• The HHS decision for Arkansas is baffling me a bit

    Per Sarah Kliff, Arkansas has gotten a waiver fancy deal to provide insurance to the Medicaid eligible through the exchanges. The feds will pick up the tab for now.

    Don’t get me wrong – I have no problem with this per se. I want the poor to have health care coverage. But let’s be clear, it will cost a lot more money than the Medicaid expansion would. Per Avik Roy, it will cost the federal government 50% more now, and both the feds and the state more in the future. I agree with Matt Yglesias that providers will love this – cause they’ll get more money. That’s why this costs more.

    I guess some people assume progressives love Medicaid just because it’s government run. I support the expansion not because it’s un-private, but because it’s a cost-effective way to expand insurance coverage to the poor. Since so many conservatives think we can’t afford the cost of the Medicaid expansion, it seems odd to me that they’d be willing to spend more money to give them private insurance. I assumed that when they said we didn’t have the money for Obamacare, they meant we needed to spend less. I assumed that fiscal conservatives were worried about health care spending.

    I imagine we’ll see another revision of history. I expect some will write that if only Obamacare had allowed more of the poor to get private insurance, if only it had allowed for that spending, than surely it would have had more support. Is that what opponents of Obamacare wanted? For it to be more expensive?


    UPDATE: Sarah Kliff pointed out Arkansas didn’t technically get a “waiver”. She’s right.

    • Won’t the other states want this sweet deal, as well?

      • I expect so – which is the mechanism by which this program will become even more rapidly demonstrated/perceived to be “unsustainable” because clearly unaffordable …

        For the opponents of “Obamacare” there is more than one way to “skin a cat” …

        This may, or may not, backfire, it seems to me – if this model of relying on private health insurance is seen to be clearly unsustainable, the argument for single payer may be given a big boost – OR folks will actually accept or perhaps even press for, a system of rationing. I am for the former, but given the apparent “mean spiritedness” of much of our society these days, It could go either way …

    • I’ve had this discussion many times here in Kansas. The problem is that those who are disinclined to support Medicaid expansion absolutely cannot compute the notion that Medicaid (and Medicare, for that matter) are very cost effective programs. They simply do not understand (or don’t want to understand).

      These same people often decry Medicaid for its low provider rates. When I point out that this problem is easily solved – by putting more money into the system to enhance provider payment – they’re incredulous. It can’t be so. In their minds, private is always better and less expensive. No amount of facts or data can change their mind.

    • You can’t reason people out of a position they didn’t reason themselves into. I think this is part of an unshakable faith in the idea that people are poor because they are lazy or guilty some other moral failing. You can’t just give stuff to such people, the reasoning goes. It only encourages them.

      So, even if exchanges cost more and provide fewer services than Medicaid expansion, the extra cost is worthwhile if only to encourage probity among the rabble.

    • Rceconciling EHBs on xchange side with Mcaid MOE requirements (typically Neiman Marcus package at Walmart prices) at odds.

      Are these new folks liberated from all Medicaid requirements? Do they get full freight paid for by feds, and they shop like everyone on the commerial side or rather, purchase in a silo with plans designed for them, similar but distinct from other QHPs?

      I never expected leeway of this sort.


    • There’s some context here: Arkansas is reportedly part of an effort to bend payments from fee for service to outcome based and Gov. Mike Beebe met with Jean Sibelius recently and, I imagine, told her the legislature ain’t gonna approve squat if they don’t put it in some privatization/Club for Growth/Freedom Works/non Uncle Sam is Santa Claus gauze.

    • Didn’t I read that the poor will be required to make signifiant co-payments for their health care under the Arkansas proposal? Significantly greater co-payments than under traditional Medicaid?