Last week, the Billings Gazette — a Montana newspaper — reported that some Arkansas officials had visited the Big Sky Country to discuss Arkansas’s Medicaid expansion. The story identified “the state’s Medicaid chief” and a Republican state senator as meeting with the state’s Democratic governor and “legislative leaders from both parties.”
DHS spokesperson Amy Webb told me that the Arkansas-Obamacare delegation included soon-to-be-departing Medicaid director Andy Allison, DHS Director John Selig, and Republican state Senator Jonathan Dismang. According to Webb, the purpose of the trip was to “provide information and share their experiences related to the creation and implementation of the Private Option,” adding:
It’s my understanding that officials in Montana are considering a similar approach and wanted more information on Arkansas’s law, related policies, and the waiver approval process. It’s not uncommon for states, especially those that are leaders and innovators in a given field, to share information.
The timeline is important here: devastating tornadoes — which prompted national headlines, a first-time visit from President Obama, and an almost as rare Arkansas visit from Senator Mark Pryor — hit the state late on April 27th. Less than 48 hours later, these state officials were in Montana promoting Obamacare implementation.
Oddly enough, I spoke to Amy Webb that day (the 29th), following up about some requests I had made a week earlier. Webb told me that the DHS employee who was handling my request was out for at least the next few days, helping family who had lost their homes in the storm. In other words, while DHS employees were dealing with the personal tragedy inflicted by this horrific storm, their department leaders were several hundred miles away, promoting Obamacare implementation.
(Notably, three weeks after my original request, I still have not received the data I asked for, even though it should be readily available. Perhaps cross-country travels by top DHS staffers do not assist in the speed or efficiency of DHS’s disclosure obligations.)
Webb told me that neither Allison nor Selig took administrative leave for the trip — that is, they were on Arkansas taxpayer-funded time while they were promoting Obamacare across the country. I asked Webb what official interest Arkansas taxpayers have in seeing Montana — or any other state — implement a “private” option-style Medicaid expansion. As of press time, I have not received an answer to that question. I posed this same question to two Arkansas lawmakers. More on that in a minute.
As for who paid for the trip: Webb said the trip was financed by the Milbank Memorial Fund. According to DHS records, this is not the first time that Allison and Selig have traveled on Milbank’s dime. In the last calendar year, Milbank has paid for two trips by Allison and five by Selig, all on taxpayer-funded time. Again, what interest do Arkansas taxpayers have in these trips?
I contacted Milbank directly to see if I could learn any more about the nature of these meetings. After three phone calls, spokesperson Judith Zimmer told me that the group facilitates health care discussion with “decision-makers,” discussing issues such as population health. According to Zimmer, the topics are driven primarily by the attendees, adding that Arkansas officials were at several meetings that covered “many topics.” Based on the document provided for the December meeting on the group’s website, it looks like the “private option” was a topic of discussion there as well.
As for the Montana trip, Zimmer told me she “doesn’t even know exactly” what the nature of that meeting was and that no minutes are taken at the meetings. However, she noted that the group is nonpartisan and “does not engage in political activity.” But again, based on the statement from Webb and the Billings Gazette, we know the “private” option was a centerpiece of the discussion.
I also spoke with Senator Dismang, the lone Republican in the Arkansas delegation to Montana. I asked him why he thinks it would be good for Montana to adopt private-option style plan:
I mean, I can’t say with any certainty that it is good for [Montana] to adopt a private option. I think every state should look at their own program as it exists now and take into account what changes need to be made. And again, I don’t think the private option is any type of one-size-fits-all and so it’ll be up to their own leadership.
Does Arkansas have an interest — either a policy interest or a political interest — in other states adopting a PO? Dismang said no:
Not in my opinion. It’s not my goal for other states to pass the private option…I’m not sure what impact that would have on our state directly, if any.
With that said, Dismang clarified that he does want other states to reform their Medicaid programs:
I do want other states to implement reforms. I believe Medicaid is a broken system. I believe premium price assistance is part of the solution. But again, that’s for each state to decide on their own and every state has a different variation of Medicaid…I just don’t think you can just take one policy and replicate it throughout the U.S. and expect it to be the way. But I think the bits and pieces that states borrow from Arkansas or we borrow from other states is important.
Dismang said he was asked to attend the Montana meetings by Milbank. He said the group paid for his trip expenses, but he does not have a retainer with the group.
I also contacted Rep. Joe Farrer, outspoken opponent of the “private” option program, for his comments on Selig and Allison’s attendance. He said that sending state officials to other states on state time isn’t a proper use of taxpayer resources, agreeing with Dismang that there’s no apparent benefit to the state of Arkansas:
Why are we sending people to Montana for a plan that we don’t even know if it’s working? The state of Arkansas may get rid of this plan next year and our officials are out trying to sell it to other states? We are paying these guys to manage our program, but it’s nearly 15% over the original estimates already. They should be here trying to make it work instead of trying to pitch it to other states.
Why are Arkansas taxpayers paying Selig and Allison to go to other states to promote the private option? We should not be paying for this. They should take time off to do this. It’s not benefiting Arkansas.
So at least these two lawmakers — who are on polar opposite ends of this issue — agree that there’s no clear interest for Arkansas nor Arkansas taxpayers in other states adopting Obamacare’s Medicaid expansion. Why, then, are state officials traveling around the country and being paid by us to promote that very thing? That’s one piece of this Montana Medicaid mystery that remains unsolved, at least for now.