Arkansas conservatives shouldn’t block Medicaid reform

Editor’s note: John Burris is a former member of the Arkansas Legislature. He now provides consulting services, and one of his clients is a managed care company.

Opinions, commentary and other essays posted in this space are wholly the view of the author(s). They may not represent the opinion of the owners of Talk Business & Politics.

––––––––––––––

Some Republicans in the Arkansas legislature have become defenders of traditional Medicaid. They call it a program for the truly needy and defend its current spending levels.

Sen. Terry Rice, R-Waldron, even resigned his membership on the Healthcare Task Force, citing as a partial reason Gov. Asa Hutchinson’s (R) goal to spend less money on Medicaid in coming years.

With few liberals holding elected offices these days, conservative Medicaid-defenders could block any type of needed reform that was long ago championed in other states. It’s almost as if they’ve found a script from an old Dale Bumpers speech and used it to chart their policy. That’s bad news for taxpayers and the patients who suffer from fragmented care in an archaic government-managed system.

It’s also willfully ignoring a million dollar taxpayer-funded report the legislature ordered up to help guide their decisions. John Stephen, the consultant of choice by the more vocal conservatives on the Healthcare Task Force, spent months comparing our state’s Medicaid system against others. He concluded we spend more and get less than almost any other state, specifically in our high-cost eligibility categories. He articulated the path to entitlement reform and the reasons it’s needed. But some of the loudest-talking conservatives in the legislature have stalled. Why?

Reasons vary. None are good.

Some have argued that money shouldn’t be saved from traditional Medicaid to pay for a continuation of healthcare coverage through “Arkansas Works,” the governor’s preferred replacement for the “Private Option.” They’re right about that. Both policies are independent of the other, and reform of Medicaid’s fee-for-service model should be a higher priority. It affects more people and spends more money. The governor should be willing to walk away from “Arkansas Works” if opponents succeed in blocking spending efficiencies on traditional Medicaid. Healthcare groups shouldn’t be allowed to gain all of the coverage they want with none of the reforms they oppose.

Others have argued against specific reforms that rely on competing private companies to coordinate the care of patients, saying the government can better deliver care without the overhead of a profit incentive. What an ironic and disillusioned argument for a conservative to make. Profit is not a cost; it’s an incentive. That’s capitalism at its core. If government is more efficient and profit corrupts, we should create state agencies to sell us furniture, cars, and hotel rooms. It would be cheaper for the consumer, according to these critics. They’re wrong. Private-sector competition controls costs, not increases them.

In reality, the reasons to ignore the Stephen Group report are more complex, as most things in healthcare are. It’s an industry that consumes almost 20% of our country’s spending, making reform a difficult cause to champion. Opponents are numerous and entrenched.

In Arkansas, Republicans who obsessively oppose the “Private Option” might unintentionally be allowing their dislike of a one billion dollar program to affect their perception of a five billion dollar program. That’s partially because of the governor’s lumping of the two debates together. That might be his logic and reasoning, but it doesn’t have to be anyone else’s. Oppose “Arkansas Woks,” but don’t become a defender of the status quo on our state’s most expensive entitlement.

The Stephen Group report clearly outlines the many, many ways we’re under-serving our most vulnerable. Children are being inappropriately treated for behavioral health problems they don’t have. Our elderly don’t have an infrastructure that offers them options on where to receive their care. Meanwhile, the state’s costs continue to grow and grow, consuming nearly 25% of the state budget.

The problem isn’t the patient. It’s a healthcare system and a government payer that has no incentives for positive outcomes. That’s nothing worth defending. The solutions are non-partisan. Sometimes payment reform is most difficult when it’s a conservative Republican who’s a victim of the reform.

Conservatives should be the champions of change, not defenders of the status quo. The patient stands to benefits most of all. Savings to the state budget is just a positive side effect.

The legislature has a million dollar document that provides more than one option on how to reform traditional Medicaid. Conservatives should read it, not ignore it, and put aside emotions from old debates. This one is more important.