Saturday, January 31, 2015

Sorting Through the Noise on SB 96 and THE REAL PROBLEM

"When you want to help people, you tell them the truth. When you want to help yourself, you tell them what they want to hear.” - Thomas Sowell

I would ask you to keep the above quote in mind, my fellow citizens, and forgive me if some of the things I write today have too fine a point. I ask that you look past any discomfort my words may cause.  Judge me not according to any sting you might feel from what I say. My words are true and my motives in writing them are not to hurt you, but to help you.  If you must judge me, I ask that you do so on that basis.

First of all, Governor Asa Hutchinson's plans set the stage for continued Medicaid expansion under Obamacare in Arkansas. I think what he wants is going to be something halfway between Romneycare and the Obamacare program which it inspired. He has not said this outright, but if you think this through, as we will together later on, then it is clear that he does. For those supporters of his who would protest that I should not put words in his mouth, I will keep it short:  He has only himself to blame. If the man does not want people speculating about what he wants then he should get off the fence and say what he wants in plain English.

So, the answer from our ruling class, after all of this, is more government. This even though the voters have made it crystal clear in multiple elections that they did not want into Obamacare to begin with, and they have voted to take us out of it ever since. This continues a long tradition of the Democrats expanding government, and Republicans elected to reduce it instead deciding they should expand it too, but more efficiently. There is your choice America, And you say we don't really have self-government anymore.

When you look beneath the shell games, this Medicaid expansion simply borrows money from the next generation in order to subsidize health insurance for able-bodied adults.  Further, the program is not sustainable because the money to pay for it does not exist and never existed. When today's politicians max out the credit capacity of your children the world will quit loaning us money and this and other unaffordable government will end (badly). The hospitals, the Obama administration, and others who are raking in the extra money love it.

If you think this is good public policy, you should support the Governor's program, if you think its a bad idea you should oppose it.  The only thing I would fault you for is if you supported something (or were silent about something) that you were formerly actively against just because now the Governor wants it.

The administration and many legislators are going around telling people that Hutchinson's plans will "end the private option."   Much like when Bill Clinton said that he did not have "sexual relations" with Monica Lewinsky, they are not technically lying, you just have to listen to them really, really, closely.  The so-called "private" option was a specific set of temporary waivers applied to Medicaid expansion under Obamacare.  Those waivers are temporary and go away anyway at the end of 2016.  If nothing else replaces them, then as it stands we go to the standard Medicaid expansion without any special waivers.

When conservative grassroots objected that the "private" option was Medicaid expansion, certain Republican legislators swore up and down that it wasn't.  Over time, it became obvious they were not being honest about that.  Now the Hutchinson plan comes along and says that we should get a study group together so that when the collection of temporary waivers known as the "private" option expire they can ask for a different set of waivers.  If the legislature accepts those waivers, Medicaid expansion stays, they just change the tweaks attached to it.

If that happens, everyone upset at the "private" option should still be upset.  That is because they were not upset at the tweaks to Medicaid expansion called the "private" option, they were upset at what was being tweaked- Medicaid expansion.  Keeping the same program with different tweaks does not address the underlying objection, but some legislators are using a verbal shell game to mislead their constituents about what is really going on.

But does the Hutchinson bill, SB96 run by his close relative Senator Jim Hendren, really aide the cause of Medicaid expansion, or does it provide a path to end Medicaid expansion?  There have been claims both ways.  What is the answer?  Like the Governor's intent, it is opaque and difficult to sort out, but I believe the best answer is that the bill provides a possible way to end Medicaid expansion a few months before it would end anyway at the potential risk of providing it a pathway making it permanent (at least until it helps bankrupt us).

Sen. Hendren argues that his bill is the only way to repeal Medicaid expansion that can get enough votes to pass.   If you are not thinking it through, his claim sounds plausible, and it may well be that he himself believes it.   Consider that the legislature has three main factions on this issue now.  One is mostly the Democrats, who will agree to any Medicaid expansion that the Obama Administration will approve, including one without special waivers.   There are a lot more Republicans than Democrats in the legislature but they are split between a second group, those who take the position of most voters in this state (no to any sort of Obamacare Medicaid expansion) and a third group who feel that they are the first people in human history smart enough to make socialism work.  That last group consists of what is left of the group that supported the Private Option and others who think that while those waivers did not work out, maybe others will.  I believe the Governor to be in this category as well, and so a lot of legislators who were in the firm "no" category are going over to the "let's grow government smarter" category.

