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Arkansas: The Twilight Zone Of Health Care Policy

Updated: Apr 13

Last week, Family Council released their survey of primary candidates for state and federal offices. Family Council has set the bar for candidate surveys over the last several years. Once again, they released a quality product that covers a wide range of issues facing our state. As I read through the survey, I saw that that candidates for Lieutenant Governor were asked to respond to this statement by expressing their support or opposition:

Medicaid Expansion: The Arkansas Private Option law passed in 2013 to increase the number of people receiving health insurance through Medicaid by using tax dollars to buy health insurance from private insurance companies under the Affordable Care Act.

I was really startled to see Rep. Andy Mayberry, now candidate for Lt. Governor, respond that he “opposes” this program because Mayberry voted for the program repeatedly, last year and and in this year’s fiscal session. I quickly took to Twitter to express my disbelief in Mayberry’s answer, but it looks like I spoke too soon: after I finished reading the survey, I saw that Mayberry was simply one of many legislators who claimed to “oppose” the “private” option after voting for it repeatedly. Those additional legislators include:

  1. Duncan Baird

  2. Andrea Lea

  3. Bruce Holland

  4. John Burris

To their credit, Rep. Sue Scott and Senator Bill Sample were up-front about their support for the program. Senator Missy Irvin said that she opposes the program, although she was a cosponsor and one of the deciding votes to implement it in 2013; she gets some credit for being willing to change her mind. I think John Burris wins the award for the most, well, creative answer to this particular survey question. Here’s what he said:

The bold-lettered title to question 5 is misleading. Arkansas has received national recognition for forging an alternative to the Medicaid expansion mandated under Obamacare. The Arkansas “Private Option” reduces the number of people on Medicaid, privatizes a substantial portion of the current Medicaid program and provides additional conservative reforms like incentivizing HSA plans, cost-sharing, income verification, and certain drug testing. The program neither expands Medicaid or provides “health insurance through Medicaid”.

As David Sanders once said, there’s a lot wrong with this; but unlike David Sanders, I will actually identify what is wrong. In particular, I find it interesting that Burris denies that the program “expands Medicaid.” He should take a closer look at the private option bill — of which he was a primary sponsor:

“Eligible individuals” means individuals who: Are adults between nineteen (19) years of age and sixty-five (65) years of age with an income that is equal to or less than one hundred thirty-eight percent (138%) of the federal poverty level, including without limitation individuals who would not be eligible for Medicaid under laws and rules in effect on January 1, 2013.

Before this law passed, Medicaid eligibility in Arkansas was defined as 0-17% percent of poverty. That threshold was increased, or expanded, from 0-138% as set forth by Obamacare, thanks to Rep. Burris and others. Also notice that line, “including without limitation individuals who would not be eligible for Medicaid under laws and rules in effect on January 1, 2013.” These are newly eligible Medicaid recipients. This is Medicaid expansion. Don’t just take my word for it: the state’s own Medicaid website says it as well. In addition, I found Burris’s use of the terms “certain drug testing” to be very interesting. As far as I know, there are no drug-testing requirements for Medicaid recipients in Arkansas. Because this is not the first time I’ve heard Burris make this claim, I contacted him for clarification. He was quick to correct me:

I did not say drug testing for Medicaid recipients. I said “and certain drug testing”. This is in reference to Rep. Miller’s bill that allows for drug-testing for in-home providers. This is a program with thousands of enrollees and open for abuse. It was a good first step.

I asked Rep. Burris what Rep. Miller’s bill had to do with the PO. He replied,

I didn’t say that it did. As you accurately stated in your first question, I referenced it as a Medicaid reform. I have always complemented the legislature for passing significant Medicaid reforms, like certain drug testing and income verification.

It seems pretty obvious to me that when Burris says, “The Arkansas “Private Option”…provides additional conservative reforms like incentivizing HSA plans, cost-sharing, income verification, and certain drug testing,” he’s actually talking about the private option and drug testing in the private option because, well, that’s what he said. This is an example of the myriad of word games that pro-PO candidates are resorting to when they are forced to defend their record: most folks will read “drug testing” and assume it’s aimed at recipients, not providers. Furthermore, none of these providers are treating PO enrollees; they’re treating traditional Medicaid clients. This is Burris’s next email to me, in which he attempted to resolve this tension:

The legislature passed a package of conservative reforms accompanying the private option. This is indisputable and pointless to argue.

I read this an insistence that the drug testing does have something to do with the PO, despite Burris’s initial claim that he never associated the two. But nonetheless, I’m glad we are at least somewhat on the same page now: drug-testing requirements that were passed last year do not apply to Medicaid recipientsI guess we can agree to disagree about whether or not new reforms to old Medicaid should be considered part of the private option. Finally, I expressed my concerns to Burris that his answer is misleading because it suggests that there is drug testing in the private option program — which is, again, flatly untrue and something I think we agree on. Burris concluded by saying:

I do not believe it was misleading at all. There is limited space to provide an answer, and I think my answer is clear.

I’ll let our readers be the judge of that. This entire episode is simply the latest reminder that, at least for now, we still live in the twilight zone of healthcare policy in Arkansas — the place where Medicaid expansion is not Medicaid expansion, and indeed where Obamacare is not Obamacare. It’s a place where PO advocates are determined to use words in very different ways than the rest of us do, defeating the entire point of candidate questionnaires — which is to extinguish this very kind of gamesmanship and force candidates to use the same language that the rest of the world does, so voters will have an idea what policies candidates support and what they oppose. Perhaps the most offensive part of all is that many voters, as they have for years, depend on the Family Council survey to get meaningful answers from candidates on policy questions. Unfortunately, this year, they’re getting a lot of gibberish.

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