• Why I Voted Against the Private Option

    In this past session, I voted against the expansion of the Private Option. As I stated previously, this is the one bill I voted against that I hope I am wrong about, but only time will tell.

    Before reading my list of reasons, let me set the time frame. Before the session began, we all knew that we would be going into the session having to deal with the Medicaid issue. There was a group which had taken the lead to develop a bill that would be presented for vote. It was not until the last few weeks of the session that the bill was revealed. One of the lead sponsors pulled his name off of the bill and submitted another option because of fundamental objections to the direction the bill would take the state. It was my position that we should have cleared all remaining bills and dedicated the final portion of the session to an expanded debate on the Medicaid expansion. Unfortunately, the tax package was tied directly to the decision of Medicaid expansion and debate as a stand-alone issue was not an option. It was also my position that Medicaid was important enough of an issue that if required, DHS could continue to work out the development of the bill and come back for a special session to address Medicaid alone.

    While the committee process serves a valuable format, it denies all Representatives the opportunity to hear firsthand the dialogue that occurs on matters such as Medicaid reform. In my opinion, it would have been best to clear the calendar and allow all Representatives to sit in on the Public Health meetings before going to the House Chamber for a vote. This would have also allowed time to work out some of the issues that are going to require attention after the Private Option becomes law.

    With that said, my reasons for voting against the Private Option include the following:

    • If you’ve ever complained about how the Federal Government is increasing its debt, you will understand my first reason. Any expansion ultimately results in the federal government having to assume the cost. You cannot assume cost without cutting services at another point or passing on the increased debt to the taxpayer. The basic concept is “We are using Federal Medicaid dollars to buy into the private sector.”
    • The concept of expanding Medicaid while reducing Medicare benefits. Medicare is reducing its reimbursement rate while Medicaid is attempting to expand its coverage. This will only hurt our senior population who are not as able to work or who are on a fixed income.
    • An increase in the cost of premiums will occur. As of this moment, some are already realizing that premiums are going to increase with the expansion. This will be further realized as the state draws closer to the three-year window where it has to assume a greater role in covering the cost. This will most likely be realized in increased premiums or tax increases.
    • It is a tax. The cost to cover Medicaid will be covered in part by raising the insurance premiums of those who are not on Medicaid.
    • Our focus should be on the 18% to 99.99% of the poverty level which will be the primary challenge of the state. This would amount to about 98,000 people who would be candidates for coverage. Everyone else is going to be covered by a combination of state and federal funds.
    • Potentially, this will lead to decreasing full-time employees to below the 30-hour limit, placing a financial burden on employees who will have to get an additional job to make up the difference.
    • There is no guarantee of how many insurance companies are going to actually participate in providing insurance. This could result in creating a monopoly and higher insurance rates.
    • During the session, legislators had to pass a law to hold a major insurance company accountable to pay what should have been their responsibility to pay. Their refusal required the legislative body to get involved.
    • There is no trigger were the Centers for Medicaid and Medicare Services (CMS) declines one of the triggers in the law that gives 100% assurance that all legislators would be involve in responding.
    • In the House Public Health Committee, the commitment was made to pull out the appropriation amount for the enabling legislation so it could be voted on as a separate item. This would allow essential services to continue without being held up if the enabling legislation failed. This approach would have allowed for the enabling legislation to be addressed during the Fiscal Session.
    • The number of lobbying firms hired to push the Medicaid expansion expanded greatly in order to get the Private Option passed.
    • We have been told all along that the plan is “very complex.” Have you ever known anything that was “very complex” that did not end up costing more than originally projected? It seems be a bit like we have to pass something so we can begin to understand it. In fact, the comment was made that “we don’t know all the answers and we don’t even know all the questions.”
    • In the event that CMS refuses any one portion of the law and any one of the “triggers” in the law is tripped, the entire law has the potential to be discarded. If thousands of citizens are signed up and then the plan is not approved at any level, what will they be told? Would it not have been better to develop the concept and come back for a special session once we knew the federal government was going to approve the plan?
    • We have been told that the government would control the cost of the health care plans. The Federal Government cannot even control their own costs.
    • The majority of the Arkansas Federal delegation do not agree with the private option.
    • The level of bureaucracy this creates can only lead to higher costs.
    • Private Option requires the IRS to be more involved with the matter of health care.
    • “Wrap around services” will be required to be covered by the state Medicaid program. The cost of this additional requirement is unknown, yet we are obligating ourselves to this unknown amount.
    • Medicaid will be buying the premiums from the private providers. In the event the premiums rise, the cost to the state will go up.
    • Some of the driving motivation behind why we had to create private option follows: a). We needed to get our share of the money before other states who embraced Obamacare (a phrase used by the President himself) get our money.  b). It’s the best option.  c). It’s the law and we have to go along with it.  d). If we didn’t, our small businesses would have been forced to pay a penalty/tax.
    • There was a strong attempt to advance several concepts that could have helped meet the goal, yet they were not heard.
    • There was not included in any of the Medicaid expansion how to provide access to qualified medical treatment. We will put on the Medicaid system a projected 350,000 additional people without any greater access to physicians. I ran a bill that would have allowed the Medicaid population greater access to Nurse Practitioners but it was opposed by the Medical Society.
    • What were our other options?  a). Let the federal government set up exchanges.      b). Push for other Medicaid reform to assure that Medicaid dollars are available for the most needy, including focusing on:  i). Income verification. ii). Fraud investigation. iii). Restructuring the existing system to provide coverage to the uninsured through county clinics and charitable clinics. iv). Implementation of laws to require greater accountability for actions. v). Tax deductions to encourage responsible action of individuals and medical entities that help meet the need of the population.
    • Will eventually decrease potential student interest to enter the medical field because of reduced reimbursement.
    • As the details of the plan begin to be revealed and the reality of the detrimental effect this plan will have becomes apparent, there will be a falling away as people begin to experience firsthand the direct negative impact of Obamacare.
    • You can’t make people pay for something that they won’t pay for. Take their tax return away, if they have one, and at the end of the day the cost will be passed on to the middle class through higher insurance rates on their individual policies.

    I began compiling this list in June after the session had officially ended. Some of the reasons have already proven to be legitimate concerns.