So is Hendren right?  Is SB 96 the best way to end Medicaid expansion given the make up of the legislature? Here is the flaw in that thinking: His bill funds Medicaid expansion until the waivers required to pass it in the first place end anyway.  Hendren says that without the repeal in SB96 that once the waivers expire we will be stuck with standard Medicaid expansion with no tweaks (waivers).  I would answer "for how long though"?  Only until the next legislature sat down in January of 2017.   If the Governor's office said "no waivers" then the Democrats would be isolated.   The group of Republicans who opposed this from the start, and the group who would only vote for Medicaid expansion if they got to tinker with it, would be against going on with the program.  The Republican party would be re-united, and in a way that pleases the majority of the voters.

The provision in Hendren's bill to shut down Medicaid at the end of 2016 is little more than a fig leaf.  It gives those who really want to shut it down next to nothing, while the rest of his bill undermines them terribly.  A glance at the bill shows that supporters of the original "private" option will pick the lion's share of the "Task Force" members who will give recommendations. A best case scenario for Hendren's bill would be if it shut down the Medicaid expansion a couple of months earlier than would happen anyway without his bill.   The worst case scenario seems more likely- that it keeps factions one and three above working together and isolates those who are listening to the voters and want to end this thing now.

Further proof that Hutchinson wants some sort of Medicaid expansion and that those who support SB 96 are (wittingly or unwittingly) helping him, is the way they have blocked alternative bills that really did wind down Medicaid expansion.  I am talking about SB 144 by Linda Collins-Smith and a similar measure in the house sponsored by Donnie Copeland.   Those bills never got out of committee.

Senator Hendren says a bill that Private Option supporters can vote for is the only kind of bill that can pass. Even if that is true, if Senator Hendren really does want to shut down Medicaid as he claims, then he and the rest should do everything they can to get those bills re-filled and voted on by the full house and senate.  If he is wrong and one of those bills passes, Medicaid expansion is gone sooner, before it further distorts our medical infrastructure.  But even if he is right and the bills fail, having a vote will give the voters valuable information on who they need to target.  We can't tell a thing about all those freshmen or potential flip-floppers by how they vote on SB 96, because as the Senator himself says, it is a bill that even those who want Medicaid to stay swollen can vote for.  We the People can get him the most help if there is a floor vote on those kinds of alternatives.
And now we get to the real point of the article.  The part you may not care for because it may require change of you, and not just them.  The aspect of this drama that is most shocking to many people watching is the speed and even ferocity with which many of the formerly most steadfast opponents of Medicaid expansion are lining up behind the Governor's plan, even though that plan is, when properly analyzed as above, pro-Medicaid expansion.  Why are they flipping, or at the least, why are they so reluctant to see what the rest of us can see?

The answer is simple, the Governor is of their own party now.  It was bad when a Democrat was doing it, but now that it is a member of their own party doing it, well, as Upton Sinclair once noted "it is hard to get a man to see something when his salary depends on him not seeing it."  There place in the party hierarchy, in being in "the club" depends upon them not seeing it. That explains why some legislators have been lashing out at people who point to the widening gap between how these legislators wish to see themselves and what they are actually doing. 

The point is that when a legislator's party holds the Governorship or the Presidency, the typical response of legislators is that they don't really need constituents anymore- they work for the Executive branch. Thus it is that the People's Branch, that entity most accessible to the citizens, becomes lost to them. This is how the unitary party system, where the same organization sends up candidates for all branches of government at all levels of government, undermines the formal system of checks and balances established by the Founders to protect the American people from their government.

The bottom line is that if you want your legislators to represent you instead of the Governor, you are going to have to quit electing them via the same political organization which elects the executive branch.   You will have to elect them as, for example, independents.   Until you do, the effect you see right now on this issue will keep happening over and over and over.  I am a part of Neighbors of Arkansas, a group which helps independent candidates who answer only to their constituents and not a party label run from DC. I ask you to consider signing up.


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