Despite an outpouring of interest and questions as many of the key components of Obamacare launched this week, federal grant money to continue an outreach campaign in Arkansas remains in limbo. Without the money, the Arkansas Insurance Department would have no funds to educate people about new coverage options under the law. That means no media campaign, no direct mail. When they run out of brochures, they’ll be unable to print more.

On Monday, the Legislative Council declined to review a $4.5 million, federally funded contract that AID had with Mangan Holcomb, a local marketing firm. The review process is merely symbolic and Gov. Mike Beebe could simply ignore the Legislative Council and have AID fulfill the contract, which has already been appropriated. Thus far, he has shown no inclination to do so. (Some argue that giving legislative review a real veto makes it easier to get appropriations passed during the session — legislators may be more likely to vote for an appropriation to begin with if they’re told they’ll have a chance to review and potentially nix it after the session.)


So what’s next? 

Insurance Commissioner Jay Bradford
said that he was an “eternal optimist” and that AID might try going back to the Legislative Council after the shutdown and debt ceiling are resolved. “Once they get those issues solved in D.C., that might settle down some of the issues here in the state of Arkansas,” Bradford said. “We’ve got the money, it’s committed to the state of Arkansas from the federal government, and we desperately need to educate the public.”

“We certainly want to listen to the legislature and get their advice about how to best communicate with their constituents,” Bradford said. “I feel like we’ll reach some type of agreement with the legislature to go forward.”


However, Republican legislators, spurred on by a “#StopTheAds” campaign from Americans for Prosperity, seemed dead-set against any expenditure on outreach whatsoever on Monday. Short of making ads telling people not to sign up and that Obamacare was evil (maybe this would get approved), it’s hard to imagine a compromise or tweak to the outreach campaign that would make any difference. One Republican lawmaker I spoke with suggested that perhaps the campaign could have more of a focus on educating people generally about insurance and health care utilization. We’ll see.

Even if there’s a compromise that can bring a few pro-“private option” Republicans on board (outreach is crucial for the functioning of that policy), it won’t do much good if so many Democrats keep no-showing to Legislative Council meetings. Ultimately, “review” of the contract requires only a majority of the quorum. The Tea Partiers have been much more disciplined about attending off-session meetings than the Dems. 


If Arkansas doesn’t spend the money, what happens? Unclear! The feds have already given the grant money to the state. According to AID, this type of grant money cannot be returned to the feds. It also can’t be spent on something else.

What happens if Arkansas is suddenly left without an outreach budget? Will the feds step in and help? Unfortunately, probably not — the federal money is largely allocated to states that declined to do any outreach work on their own. Because Arkansas received grant money to take on the work ourselves, the feds haven’t allocated any advertising or outreach funds to Arkansas.

The contract was intended to continue a campaign that Mangan Holcomb already began, with an initial focus on getting the word out that new options were coming. The next phase, which was supposed to begin on October 1 when the Health Insurance Marketplace launched, was supposed to transition into the nuts and bolts of how to enroll. “It’s like going to a second act of a play and you stop,” Bradford said. For now, AID will have to rely exclusively on the “guides” (trained outreach workers, also federally funded, via a different grant). 

If outreach is underfunded in the state, fewer people may find out about new options they have for health insurance, in many cases including insurance at little or no cost to the consumer. That’s not just bad for bleeding-heart reasons. If healthy people eligible for the Marketplace or the “private option” don’t sign up, premiums will shoot up over the long run, which means higher costs for the government and for consumers. Since sick people are the ones most likely to find out about insurance options on their own, it’s vital to have a strong outreach campaign to get the word out to healthy folks.


Millions of people are trying to get on to the federal website to sign up, so many that the system hasn’t been able to handle it this week. Locally, the AR Health Connector web site has had more than 60,000 visits. The Department of Human Services sent out 132,000 direct mail pieces about the “private option” and got responses from an incredible 55,400 adults (this announcement came just a day after Sen. Gary Stubblefield said during the debate over the contract that direct mail didn’t work because it would just get thrown away). People are interested. They have questions. They need information. Particularly when there is a very well-funded misinformation campaign afoot. 

Rep. David Meeks and others have several times said that we shouldn’t encourage people to “board the train” because he is concerned that there will be a TRAINWRECK!!! This a particularly clownish use of U.S. Sen. Max Baucus’s out-of-context quote. Baucus said that the rollout of the law could be a train wreck if outreach and education weren’t properly funded. Meeks & co. are desperate to defund outreach and education. They’re not concerned about protecting people from a train wreck. They’re trying to wreck the train. 

And hey, I get it, they hate Obamacare and they want to see it fail. But blocking outreach money means that citizens will be more confused. It means citizens may be less likely to learn about affordable options for coverage that they desperately need. That’s the thing about trying to make public policy malfunction. It hurts people.

That’s the really infuriating part about this whole kerfuffle. The very same lawmakers insisting that Obamacare won’t work and that no one will want these plans are the ones fervently working to keep citizens in the dark. It’s almost like they’re afraid of what will happen if their constituents know and understand their options, and decide for themselves.