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What On Earth Is Nate Bell Thinking?

Updated: Apr 13

Many observers of the “private” option’s passage through the legislative process were taken aback by Rep. Nate Bell’s amendment earlier this week. Bell has explained that his goal is to end the “private” option, and he believes that his amendment (which appears to make House “private”-option passage more likely) is the best route to achieve this goal. I found this puzzling, so I called him up for a further explanation. Following are my paraphrased questions and his italicized answers; I also have a few comments at the end. DG: Let me start by asking you about something you said yesterday: “I don’t believe there’s any other path we have to exit this session without a shutdown.” NB: I’ll just say this: there is no mathematical scenario that I can see that allows anything other than an appropriation with the private option in it to come out of Joint Budget Committee. DG: I’m trying to figure out why you’re using the word ‘shutdown’. Are you trying to draw an analogy between a budget standoff in Little Rock to what we see in Washington, D.C.? NB: Well, no. There clearly is an attempt to draw the analogy, but the shutdown word is not the best word to describe that… [I use that word] generally to draw the parallel to some of the gaming that we see in DC with no endgame. DG: If you want to end the private option, and there are 80,000 people on it now, why not try to end it now? Won’t it be much harder to end the private option a year from now, when there are a lot more than 80,000 clients? NB: First: I am reasonably confident that, next year, there will be a Republican in the governor’s office. It is incredibly difficult, and we’ve seen this in other states, to accomplish real reforms with the Democrats controlling the executive branch … Second: There’s an underlying assumption in your statement that I don’t agree with. First of all: If my language is passed, the program’s not going to be substantially bigger next year. That is the idea of what I’m trying to do: is to stop it in time. DG: So you think your proposal will put the brakes on, or at least slow the growth of, enrollees? NB: That’s entirely my goal here, to stop this thing from expanding, to lock it where it’s at. Let me explain … the bulk of the enrollment has come from what’s been known as the auto-enrollment, where they take the people in existing programs, send them a letter that says: you’re eligible … please check here and we’ll enroll you. My language takes that ability to do that away. DG: Your point is that enrollment is, by and large, driven by taxpayer-funded advertising and promotion? What do the numbers look like? NB: Auto enrollment is something upwards of 65,000 … Of the 20,000 [who aren’t auto-enrolled], I would say nearly all of them are in some form advertising or promotion-generated … What I have proposed immediately removes all of the ads in Arkansas – like the Arkansas Health Networks ads? They’re gone! There’s probably around 18 to 20 million dollars being spent on those ads currently. That’s a huge cost savings. My amendment gets rid of all the navigators. That’s probably 500 to 750 jobs eliminated. They’re gone. DG: You’ve suggested that a strategy of conservative Republican holding out – never letting the Speaker get the 75 votes he needs in the House – will not work. Explain. NB: Right now we have 28 or so of us who would vote no on a straight up or down vote in the House … Assume that we continue throughout the session and we all continue to vote no … I can assure you that leadership is not going to allow in any circumstances a vote to come up in Joint Budget without the private option attached. We keep voting no, we keep voting no, and in 45 days we go home. That assumes everybody holds, and I think that might happen. I could conceivably see that happening. The Governor calls a special session. He very narrowly defines what we can consider. Given that narrow definition, we still can’t do anything except a straight up or down vote. DG: So your view is that, once we leave the regular session, that Governor Beebe would be willing to be “Doctor No” and not let a DHS bill be passed unless the private option’s attached to it? NB: Absolutely. Because he can 100% blame the Republicans for depriving all the poor people in Arkansas of health care. Absolutely. And he’ll take that and run with it in an election year. DG: It seems to me that every Republican in the state would be saying in response: why don’t we just have a clean DHS bill? You really think that Beebe could successfully demagogue things in that way? NB: I would stake my life on it, and I wouldn’t stake my life on much of anything. Look, I am sitting here as a guy who knows where I’m at. I know that, by doing what I’m doing, even though I fervently believe it is absolutely the right thing to do, I know that I am ensuring that I will never win a Republican primary for much of anything. I am also OK with that. Because this is the only option that I believe we have to destroy the private option. If I felt like there was anything else, in any way shape or form, that had even a 5% chance of success, I’d be all over it. This is coming from me at a huge, huge cost. It would be very easy for me to sit with the folks who are voting no and vote no. I’d have the wind at my back, I’d win re-election easily, and I could dance around in every Republican primary in the future and talk about how intellectually pure I was. I’m doing this because it’s the right thing to do. It is the only way I can see to reduce the private option … If I didn’t think that what I’m doing is not the single strongest way to advance conservative principles, I wouldn’t be doing it … I am just laying it out the way it is. Rep. Bell makes interesting arguments for his position: let me just close by pointing out some assumptions about the future that his legislative plans depend on. Assumption 1: Democratic legislators, and a Democratic governor, will always vote against a DHS bill that doesn’t contain “private”-option funding. Assumption 2: Enrollment growth will sharply decrease when state government “private”-option publicity stops, even though private insurance companies might have an interest in advertising and distributing a good that is free to the client. Assumption 3: A minority-holdout strategy cannot work in Arkansas in 2014, although similar strategies have worked in previous legislative sessions and in other states. Assumption 4: Arkansas will have more conservative people in charge of the governor’s office and the legislature next year than it has now. Assumption 5: During the 2015 session, when legislators are once again presented with the “private” option, legislators won’t decide that they should, yet again, postpone substantive decisions for another year. I don’t want to be unfair to Nate Bell; it seems to me that a reasonable person could endorse any or all of the above assumptions. However, I like to think that I’m a reasonable person too, and I think there are grounds to be skeptical that all of the five predictions above would prove true. For instance: Bell’s perspective (as I understand it) is that legislative minorities cannot accomplish their goals because, for several reasons, they won’t be able to successfully hold out; I’m more optimistic. Bell’s legislative strategy rests largely on his predictions about the future; as for me, I’m not nearly so confident in his – or my – power to predict what will happen tomorrow.

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