I wasn’t at yesterday’s Joint Public Health meeting at the Capitol, which reviewed the ongoing implementation of the “private option” policy for Medicaid expansion, but I gather that it was an occasion for repetitive concern trolling from anti-“private option” legislators over the auto-assignment rules created by the Department of Human Services.

You can read all about auto-assignment here. The gist is that because, at least this year, the “private option” has a somewhat disjointed signup process, many folks signing up may apply for coverage but not do the final step of picking a plan (the “private option” uses Medicaid funds to fully pay the premiums of private health plans on the Health Insurance Marketplace for beneficiaries). In that event, beneficiaries will be automatically assigned a plan, informed, and then have a month to switch if they like. The assignments are based on targets geared to a minimum market share for each carrier in a given region (see here for details on the first round of auto-assignments).

Shockingly, people that happened to oppose the “private option” happen to also find complaint with auto-assignment. So we hear lots of misleading stuff like this: 


We’ve already debunked the spurious attacks from anti-“private option” crusaders at Americans for Prosperity that eligible people would be forced to enroll or forced into particular plans. What Rep. David Meeks refers to above is the wildly successful direct mail campaign conducted by DHS to reach out to SNAP beneficiaries eligible for the “private option.” More than 55,000 people sent a letter back, affirmatively replying that they wished to be enrolled in the “private option.” No one was automatically enrolled. As SNAP beneficiaries, DHS had already confirmed their income and knew they were eligible. Those folks that applied were then contacted with information on how to pick a plan. If they didn’t do so, they were auto-assigned, just like any other applicant who does everything except for picking a plan. 

Sen. Bryan King griped at yesterday’s meeting that auto-assignment “gives too much power to a government bureaucracy” and others complained about it not jibing with ideals of consumer choice. What I’ve yet to hear is a suggestion for an alternative to the situation that auto-assignment addresses: a beneficiary applying for coverage but not choosing a plan. The implication seems to be that people in this situation should be denied coverage altogether. Does that sound like a good way to implement the “private option”? Does that sound like a positive outcome for beneficiaries? To me, it sounds like something that would be appealing to people that wanted the “private option” to fail and didn’t want eligible beneficiaries to have coverage. People like King and Meeks and Rep. Justin Harris.


In this morning’s D-G, Michael Wickline reported that Harris directed a hissy fit at Arkansas Surgeon General Joe Thompson after Thompson stated the obvious: state officials should work to enroll eligible people in the “private option” if legislators want the policy to work, but “[i]f you don’t want it to work, we need to stop trying to get people enrolled and put barricades in place.” That’s a helpfully frank assessment of the situation. Harris blew up: “I think our questions are very respectful and we want the answers, and I don’t appreciate you as a surgeon general saying that’s blocking a program.” Oh please. Anyone that sits through these meetings would laugh out loud at the notion that these are fact-finding missions. It’s just talking-point-driven grandstanding. Does Harris wish us to take seriously the notion that anti-“private option” legislators are simply trying to implement this policy as effectively as possible? 

Part of what we’re seeing is lawmakers flail in search of objections to the “private option” even as the policy has thus far been a success, with around a quarter of those eligible already signed up and prices on the marketplace in line with actuarial projections of the policy’s cost. This success has come alongside the much rockier rollout of other parts of Obamacare. The desire to say “this is bad just like Obamacare” runs so deep that we get somewhat arbitrary objections on each component of the “private option,” regardless of the merits. This piecemeal bellyaching is in line with the trolling micro-management that has become the signature style of the Republican-controlled legislature. Forget the separation of powers — Republicans howl about each and every decision from state agencies on the implementation of laws. 


Auto-assignment should be drastically reduced or phased out in future years, but it’s a perfectly reasonable way to go about implementing the first year of the “private option,” which passed by super-majority last session, as smoothly as possible. It may help smaller carriers get a foot in the door in Year One of the marketplace, which could lead to enhanced competition and lower premiums down the road. It ensures that eligible people that apply for coverage get it (and gives them the ability to pick their own plan if they wish to). The main reason to be up in arms about auto-assignment? If you were rooting for the “private option” to fail.