GOP Senate Primaries, Round 4: Burris vs. Flippo vs. Osmon

As part of our continuing series of articles on the various GOP primaries across the state, we now turn our attention to state Senate District 17. After state Senator Johnny Key announced he would not seek re-election so that he could pursue a better paying career with the University of Arkansas, three candidates filed to replace him: Representative John Burris, business owner Scott Flippo, and Mountain Home Mayor Dave Osmon, all Republicans.

Unlike my previous GOP Senate primary articles, I conducted my own interviews with each candidate in this race. I asked them all the same questions on a variety of topics, ranging from term limits to transparency. However, consistent with the theme of the earlier primary series, this article focuses solely on healthcare issues. In the coming weeks, I’ll try to discuss where these candidates differ on other matters, but (by far) the greatest area of disagreement centers around health care and the state’s Obamacare “private” option version of Medicaid expansion. Two candidates favor expansion, painting it as an alternative to Obamacare; one candidate opposes it outright. And how would the candidates vote on re-approving the program in the 2015 session? Well, keep reading.

I asked all three candidates this question: Is the “private” option Obamacare or part of Obamacare? Please explain. I have reproduced their answers below, in full.

Representative Burris provided an extensive response, but did not answer the question I asked. Instead, he provided this explanation of the “private” option:

ACA mandated states to expand their Medicaid programs up to the 138% FPL. The Supreme Court declared this mandate unconstitutional. However, it still allowed the federal government to raise our taxes, cut Medicare for our seniors, tax our businesses and individuals, and mandate minimum benefit levels for all insurance policies. All told, approximately $1.25 billion is confiscated out of the pockets of Arkansas citizens annually as a result of ACA, beginning this year. The Arkansas Private Option was passed in an attempt to regain control of that money, while simultaneously reforming our entitlement systems rather than grow them, as originally required by ACA.

Before the Private Option, one could qualify for free Medicaid by earning no income and having children. Our entitlement systems perpetuated “earnings cliffs” that discouraged work and personal betterment. We had no cost controls, no cost-sharing, and the government managed the program. The Private Option reformed our Medicaid program by returning it to a program for only the aged, blind, and disabled population. It implemented conservative policies such as income verification and Health Savings Accounts for all populations on the insurance exchange. It protects the state from the instability created by passage of the ACA.

I don’t have space to address all of the claims made here in depth, but readers of this blog will likely know that, despite these claims, the “private” option does in fact grow the Medicaid rolls, it is still governed by Medicaid rules, it includes earning cliffs and discourages work and personal betterment, it does not provide for cost controls, there is virtually no cost sharing in the program, it didn’t implement HSAs (at least not yet — the state will need an additional waiver from the Feds in the future in order to implement them), and it didn’t return Medicaid into a program “for only the aged, blind, and disabled.” In fact, it added an entirely new population — of able-bodied, working adults — to a program that was designed for the aged, blind and disabled, a population more often thought of as truly needy. Don’t just take my word for it: Jonathan Ingram of the Foundation for Government Accountability has debunked pretty much all of these claims in his paper, “The Empty Promises Of Arkansas’s Medicaid Private Option.” I highly recommend it.

In short: when Arkansas passed the “private” option, lawmakers passed on a chance to reject Obamacare’s Medicaid expansion and reform the many problems with the existing Medicaid program. Instead, lawmakers created a new program that prioritizes childless, able-bodied adults over the truly needy, as we’re already seeing. In short, I’ll just add that creating a new entitlement for hundreds of thousands of people and inserting a few conservative elements only into that new program is not my definition of “reform.”

In contrast, candidate Scott Flippo said he believes the “private” option is Obamacare:

Yes, it is most certainly Obamacare. The private option utilizes federal Medicaid dollars to expand coverage to individuals up to 138 percent of the federal poverty level. The plans meet the new standards as outlined by the Obamacare law.

It furthers our exponential federal debt and passes on job killing taxes and regulations to all businesses across our state. Many have said there was no option, and this was Arkansas’ way of not implementing Obamacare and providing for those in need. I would argue that not only did they implement Obamacare, they further locked an entire generation into government assistance. Rather than providing a hand up by creating an environment in our state that is business friendly, they provided a handout.

Finally, Dave Osmon said “no” to my question, but explained that he believes the PO is “an adaptation” of Obamacare:

No. I believe the “Private Option”, as structured in Arkansas, is an adaptation to the Affordable Care Act. Until we can rid ourselves of the Affordable Care Act, we must live with it, as best as we can.

I don’t really have any idea what that means. An adaptation of Obamacare isn’t Obamacare — and isn’t part of Obamacare? Boy, just when I thought the pro-PO arguments couldn’t get any weirder. Perhaps Osmon agrees with Senator Holland that “everyone” has Obamacare? At some point I have to wonder if Obamacare is even Obamacare. Maybe Senator Angus King of Maine was right when he said “there is no such thing as Obamacare.”

In all seriousness, it’s quite clear to me that expanding Medicaid eligibility as outlined in the Obamacare law and using Obamacare dollars to provide insurance for people on the Obamacare exchange is, pretty simply, Obamacare. If that’s not Obamacare, I don’t know what is. On this point, I think Flippo clearly has it right.

I also asked the candidates, If elected to the state Senate, would you vote to continue the “private” option in the 2015 session or would you vote to end the program?

Rep. Burris said:

I don’t think it is wise to affirmatively commit to a vote over a year away, specifically on a policy as fluid as healthcare. I am certainly inclined to continue the program through the duration of the 1115 Waiver (three years total), but there is important information that every legislator should wait to review before making a vote. These include PMPM costs for plan year 2015, pending approval of future waivers to allow for more cost-sharing and HSA programs, as well as additional reforms a state could pursue to gain more control over the Medicaid program.

(Speaking of PMPM costs: so far, the plans are 11% above original projections and have exceeded the federal cap in the first two months of the program. If the premiums continue to rise, state taxpayers will be on the hook for the overruns, as this Forbes article explains.)

Flippo said:

If elected I would vote to end the Private Option. I would work towards creating a competitive business environment where our workforce was receiving benefits from employers. I would work for tax reform that built people up and empowered them to make their own health choices. I would work to restore Arkansas as the land of opportunity for everyone in this state. We can be leaders and innovators showing the country what empowered people can accomplish on their own, rather than leaders in implementing a failed Obama Administration policy only aimed at entrapping and controlling our citizens lives.

Osmon said:

Assuming there is no change in the “Private Option” response to the Affordable Care Act and the “Act” is not amended or the application thereof is not amended, then yes, I would support the “Private Option”.

So there you go.

One of these three men will be the next state Senator from District 17. Given that the “private” option program only cleared the Senate with one vote to spare in the recent fiscal session, it’s anything but an exaggeration to say that the next Senator from District 17 could determine the fate of the program in 2015. Elections, as they say, have consequences.

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