Sunday, February 19, 2017

House Republican Plan Would Crush "Arkansas Works"/"Private Option"

State Republicans and Democrats joined together in the grossly immoral practice of generational looting when they expanded Medicaid to cover able-bodied adults. The plan was deceptively called the "Private Option" even though it was a Medicaid program that just had a facade built on the front end to give it the look and feel of private insurance as a part of that deception. Then they changed the name to "Arkansas Works" because too many people had caught on to the fact the "Private Option" was a farce.

"Arkansas Works" is also a farce, both because it is not fundamentally different from what it claimed to do away with and because non-workers and those barely working will continue to harvest benefits to be paid for later by your grandchildren. The new tweak just asks Medicaid for permission to have applicants "seek work". The Obama administration was not keen on granting that permission. The Trump Administration will likely reverse that, but if you had anything to do with hiring when unemployment benefits were stretched to 99 weeks you know what a sham that "seek work" requirement can be. But the establishment in Arkansas, Republicans and Democrats, saw that Washington was handing out the next generation's money and they united in determining that they were going to do everything they could to grab as much of it as they could- including committing welfare fraud on a massive and systemic scale.

Now the Republicans in Congress have rolled out their plan to "replace" Obamacare. If they pass a plan that looks anything like their roll out, the wheels are going to come off of "Arkansas Works", a program State Senator Bryan King called "a scam." The state was happy to sign up everyone they could (including those who were not eligible) when FEDGOV was paying 100% of the costs. But that was just a trick by Obama to suck states into expanding Medicaid during the first three years. Now the state must pay an increasing share of the costs.

Supposedly, the state's share was to max out at 10%. The state's share of traditional Medicaid spending is around a 33% share so adding new people to Arkansas Works costs the state less (but taxpayers the same) as adding a traditional Medicaid recipient.  But when you add hundreds of thousands of new beneficiaries and don't have your own printing press, even 10% of the cost can overwhelm the state budget. If they could have found sneaky ways to shift beneficiaries of traditional Medicaid onto the rolls of the new Medicaid program "Arkansas Works" then they might have found a way to break even.

Not only is that not going to happen, but House Republicans seem fully aware of some of the system-gaming going on in states like Arkansas. Here is a quote from the roll out of the house plan......
"This is unfair because the federal government is paying a greater portion of the cost of coverage for able-bodied adults, than for the disabled, elderly, and most vulnerable patients. This disparity also creates a perverse incentive for States when they have budget shortfalls and need to trim their Medicaid program. That’s because it creates an incentive for States to reduce services or provider payments related to the most vulnerable patients, rather than able-bodied adults."
Exactly right. Many of us have expressed concern that when it comes to crunch time the legislature will cut benefits to children and the disabled first because they have to match 33% of the dollars spent in that program but only 10% of the dollars spend on the Obamacare Medicaid expansion of able-bodied adults. They were betting people's lives that Obamacare would be successful. Or maybe they were not even thinking that far ahead. They just saw a chance to take "free" money from Washington and they took it.

The House  Republicans propose to fix this disparity by making the Fed's share for Obamacare Medicaid expansion the same as any other Medicaid......
"Under our proposal, Obamacare’s Medicaid expansion for able-bodied adults enrollees would be repealed in its current form. There would be a period of stability to ensure we are not pulling the rug out from underneath States or patients. States that chose to expand their Medicaid programs under Obamacare could continue to receive enhanced federal payments for currently enrolled beneficiaries for a limited period of time. However, after a date certain, if states choose to keep their Medicaid programs open to new enrollees in the expansion population, states would be reimbursed at their traditional match rates for these beneficiaries."
The Republicrat Establishment in Arkansas expanded Medicaid under the politics of fiscal delusion. The money to pay for this program does not exist. It never existed. The state never had a realistic way to pay the bills once they had to match 10% of the dollars in 2020. Its going to be tough to match the smaller percentages from now until then. They entered a program that offered three years of "free" money" with no real plan because it was tomorrow's problem. Now not only is it tomorrow but the feds are about to change the deal to make it even more painful.

The original "Private Option" bill had provisions stating that it "is terminated" if the feds ever reneged on their percentages- a possibility that many of us tried to warn them about. It also had language declaring that this program was "not a right". Some of us, even Forbes, tried to warn them that extracting themselves from the program after getting people hooked on it and altering our health care infrastructure to accommodate it may not be possible. The new language in the successor bill (SB 1) seems to recognize these difficulties. It does not say participation in Medicaid Expansion"is terminated" if the Feds reduce the matching funds. It just says DHS shall present "a plan to terminate" those services to the Centers of Medicare and Medicaid Services.

CMMS has to approve these plan changes so whether we can leave or not is no longer in our hands! The feds have to approve the plan. At that point, it is going to be a disaster whether they do or they don't. And SB1 makes no mention of the part in the original "Private Option" saying that this program is "not a right". Even if CMMS let's us out of the deal, the judges might not.



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