The Senate yesterday passed Rep. Donnie Copeland’s bill to send a letter to everyone enrolled in the private option telling them that “the program will end on December 31, 2016” and “the coverage provided by the program expires on December 31, 2016.” It will head back to the House to approve an amendment adding co-sponsors, and then it’s off to the governor, who has said he will sign it into law.
What you are seeing here is the political desire of Republicans to say that they have killed the private option even though the policy is continuing for two more years and a task force has been created with the express aim of continuing some form of the coverage expansion in 2017 and beyond. Copeland’s bill is meaningless, but the only ones who will be hurt are poor people, so why not?
It is true, of course, that Act 46, which funds the private option through the end of 2016 and creates the governor’s requested task force, ends eligibility for Medicaid expansion after December 31, 2016 without express approval from the legislature. Of course, it was already the case that the legislature was engaged in annual high-stakes fights over the continuation of the private option, with health insurance for more than 200,000 Arkansans in jeopardy (and it was already the case that the private option waiver ends at the end of 2016). So Act 46 isn’t some kind of dramatic shift on that front, other than putting particular pressure on a likely special session in 2016 to implement the task force recommendations. In terms of what’s next, there is little doubt that whatever is in place in 2017 will be called something other than the private option. And it’s possible that it will use some mechanisms with real substantive differences from the policy in place today. But both the governor’s speech introducing his health care plan and the legislation itself explicitly state that the task force is charged with coming up with coverage options for the folks currently covered by the private option.
In other words, before even the first meeting of a task force charged with continuing coverage for private option beneficiaries, Copeland wants to send out a letter to everyone telling them their coverage is going away. This is not just silly, it’s cruel. Remember, most beneficiaries aren’t following all of the policy nuances here. Most beneficiaries don’t care whether it’s called the “private option” or whether a task force comes up with enough alterations to give cover for wobbly conservatives. Most beneficiaries aren’t following the hot legislative drama over whether lawmakers get to make meaningless boasts that they killed the private option. They just want health insurance. They just want the security that comes with being covered. And they’re going to get a confusing, scary, and misleading letter telling them that their coverage is going away.
Hutchinson spokesman J.R. Davis told the D-G’s Michael Wickline that Hutchinson supports the bill because it would give private option beneficiaries time to prepare for whatever comes next. Unfortunately, this makes absolutely no sense. The task force hasn’t made any recommendations yet! We don’t know what comes next. Given that the same political pressures to continue the coverage expansion will be even greater in 2016 — by then, likely more than 250,000 Arkansans dependent on the coverage, hundreds of millions of uncompensated care savings accrued by hospitals, and of course billions more in federal dollars pumping in to the state economy at stake — the most likely scenario is that coverage will continue and whatever policy changes come won’t be nearly as dramatic for beneficiaries as Copeland’s letter implies. Now it’s possible, though I would say highly unlikely, that the legislature simply ends the coverage expansion and hundreds of thousands of Arkansans lose their insurance. Private option opponents like to stick their head in the sand about this, but there is no magical alternative for poor folks in Arkansas if the legislature snatches away their coverage. They’ll simply go without insurance and the uninsurance rate will likely double overnight. What sort of preparations are the state’s poorest residents supposed to make for that? Of course Hutchinson, and even private option opponents like Rep. David Meeks or Sen. Jim Hendren, claim that the task force is going to avoid this scenario by finding a new coverage model better than the private option. Okay, but how exactly are beneficiaries supposed to prepare for these alternatives when they don’t exist yet?
Under the circumstances, the single most confusing and least helpful thing you could do right now for vulnerable beneficiaries is to send a scary letter long before we even know what direction the legislature and the task force are going to take. As a policy measure, it’s indefensibly idiotic. What’s important, however, is for lawmakers to have the opportunity to grandstand.