Surgeon General, Marketplace Director expect two numbers to alter health care policy: 1332 and 1115

State Surgeon General Dr. Greg Bledsoe and Arkansas Health Insurance Marketplace Director Cheryl Gardner say two numbers and federal flexibility will dictate reforms to Arkansas’ health care future: 1332 and 1115.

Bledsoe and Gardner both appeared on this week’s edition of Talk Business & Politics, which airs Sundays at 9:30 a.m. on KATV Ch. 7, to explain how 1332 and 1115 waivers from the federal government could be altered to allow Arkansas to experiment further in its Medicaid expansion and health care reforms. The two waivers speak to rules that the state must follow in response to federal guidelines.

Bledsoe says the Legislative Health Reform Task Force that is set to make recommendations later this month to the governor has flushed out all options as part of its conversations, but he’s still not sure all of what may be referred for consideration.

“I do hear a lot about expanding the episodes of care and the patient-centered medical homes. There’s some discussion about managed care. There’s discussion about combining the 1115 and the 1332 waivers to get more flexibility from the federal government. I think you’re going to have a continuation of this discussion up until the votes,” said Bledsoe, who is still not certain as to all that will be recommended.

He added that policy makers are looking for “maximum flexibility” for the state.

“No one is looking at managed care for the entire Medicaid population. For the high cost populations – like developmental disabilities, long-term care, behavioral health – it is certainly on the table,” Bledsoe said. “When you look at managed care, I don’t think you see anyone pushing it as their first choice. But what I tell people is that it might be the inevitable choice if we can’t get other reforms in those spaces.”

Gardner oversees the Arkansas Health Insurance Marketplace (AHIM), which was created to manage and implement a state-based health insurance exchange in Arkansas in accordance with state and federal law. While Gov. Hutchinson has paused plans for a larger exchange, AHIM recently launched the Small Business Health Options Program, or SHOP, an insurance exchange serving small businesses with 2-50 employees.

Gardner said the launch has been successful – and on-budget – and there has been a steady stream of activity during the current enrollment period. She said a recent letter from State Sen. David Sanders, R-Little Rock, asking AHIM consultants to explore possible options tied to 1332 and 1115 waivers could utilize the AHIM model to help in other areas of health insurance delivery.

“Now that we have this viable option that is this insurance exchange – this small business exchange – how can we leverage the functionality of that exchange to best serve Arkansans?” she said.

Gardner added: “There are a few specific policy options that could be exacted under a combination of 1115 and 1332 waivers. Probably top of that list is using premium tax credits on the small employer side as opposed to the individual side. If there’s a fatal flaw to the Affordable Care Act, it is that it didn’t leverage what employers were willing to do for their employees anyway.”

Watch Gardner’s and Bledsoe’s full roundtable interview in the video below.