Friday, April 12, 2013

Here We Go Again

So I have been in numerous exchanges with Republican legislators over HB1143.   They express supreme confidence that the bill will reform Medicaid the way they want it to, or the bill itself will be made void.   Their confidence is not supported by either the actual content of the bill or recent history on similar events.

The bill only says that the plan will not be "implemented" unless waivers to do a few general things are granted.  But it is silent as to who will decide whether or not these vague requirements are met.   The answer of course, is the Beebe administration.    They determine whether the language of any forth-coming waivers will meet the requirements of the bill.  You already know what they are going to say.   At any rate, there is nothing in the bill about shutting down the program if any of those waivers are cancelled later.   Once the program is implemented, it goes on, even if waivers are amended or killed outright.    The only provisions which end the bill after implementation have to do with the amount of FEDGOV's match- which is a whole 'nother subject.

As to the history, I have been through this before with these guys concerning the other half of Obamacare, setting up the Health Care Exchanges.    I urged them to not even fund the state insurance department until they had it in writing that they would not do anything to set up an exchange.  They did not want to take the heat that would have come with shutting down the Insurance Department until Beebe agreed.  Instead, they decided to bargain.

They were sure they had reached a bargain that would allow them to fund the department and still block the exchange.  At the time, I expressed the view that they had been "taken."    I said once Beebe and Co. had the money, they were going to set up that exchange with or without their approval.  "We will still have legislative oversight" one of them opined.  I replied that they were about to find out just how worthless that was dealing with people like this.

Over the next few months the Beebe administration tried everything they could to lure some Republicans into going along with the idea of going forward with an exchange, but they did not budge.  Every time Beebe spent some money to advance the exchange concept, the legislature asked him what he thought he was doing.   For a while, it looked like I was wrong.   I then did what honest men do when they are wrong.  I fessed up to being wrong and congratulated them for threading the needle between keeping the Insurance Department funded and still blocking the Health Care Exchange.

Well, it turns out that I was wrong about being wrong.  And the Republican legislators who thought they could manage this thing?  They were just wrong.   Beebe kept working with the feds and started using regulation and policy to implement the Exchange, even without the benefit of a law authorizing it.    The legislature could not stop him from setting up a "partnership" exchange once he had the money.

They are close to making the same mistake again.   They are highly confident they have a bill that has the Democrats penned in.  Just like they thought last time.  They are highly confident that if the new Medicaid plan (the private option) does not have all the features they say it will then the bill will never be implemented.   About like they thought last time.   They think they have a deal with the Democrats, just like last time.  I am here to tell you something- they are wrong. Just like last time.

Here is the video where Kathleen Sebulius is asked by Cong. Tim Griffith about whether she has approved Arkansas' so-called "Private Option."   She says that she has not read the bill, did not commit to it, and when they pass a bill then they will read it.   I have to hand it to her, she is not willing to lie.  She will only negotiate with "the state" - i.e. the Beebe Administration.  She is spinning me less than the Republican legislators who are telling us that the bill is not an expansion of Medicaid.


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