Gov. Beebe, House GOP Continue Medicaid Posturing

In an uncoordinated effort, Gov. Mike Beebe (D) and House Minority Leader Bruce Westerman (R-Hot Springs) used their weekly radio addresses to discuss approaches to Medicaid reform.

Beebe highlighted a new federal pilot program that provides funding to the state in an effort to get doctors to enhance coordination of care throughout the Medicaid system — a fundamental component of Beebe’s payment initiative reform that started in July.

In the past week, a new federal pilot program, called the Comprehensive Primary Care Initiative, was introduced in eight states, including Arkansas.

Under this program, the Centers for Medicare and Medicaid Services will pay incentives to 66 primary-care medical practices in Arkansas to support enhanced, coordinated services. At the same time, private, state, and other federal insurance plans will offer their own bonuses to these same doctors.

To receive these incentives, primary-care physicians must provide increased services to their patients. These services include longer and more flexible hours and the use of electronic health records. Doctors will also be expected to coordinate care with the patients’ other health-care providers to eliminate duplicate or unnecessary procedures. These doctors will also encourage their patients to become more involved in their own care.

Finally, physicians or health-care professionals must also provide individualized, enhanced care for patients living with multiple chronic diseases and complex medical needs. There are about 50,000 Arkansans on federal insurance plans already being treated through these practices.

Beebe said that Arkansas has a chance to “blaze a trail for the rest of the country to follow,” but Republican House members seem disinterested in that distinction.

Rep. Bruce Westerman, the House Minority Leader, said that the current debate on Medicaid expansion is really about supporting the federal health care law, held up as constitutional by the U.S. Supreme Court earlier this summer. The nation’s high court ruled that the individual mandate clause of the law — a primary objection of opponents — was constitutional if considered a tax, and the Supreme Court said states could opt out of the potential Medicaid expansion portion of the law without penalty.

Beebe said he’s supportive of the expansion if the state can have flexibility to opt out later for financial reasons. In his counter-message, Westerman said the Medicaid expansion was a major concern of the federal law all along.

Much of the opposition to President Obama’s health care law was because of the forced Medicaid expansion upon states. As the state’s now have protection from being forced to expand the program, our view is that supporting Medicaid expansion is really embracing President Obama’s law.

But the real question facing us is not who is embracing President Obama’s agenda.  We all know which side has made the decisions and taken the votes to move the Obama agenda forward in Arkansas.

The real question is whether it is practically or philosophically in the best interest of Arkansas to increase people’s dependence on government services and programs?  Wouldn’t a better approach to providing health care services be to unleash the Arkansas economy so working age adults could get good jobs and afford their own health care services while contributing to the tax system?  Would this not allow better medical care for all involved, including the most vulnerable and needy who rely on Medicaid?

In his comments, Westerman also raised a litany of concerns about how to pay for the changes.

The ultimate answer will be from increased taxes that will be required to pay off huge debts. Check your pay stub. Federal taxes are real dollars being taken out of our hurting economy at a real cost to Arkansans. There is no such thing as free money.

Medicaid already has built-in unfunded liabilities because of the increasing cost of health care that is not addressed in baseline budgeting.  Expanding Medicaid at this time with so called “free money” really will be kicking the can down the road, creating even more problems in the future not only for Arkansas, but for the whole United States.

And in Arkansas, our Medicaid system has been running deficits for several years now.  These deficits, averaging around $200 million per year, have been covered up by using President Obama’s one-time stimulus money.  Additionally, the state Medicaid trust fund will soon be empty, leaving our state Medicaid system with a $400 million shortfall next year.

In his final notes in his address, Westerman said that the Medicaid debate is a defining issue in this year’s legislative races — a notion Gov. Beebe would agree with based on his recent rhetoric.

Beebe has challenged Republicans and Democrats to get behind the expansion, citing a requirement of a three-fourths majority of both legislative chambers to pass a budget bill related to the costs of Medicaid.

“Republicans and Democrats are going to have to agree on this or it’s not going to happen,” Beebe said in a recent interview.

“These are important questions that will need to be answered by the General Assembly working as a co-equal branch of government—not a rubber stamp,” countered Westerman. “In recent days, the idea of a strong, co-equal legislative branch of government has been negatively characterized. The governor has couched the debate in terms of who would best work with him.”

You can read Beebe’s full comments here and Westerman’s full address at this link.