Talk Business & Politics Daily: The ‘Can Obamacare be fixed?’ edition

Tuesday’s version of Talk Business & Politics Daily features a sit-down interview with Ray Hanley, President and CEO of the Arkansas Foundation for Medical Care. He’s been with AFMC since 2010 and prior to that spent 28 years with the Arkansas Department of Human Services, 16 of which were as director of Arkansas Medicaid.

With rising Affordable Care Act premiums, insurers dropping out of markets in other states, an Arkansas Medicaid expansion that is growing, and rising rates for private health plans, there are a lot of moving parts to health care presently. Hanley offers his thoughts on a couple of key points in this TB&P Daily interview.

TB&P: Let’s clarify a few things because I think everybody in this day and age tends to take their health insurance premiums that are part of their private employer benefits; the Affordable Care Act and all its mechanisms; and Medicaid expansion, which is part of the Affordable Care Act – our private option, soon to be Arkansas works. All of that seems to get lumped into we have a really bad health insurance problem. Separate all of that for me.

Ray Hanley: We have a ‘bad healthcare costs’ spans it all, but you can’t lump it altogether. You know, the state didn’t do a regular Medicaid expansion. We did the private option and Arkansas Works, which is a premium support system that was a pretty conservative approach which has worked well. You have other states that did a regular Medicaid expansion of their existing program without some of the innovations. And then, you’ve got the people that have got to buy on the market, which are the ones that are really getting hurt now particularly those without subsidies so it’s really in about three buckets, you are correct.

TB&P: So let’s say you’re the health care czar for the nation and you get to fix all of this, Ray. I know it’s just not as simple as waving a magic wand but surely there are a couple of things that could be put into place that could correct the imbalances that we are seeing.

Hanley: There are three things. You could do what Obama did the first couple of years: provide the insurance companies with extra risk quarter payments to compensate for the more expensive pools than projected. But the courts ruled that the law didn’t allow that so that stopped.

You could raise the penalties for being uninsured to make it more attractive and a better proposition to get insurance, which I think has a certain amount of appeal because I think personally everybody should have coverage.

Or you can do things to give the states and these plans more flexibility to contain costs. You can allow higher co-payments. If you don’t do the things you should do – if you don’t quit smoking, if you don’t participate in diabetes education and other things you should do – perhaps it should cost you more. And I think given more flexibility and the ability to enforce personal responsibility, I think Arkansas and some other states would do more in that and I think giving the plans that flexibility would help lower costs. And personally, I would come down pretty strongly on being able to impose more personal responsibility on the patients we are insuring.

Watch Hanley’s full interview in the video below. Also on today’s program, we’ll review the top stories of the day, take a look at headlines in the tourism industry, and KATV’s Janelle Lilley and Elicia Dover review two buzz-generating political TV ads that are airing in neighboring states.