Between when I wrote this and when you read it, the Legislature may have come to a conclusion on the private option. It doesn’t look that way, but lots can change in a day. Regardless, the debate will continue.
Here’s the background. The private option uses Obamacare-targeted dollars intended to enroll people in Medicaid and instead subsidizes the cost of private insurance through the Affordable Care Act’s health care exchanges. It serves Arkansans earning up to 138 percent of the poverty line — working people who previously made too much money to qualify for Medicaid but struggle to afford insurance.
It was created by Republican legislators last year while Republicans in other states were refusing those dollars entirely. Arkansas is a poor state with cash-strapped rural hospitals. The Obama administration, desperate to get states on board, gave Arkansas everything it wanted. Since the private option was created, it has attracted about 100,000 participants.
It was a huge debate last year, it’s a huge debate this year, and it will be a huge debate next year if it survives this fiscal session. The Arkansas Constitution requires a 75 percent vote for all spending bills, which means all but nine senators or 26 representatives must vote for it.
On Tuesday, the Senate, which was supposed to be the problem for supporters, apparently found its necessary 27th vote for the program when Sen. Jane English, R-North Little Rock, switched from a no to a yes. All it took was to meet her demand that the state fundamentally change its workforce education system. Lots of people wanted to change that, anyway.
Then the House failed to get the 75 necessary votes that same day. Maybe some legislators decided to see what they could get out of the deal, too.
Opponents say the private option is another big government program that will only get bigger, that Arkansas will pay too much and will end up holding the bag when the feds back out, that it will increase government dependency, and that it will add to the national debt. Just say no to Obamacare, don’t enable it, and work to make it go away.
Supporters say it’s not just a government program. It’s also — in fact, primarily — what Sen. David Sanders, R-Little Rock, calls a "demonstration project." Sanders, a private option architect and staunch conservative, says the real goal is reforming all government health care programs, not just Obamacare, as well as health care in general.
Health care’s big problem, Sanders says, is that people don’t have incentives to act like consumers. Patients with insurance or government health care don’t ask how much a service costs — just if it’s covered.
Consumers, in contrast, compare prices, decline unnecessary procedures, and haggle with their providers, forcing providers to compete for their business by offering a better value.
Private option supporters now hope to introduce consumer-driven reforms. Among the goals is to move more recipients from Medicaid, a straight government health care plan, to the private option, which offers more flexibility because Arkansas is running it and insurance companies are providing the services. More future recipients would be required to pay co-payments when they go to the doctor than currently do. Another goal is to create health savings accounts for private option recipients. That’s where money is deposited into a private account controlled by the recipient to be used for the recipient’s medical needs, instead of the government writing checks to the doctor. Because it’s the patient’s money, he or she has an incentive to control costs.
States have been called the "laboratories of democracy." Other states have followed or are considering Arkansas’ experiment. Those states will create their own innovations, Sanders says. The various reforms, Sanders says, hopefully would seep into other government health care programs and even private insurance.
Those arguments won’t sway opponents, who say it’s still a government program tied to Obamacare.
Republicans are driving the debate, and every Republican legislator hates Obamacare. If they were in Congress, they would all vote against it.
As state legislators, these are their options: Oppose it at every turn, or try to reform it however they can. They have to do one or the other, because for now, Obamacare isn’t going away.
Steve Brawner is an independent journalist in Arkansas. His email address is firstname.lastname@example.org. Follow him on Twitter at @stevebrawner.