“I am not all about letting these people that’s on this insurance plan be in the cold. I’m not about that. I think we can fix this before we leave here. I think we all can agree with that.”
–Rep. John Hutchison
“Nobody here wants to hurt anybody.”
–Rep. Bob Ballinger
“This idea that we’re going cast 100,000 people off their insurance plan is not part of this plan.”
–Sen. Jim Hendren, referring to the Ballinger amendment which would cast off 100,000 people off their insurance plan in March — or actually more likely July in practice because of a poison pill request to the feds; Hendren previously proposed an amendment that would cast 100,000 people off their insurance plan in December rather than July.
“[We need to] make sure we continue to cover Arkansas, make sure those folks [under the poverty line], make sure they have the health care.”
–Rep. David Meeks
The opponents of the private option do not believe there should be a publicly funded safety-net program providing health insurance for low-income Arkansans. They are putting enormous energy into ending the private option, which would take away coverage from 100,000 (and counting) people.
For some, politics come into play, but those in the hardcore opposition – the Ballingers and the Hendrens – have sincerely held reasons for that belief. I certainly do not think that they wish to kick 100,000 people off of coverage out of spite, or lack of care. They simply believe that the private option is bad public policy.
But the outcome of their preferred policy — ending the private option — is precisely to kick 100,000 people off of the coverage they’ve gained this year through the private option, and to ensure that around 100,000 more eligible people never gain that coverage at all. It’s time for opponents to own that. The press conference introducing the Ballinger amendment last week was a bizarre spectacle. Lawmakers deeply committed to ending the private option offered a “compromise” which explicitly ends the private option, and then stood up there saying they weren’t ending the private option. But the really silly part was their insistence that they weren’t kicking people off of coverage, as if kicking folks off in December, or in March, doesn’t count.
I think it’s helpful to think through this in the context of the full debate over the past year. Ballinger and Hendren and others in the hardcore opposition are on the record vociferously arguing that the state never should have enacted the private option to give coverage to low-income Arkansans, that it should be defunded as soon as possible and indeed that they are willing to block the entire Medicaid budget if it includes the appropriation to cover low-income Arkansans under the private option. They do not believe that this policy should be in place to cover 100,000+ Arkansans. They want it to end, and for coverage for 100,000+ Arkansans to end with it. Again, they have sincerely held reasons for that belief but their specific policy goal is to take that coverage away. Every “compromise” they have offered explicitly does exactly that. Taking people’s coverage away at a later date than July 1 or hand-waving about some unnamed alternative plan does not provide political cover or change this fundamental fact.
During the press conference, both Ballinger and Hendren used the old argument that Sen. Cecile Bledsoe used to trot out, that somehow it was better for someone to never have health insurance than have it and then some day, possibly, lose it (in addition to ending the private option altogether in March, the Ballinger amendment would prohibit eligible beneficiaries from enrolling after July 1 — along with defeating the purpose of a safety-net program, this would be a total non-starter with the feds).
“[Let’s] limit the enrollment so we’re not affecting so many people,” Ballinger said. “The reality is one way or the other, in November, a lot of the votes that are taken are going to be about this. If this program is going to go away, than we don’t want a lot of people who are going to be hurt by it.”
Hendred agreed; they were proposing “pausing it so we don’t hurt more in the event that it does have to go away.”
Ballinger and Hendren, in other words, claim that it only “hurts” people if they gain coverage but then lose it at a later date; refuse to give them coverage at all, no harm done! If one gives it even a moment’s thought from the perspective of beneficiaries, this makes absolutely no sense.
I think this is the tell about what’s really going on here. It’s not that private option opponents are worried about hurting the people who would be denied coverage – again, they do not believe they should have this publicly funded coverage and ending it is precisely the goal. They’re worried about the political optics of folks losing coverage. That’s the only sense in which the distinction they’re making makes any sense. Of course a person who needs health insurance would rather have it even for a year than never have it at all. But from the perspective of a politician, taking something away, well, looks worse.
The other bit of political cover that Ballinger and co. like to trot out is that they oppose the private option but maybe there is some other magical policy that would cover these people that they would support, if only we end the private option first. “If we have an end to the program, what kind of ideas can be brought in?” Ballinger asked last week. “What can be done to help these people?” But here’s the thing: they never, ever, ever offer specific, affordable plans to offer coverage after they take it away. That’s despite the fact that the private option has been vigorously debated for a year. The simplest reason for that is likely that they actually have a philosophical opposition to publicly funded safety-net programs for low-income people. They are not offering a plan to provide health insurance for these folks because they do not want Arkansas or the feds to do so.
The other factor to keep in mind is that any alternative plan to cover these folks without using the federal funds available via the Affordable Care Act would be orders of magnitude more expensive for the state of Arkansas. Remember, the feds are fully paying for the private option for the first three years. Then they’re picking up 95 percent of the tab in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and beyond. Hendren said that the problem is partnering with the feds “and you have to say mother-may-I and they have to give us permission…” without mentioning that the feds are the ones footing the bill. If Arkansas goes it alone, and those match rates disappear, even a plan significantly stingier than the private option would cost the state so much more as to be effectively impossible.
“If the 90th legislature decides to do nothing for these 100,000 people, then they get nothing,” Ballinger said last week in arguing for his amendment. “I don’t see that happening. The reality is nobody is putting forth that position at this time.”
In fact, the reality is that is exactly the position being put forward by those seeking to defund this policy. They are fighting very hard to kill the private option, which would take health insurance plans away from 100,000 people and keep 100,000 more from ever getting coverage at all. That is their position, sincerely held. They need to own it.