AR Medicaid Expansion: Dems’ Playbook?

20 Apr

Make no mistake, Arkansas Republicans campaigned on, almost exclusively, an anti-Obama platform, mostly premised on the promise to prevent implementation of his most notable legislative initiative — the Affordable Care Act — here in Arkansas.

Then, they had to actually govern and come up with justifications in rejecting federal Medicaid funds under the Affordable Care Act while still helping to subsidize its implementation to other states via tax dollars.

Next, here came the powerful hospital and insurance lobby, long eager to find a way to be able to capitalize financially on Medicaid patients. What’s an Arkansas Republican to do???

Obamacare, as the law is popularly known, once seemed doomed in Arkansas, where Republican candidates ran hard in the 2012 election campaign on the promise of stopping reform, and won majorities in both state legislative chambers for the first time since the Civil War era.

Then [Representatives] Dismang, Sanders, House Majority Leader Bruce Westerman and House member John Burris started sounding out whether the Obama administration would allow Medicaid expansion funds to be used to purchase private coverage through an online healthcare exchange that Arkansas will run in partnership with Washington beginning Jan. 1, 2014.

Under Obamacare, people earning from 100 percent to 133 percent of the federal poverty level would qualify for Medicaid. But they could also receive federal premium tax credits to help purchase private coverage through an exchange. States such as Wisconsin have already opted for that route.

The Arkansas plan would utilize Medicaid funds instead of tax credits and cover everyone who qualifies for the expansion, including those living below the federal poverty level – currently $23,550 for a family of four.

But yesterday, as Medicaid expansion (via a private health insurance exchange) in Arkansas became a foregone conclusion one step closer to being reality, for the betterment of our state, however ironic this notion may be considering the rhetoric of the past couple of years. From ThinkProgress.org:

Arkansas came one step closer to expanding Medicaid under Obamacare on Thursday after the state senate advanced a modified expansion bill by a 27-8 vote. The bill now heads to Gov. Mike Beebe (D), who is expected to sign it promptly.

In March, Beebe and the Obama Department of Health and Human Services (HHS) struck a first-of-its-kind deal that would allow Arkansas to expand Medicaid while also privatizing the state-federal partnership program. Under the tentative deal, the federal government will subsidize the entire cost of Arkansas’ Medicaid expansion, but allow the state to use that federal money to buy poor people private insurance, rather than expand the existing public program. The compromise — which has been dubbed “the private option” — was appealing to both Beebe and the Obama Administration, since conservative Arkansas legislators are skeptical of public entitlements, but the state has a high number of poor and uninsured residents who will benefit from expanded access to health coverage.

The development is particularly significant since the private option could serve as a template for Republican-controlled states. Conservatives who are adamantly opposed to public health entitlements like Medicaid are being fiercely lobbied by hospital associations and advocates for the poor, who are warning them that safety net hospitals and state budgets could buckle under the weight of uncompensated medical care costs barring expanded insurance access for the poor. The private option could allow Republicans to heed those warnings without endorsing a program they have historically slammed.

Rep. David Sanders, R-Little Rock, left, and Rep. Jonathan Dismang, R-Beebe, helped lead the GOP’s change of heart.

Funny how things once undebatable can quickly change when faced with reality, isn’t it? But at least this time it was for an improved way of doing things, even if it might’ve not necessarily been the ideal way of doing them.

But now I have to ask, what of the politics of this moment? How can Arkansas Democrats both take credit for the enactment of the Obamacare Medicaid expansion AND still remind voters of the political posturing and subsequent flip-flopping on the issue by their anti-all-things-fed counterparts on the other side of the aisle?

My take is that Ark Dems generally have a small window to do something creative and positive with this. While I’ll admit to you readers that the more idealist “Third Way” notions in me find it a bit disingenuous that Democrats would now be snarking about a GOP flip-flop on the ACA’s Medicaid implementation here, when we should really just be making the most of this seemingly grand compromise and revel in the fact that SOMETHING got done in this otherwise nutty legislative session to improve the lives of thousands of needy Arkansans. I say this primarily because these same Democrats played no real part in the substantive debate in the legislature — the entire discussion and associated compromises — at least once the general blessing for a “private option” was granted by Kathleen Sebelius to Governor Beebe — was controlled by Arkansas Republicans. The whole thing hinged on whether or enough of their members would toe the line on often ridiculous campaign rhetoric, or would give in to a common sense and get the legislation passed.

That being said, I figure Dems going on the offensive with this outweighs the risk of some people having a reaction like mine and backfiring.  I mean, Dems haven’t had much part in any debate because these Republicans have been passing whatever they want and blocking whatever they want.  So turn that on it’s head.  “You clearly could pass anything you wanted, so thank you for passing Obamacare.”

As I was talking with a friend last night about the passage of healthcare expansion, it dawned on me that this moment actually presents a great opportunity for the ArkDems to seize control of the discussion, attempt to take the moral highground, and define the debate going forward.  Rather than letting the Republicans tout how they “avoided Obamacare” by passing the “private option,” I think you guys could turn the whole thing on its head by embracing the term “Obamacare” and literally thanking, by name in a press a release, all of the Republican legislators who voted for the expansion “and made healthcare available to 250,000 Arkansans that did not have it before the passage of Obamacare.”

If they want to scream and holler about how it’s not Obamacare, then they are going to have to be able to explain how the private option is appreciably different than what would have happened under the ACA anyway.  That’s like trying to explain why French vanilla ice cream is completely and totally different from regular vanilla, or why scallions are not the same as green onions.  It’s a distinction without a difference, and most Arkansans will see through it.  This is great on two levels for our side.

First, by embracing the term “Obamacare,” if the Republicans can’t satisfy various constituents that there is a difference in the private option, then they run the risk of being primaried, almost certainly by someone even more crazy and right wing, which should help moderate Dems have a shot in those areas.

Second, if you control the message, the attempts in 2014 by House and Senate members to campaign on having “avoided implementation of Obamacare in Arkansas” will ring hollow and will have about 18 months of rebuttal messaging to contend with.

I think this is a golden opportunity for the party.  Heck, it even allows you to praise the “bipartisan effort that brought the benefits of Obamacare to Arkansas.”  But selling that idea probably requires getting out front with this message almost immediately.

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