by the Administration.”
Dismang had a twist that’s new to me—perhaps the state could pick up the tab for the reduced premiums low-income citizens between 100 and 138 FPL would have to pay on the exchange if they remained ineligible for Medicaid. (Dismang said he has not yet discussed this idea with other members.)
Here’s how this would work. The most common form of the partial expansion idea has Arkansas expanding Medicaid only up to 100 percent of the FPL. The group between 100 and 138 of FPL would then be able to buy federally subsidized insurance on the exchange. For example, with no expansion, an individual making 138 percent of FPL (a little more than $15,000 a year) would pay $26 per month out of pocket for a subsidized health-insurance plan bought on the exchange. (The feds pay the rest.)
Dismang floats the notion of the state paying that $26 a month, subsidizing the remaining bit that the feds don’t. He figures that if the average Medicaid recipient costs the program more than $5,000 a year, that’s a cost of more than $500 for the average recipient once the state has to pay 10 percent starting in 2020. The yearly premiums, after federal subsidies, for folks between 100 and 138 FPL would typically be less than that, so the state might be able to save money paying that instead. And in theory, such a plan could cover everyone that expansion would.