We’ve noted before that while Rep. Tom Cotton wants to repeal Obamacare (which would have the effect of ending the private option), he refuses to take a position on whether the state made the right decision in pursuing the private option policy, which uses Medicaid funds to purchase health insurance for low-income Arkansans.
Cotton was asked about the private option by a constituent at a townhall event focused on health care in Waldron last Monday (no media was present; someone in attendance sent the Arkansas Blog an audio recording of the meeting).
A constituent named Leonard asked about the “part of [Medicaid] that our legislature was so nice about…to give the government the opportunity to come in here for three years and establish Medicare [he actually means Medicaid] the way they want it and put all the bells and whistles on it and at the end of three years, after three years is up we’re stuck with the bill and we have to pay the whole amount — but the legislature wasn’t smart enough to figure out how we’re going to pay for this after it gets here.”
Rep. Terry Rice, a state representative opposed to the private option who is now running for state Senate interjected to clarify that Leonard was talking about Medicaid.
“Medicaid, sorry, not Medicare,” Leonard said. “[Rice] is one of the ones that didn’t vote for it, so I’m not talking about him.”
Cotton: “Yeah, I was going to let him answer it.”
Leonard asks Cotton, “What I want to know is, is there anything that’s going to help us out on that? If it comes to that — if we can’t get rid of this Obamacare?”
Cotton responds: “Well, Terry, correct me if I’m wrong because I’m not well versed in the details of the law, but y’all do have some kind of circuit breaker so that if we do repeal or change the reimbursement rates for the state, the program is reduced or even eliminated, right?
“There are triggers in there,” Rice responded and then switched to talking about the decision by Insurance Commissioner Jay Bradford to take advantage of a decision by the Obama administration and allow Arkansans to keep non-compliant health insurance plans through the fall of 2017.
Cotton eventually circled back to Leonard’s question about the private option:
My understanding is that Kathleen Sebelius and Beebe might have had a good working relationship from their time as Governors together, and you know, at the time when they were striking that deal Sebelius and the President were desperate for any state to join into the Medicaid expansion, so they were willing to give away lots of things. I think surprised a lot of your colleagues, right Terry? But, the history of these programs is not the history of Washington upholding its end of the bargain or giving states more flexibility. The history of these programs — and that’s not just in the health care realm — of any program that is joint federal and state, is Washington continuing to impose more requirements and red tape no matter what amount of money they give. Education is a good example. Washington provides seven percent of our education dollars in this country and usually tries to dictate 100 percent of the control. So, I’m worried about that for Arkansas. I’m also worried about it for our country and the consequences for our deficit as well. I think in the long run what we need to do is get Washington out of the role of micromanaging the states and let the states address the needs of their population.
Now, Arkansas did expand Medicaid in a way that — has any other state followed suit? It was only done because that part of Obamacare was ruled unconstitutional. I mean, initially, I think, this is what an affront, it goes to show you, it gets back to the gist of your question, Terry, what Washington thinks about the states. Obamacare initially said we will give you this pot of money to expand your Medicaid population, and if you don’t take it you will not only lose this pot of money that’s new, you’ll lose all your old Medicaid money for the elderly and the blind and disabled and for poor children. And the Supreme Court said that is such an affront to the sovereignty of states and our constitutional system that it’s unconstitutional. They struck down that part of Obamacare. But, I worry that if we don’t let states craft solutions for their own populations that Medicaid is going to continue to grow and grow and grow; and that’s not just in Arkansas, that’s in other states as well, but we pay for it.
If you can divine what Cotton’s position is on the private option from all that, more power to you. It sounds to me like Leonard wanted to know Cotton’s take on the private option specifically and Cotton dodged.
(Worth noting that Cotton highlights “circuit breakers” — triggers in the law that would end the private option if the feds stop providing the matching rates promised in the Affordable Care Act — a feature often cited by the law’s proponents and dismissed or disparaged by the law’s opponents.)