I’m happy that I’m probably going to be wrong about what I’ve written about Arkansas’ private option plan. I thought there would be a good chance that the private option and thus Medicaid expansion would be nixed in Arkansas because it has a strong majority coalition but an extremely fragile super-majority coalition in 2013 and 2014. The November elections tossed out a few marginal supporters and replaced them with Teabaggers who out-teabag Lipton, and the outgoing governor who championed the private option with an incoming governor who was non-committal about the entire thing.
I thought that meant the end of the private option after this year. I was wrong as the Arkansas Times explains that I was wrong in both the essence, and a critical detail as it looks like the Arkansas private option will get slightly less punitive and slightly better for people making under 100% of the federal poverty line.
He (the governor) is asking the legislature to fund the private option for two more years, and he’s asking for a legislative task force that would lead the way on an overhaul of the state’s health care system in 2017.
But there was also little piece of policy news buried in the bill filed yesterday by Hutchinson’s nephew (and previously outspoken opponent of the private option) Sen. Jim Hendren. If passed, Hendren’s bill would make a couple of tweaks to the existing private option. It would halt co-pays and the Health Independence Account program on private option beneficiaries below the poverty line, and it would nix future transitions of certain populations now on traditional Medicaid over to the private option.
Medicaid co-pays for people making under 100% of the federal poverty line tend to be nominal. Usually it will be $2 or $3 for office visits and prescriptions and up to $8 for emergency room visits that don’t result in admissions. Most states don’t enforce the co-pays and will reimburse providers for co-pays that weren’t paid. It is a massive administrative burden for little gain in either reduced costs per service or utilization reduction. Arkansas has tight eligibility requirements for Legacy Medicaid, so that population is probably sicker and more expensive than the current private option population. Keeping current Medicaid beneficiaries on Medicaid is an interesting choice as Arkansas pays a significant percentage of their care, while the Feds pick up the entire cost of care for current private options members, and will pay a higher percentage in the future. However, it also lowers the overall medical expense of the entire Exchange risk pool in the state, so it could lower net premiums.
Overall, I was wrong, and I am very glad to be wrong about Arkansas this week.