By Steve Boggs, publisher.
The state of Arkansas has become the focal point in the implementation of the Affordable Care Act. Also known as Obamacare, the Affordable Care Act included many controversial aspects. One was the mandate that every person carries health insurance, or faces a fine. The Supreme Court upheld that mandate when challenged in court. The other was forcing states to expand the Medicaid program to include everyone making 138 percent of the federal poverty level in wages. That one got struck down by the Supreme Court.
The Court held that the federal government could not force states to expand Medicaid for any reason. President Obama then retaliated by threatening to withhold federal Medicaid dollars from any state that did not expand Medicaid to the new income parameters. In case you’re wondering, 138 percent of the federal poverty level is around $32,500 for a family of four.
That’s where the issue began the year. State by state, governors and legislatures were weighing the pros and cons of either expanding Medicaid (as the ACA seeks), or facing federal funding cuts.
It is important to understand that Medicaid and Medicare are very different programs, both in terms of who they help and how they are viewed politically. Medicaid is designed to help lower-income people get some form of health care coverage. It is almost universally derided as a bloated, inefficient government program. Perhaps that’s why there is so much fierce opposition to expanding the program.
The state of Arkansas pitched an alternative plan last year to the director of Health and Human Services, the federal department charged with implementing much of the Affordable Care Act. The idea was simple: Rather than expanding Medicaid as a program, why not let us take the money you were to give us to do that and let us buy private insurance plans for those eligible? HHS said goes for it.
Fast forward three months, and we find every national political pundit using Arkansas as a poster child for implementing Obamacare. As near as I can tell, the General Assembly hasn’t acted on it, or even scheduled a vote. So far all we have is an idea, and some common ground on how to put it into motion.
That’s better than nothing.
The ACA’s primary focus was to provide health care coverage for millions of people who do not currently have it. The president thought expanding Medicaid was one way to do that, and now states are coming up with alternative plans that would do the same thing.
Regardless of what the “Arkansas plan” winds up being, the state is being targeted as Ground Zero in the debate over Medicaid expansion. If the alternative plan passes the Republican-controlled assembly, it could represent the first big compromise on Obamacare since it passed three years ago.
There’s a lot of ground to cover between now and then, given the deep political divides that exist at the State Capitol.
We can’t help but wonder why these types of innovative approaches weren’t rolled out 10 or 15 years ago? Perhaps if they had, we wouldn’t be dealing with Obamacare in the first place.