Arkansas Medicaid defunding a slap in the face of compromise

Arkansas failed on Feb. 19 to renew the state's expansion of Medicaid, which thus far has been a model of compromise for states that rejected Medicaid expansion outright. What is dismaying is that this compromise was showing some results for the folks who were not ordinarily covered by Medicaid in Arkansas, and, is seen as an innovation in health care reform.

The model uses federal Medicaid funds to purchase private insurance for thousands of low-income residents. More than 87,000 people have been enrolled, according to reports. But one of the representatives who voted against the bill to renew said the vote would show that Republicans in Arkansas are opposed to the Affordable Care Act.

The fear here is that this is not in the state's best interest, the recipients' best interest, and surely not in business' best interest.  Let's follow the sequencing:

1)  Uninsureds use emergency room services at a much higher rate.

2)  This crowds the ER with unnecessary patients, and many of them cannot pay the fees, so these are unreimbursed expenses.

3)  The Balanced Budget Act of 1997 created "disproportionate share" payments to hospitals that serve the uninsured in order to cover some of the unpaid expenses.  These shares come through Medicaid dollars — that's right, the very taxes that business people pay through their paychecks.

4)   Some of the still-unreimbursed expenses are rolled over into the insurance costs of the insured, so premiums go up.

So, the workers and their businesses get the real-world impact of the lack of access for the uninsured low-income worker and his/her family (for more on this impact, please click on To Be or Not to Be Uninsured in Florida). Voting no for political reasons throws thousands of families into confusion, impacts business (some of these folks have jobs and now have to scramble to stay afloat), impacts hospitals and impacts communities.

However, there is a ray of hope: One of the opponents of last year's bill has agreed to bring her coalition to vote for it this year if there is comprehensive job training with it. The governor is working with the coalition to develop this opportunity.

Innovation knows no bounds. Let's hope the good state of Arkansas is refocused on enabling this compromise to go through. It can have a great effect on business, on communities, and on the advisers that guide new efforts in building health. Leaders in both parties in Arkansas would like to give it a chance, and, as such, have committed to holding votes every day until it is passed.

Nayer leads the Center of Health Engagement.