Sens. Dismang, Sanders Outline Health Care Reform Future

Two state senators who have been and will be instrumental in Arkansas’ health care policy say they like the trends they’re seeing in several reform areas and they expect the legislative branch to exert tremendous influence over future direction.

State Senators Jonathan Dismang, R-Beebe, and David Sanders, R-Little Rock, appeared on this week’s edition of Talk Business & Politics, which airs Sundays at 9 a.m. on KATV Channel 7.

Dismang, who will lead the Arkansas State Senate in the 2015 session, said that last week’s revelation that insurance premiums in the state’s private option health exchange would drop roughly two percent could be attributed to several factors.

“Utilization was not as much as anticipated,” he said of one factor. Dismang cited “a healthy population” of participants as another key ingredient.

“It goes to the heart of the private option,” said Sanders who, with Dismang and State Rep. John Burris, R-Harrison, was a primary architect of the private option. “That market has never existed in the history of insurance markets before.”

Sanders said that other states have followed Arkansas’ lead in innovating with health care options. The private option was a response to a U.S. Supreme Court ruling that said states didn’t have to expand Medicaid when it upheld the Affordable Care Act in 2012.

Arkansas received permission to use Medicaid expansion dollars to supplement private insurance for low-income workers through a state health insurance marketplace. Nearly 200,000 Arkansans have enrolled in the program in the past year.

“We knew when we did this that other states would, in fact, follow our lead,” Sanders said. “The goal would be for them to innovate and do things that made sense for their states.”

He said Utah is looking to tie work readiness and health care. Arkansas is studying changes to its workforce education system, and some legislators have suggested future health care reforms could be tied to the overhaul as an incentive to work.

“I think that is very important – not in the sense that you want to be punitive,” Sanders said. “I think health care has been a major impediment to people begin able to get ahead. .. I think we have an obligation to connect individuals so that they can be work ready.”

“What’s good for us as policymakers in the state is we will be able to take a look at what’s happening in other states. We’ll see what that flexibility looks like and then apply it back to ourselves,” Dismang added.

Dismang also pointed out other initiatives such as patient-centered medical homes and forthcoming health insurance independence accounts as major reforms. He said when the debate sharpens on renewing the private option funding next session and as the state picks up a larger tab of the cost in future years, there will be a way to calculate the financial impact on the state.

“One of the things you have to look at is the total outflow. That’s for the tax revenues we’ll be sending to the feds on their level and also the Medicare cuts that will essentially remain on the federal level and making sure that we balance that inflow and outflow of dollars,” he said.

“I think that’s where the sustainability comes from. And I think in the long-term we’ll be able to drive down costs and not be a net cost to the federal government,” Dismang said in response to critics’ concern that some of Arkansas’ reliance on the federal government will drive up the national debt.

While the federal government pays 100% of the costs of the private option expansion in the first three years, Arkansas will eventually have to pay for roughly 10% of the costs by the year 2020.

Sanders said that from the first year’s data, he thinks over time the state will see further reductions in health care costs.

“When we’re responsible for paying part of the bill, it’s a smaller bill that we’ll be responsible for,” he said.

GOVERNOR’S RACE, OTHER ISSUES
Dismang and Sanders are both supporters of Republican gubernatorial candidate Asa Hutchinson, who faces Democratic challenger Mike Ross in November.

Ross has been unequivocal in his support of the private option. Hutchinson has been more cautious in his position on the health reform initiative, at one point calling it a “pilot project.” Hutchinson has said he wants potential changes to the private option to center on incentives for people to work.

Sanders said, “For where we want to go as a state in terms of really moving things – whether it be linkages between public assistance and work – and really using the public system to truly be something that will help achieve employment, help achieve personal responsibility, all those things, that’s certainly something that [Cong.] Hutchinson agrees with. I don’t think that Mike Ross wouldn’t, but I think we have a real opportunity here.”

Dismang said gubernatorial support – no matter who wins – would be crucial, but he felt the larger battle would play out in the chambers at both ends of the state capitol.

“I don’t think either candidate could guarantee the passage, in particular, of the appropriation [of the private option]. I think largely most of the reforms, while they can have some leadership outside the legislature, are going to occur inside the legislative body,” Dismang said. “So I’m not sure one is going to have a much stronger position than the other. I do like the fact that Asa has kept an open mind to the issue and he also, if it does continue, he’s indicated several times that there would be alterations and changes. I think I would most likely be supportive of what his direction would be as far as those changes.”

Dismang and Sanders also discussed the dwindling debt in the state’s unemployment insurance trust fund, a new EPA rule that would reduce carbon emissions in Arkansas, and the farm crisis tied to a failing grain merchandiser in east Arkansas. Dismang said he expected a package of agri business reforms to be ready for the 2015 regular session, while Sanders said a big debate would be which state agency – the securities department or agriculture department – would be most likely to oversee any regulatory changes.

Watch their full on-air and online interview below.