Arkansas

THIS JUST IN...

CMS today conditionally approved Delaware and Pennsylvania to operate State-based Marketplaces (SBMs)" #kingvburwell @charles_gaba

— Dan Mangan (@_DanMangan) June 15, 2015

Obama administration has approved Pennsylvania and Delaware’s blueprints to become state-based ACA exchanges next year.

— Dylan Scott (@dylanlscott) June 15, 2015

Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:

Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.

An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.

Two late-breaking news items, one negative, the other potentially positive:

Arkansas: The good news a few weeks ago was that newly-elected Republican Governor Asa Hutchinson did not kill off AR's unique "private option" Medicaid expansion program as many had feared; instead, he actually proposed extending it pretty much as is for another 2 years, to the relief of decent folks, and the state legislature seemed to be OK with that (another surprise).

The bad news today is that, while the program looks safe for 2 more years...the same legislation kills the program after the 2 years are up:

LITTLE ROCK, Ark. (Reuters) - Governor Asa Hutchinson of Arkansas has signed legislation that will end by 2017 the state’s innovative but controversial adaptation of the Affordable Care Act, which has provided nearly 190,000 residents with health coverage.

David Ramsey has the full skinny on the unpleasant situation in Arkansas, where their "private option" Medicaid expansion program, which was always weird with a beard to begin with, is very much at risk of collapsing altogether:

Well, here we go again. The legislature is once again ready to debate the private option – the state’s unique version of Medicaid expansion, which uses funds available via the Affordable Care Act to purchase private health insurance for low-income Arkansans. Gov. Asa Hutchinson will take a long-awaited position on the policy in a speech at UAMS tomorrow morning. Then it will be up to the legislature. Health insurance for more than 200,000 Arkansans is at stake. Here are some keys to remember as the debate unfolds tomorrow and in the coming weeks. 

The short version: The AR program has to be re-approved by the legislature every year, and requires a 75% majority to do so, so it's a wonder that it's survived this long, frankly.

Talking Point Memo reports:

The Associated Press reported Sunday that newly elected Republican. Gov. Asa Hutchinson is expected to address the program, which uses Medicaid dollars to pay for private coverage, in a speech this week. Arkansas's plan must be re-approved every year.

The program is contending with Hutchinson and a batch of newly elected Republican lawmakers who ran against it. The funding must be approved by three-fourths of the state legislature every year. As TPM previously reported, getting approval in 2014 required a significant amount of horse-trading and deal-making under Democratic Gov. Mike Beebe.

...Even if Hutchinson agrees to keep the so-called private option, he is expected to propose more conservative-minded changes. Senate President Jonathan Dismang told the AP that Medicaid expansion "is not going to exist in its current form."

How many people are we talking about here? Oh, just 218,000 or so.

The good news: Enrollment in the ACA private Medicaid option program is up to 218K, about 7,000 higher than it was as of mid-October.The bad news: With the state legislature & governor's office being completely overrun by Republicans, the future of the program isn't looking great:

The other day I noted that Republican Congressman Tom Cotton of Arkansas, currently in a heated battle with U.S. Senator Mark Pryor to take Pryor's seat, is proposing not only stripping healthcare from the 200,000 people in his state who have gained healthcare this year thanks to the Affordable Care Act's Medicaid expanion provision (the "private option" in AR) as well as 40,000 people who are paying for policies via the ACA exchange, but is going even further by pushing for half of the pre-Obamacare Medicaid/CHIP budget to be slashed.

This would effectively result in up to 20% of the state's entire population losing their healthcare coverage...every one of whom is either poor or barely middle-class at best.

Well, that number just went up a bit more:

First, I just want to take a minute to note that over the past year, I've discovered that while there's lots of good reporting on the ACA nationally, there are certain states which have one particular person who's the "go to" journalist for all things Obamacare-related.

In Connecticut, it's Arielle Levin Becker. In Vermont, Morgan True. In Kentucky, it's Joe Sonka. In Colorado, it's Louise Norris. In Oregon, it's Nick Budnick. And in Arkansas, it's David Ramsey:

Boy, this syndrome of Republicans seemingly forgetting that repealing Obamacare would mean that hundreds of thousands of the very people they're hoping will vote for them would have their shiny new healthcare coverage torn away from them seems to be spreading fast. I'm calling it "repealnesia".

First it was Joni Ernst, who wants to castrate 100,000 or more of her fellow Iowans by cutting their healthcare coverage out from under them with no plan on how (or whether) to replace it.

Then it was Kentucky's Mitch McConnell, who popped his head out to play an Obamacare-ACA-kynect shell game last night.

Now there seems to be a serious case of Cottonmouth down in Arkansas:

Well, well, well; imagine that...

While Obamacare attacks continue to fade, health reform’s success is even forcing some Republicans to acknowledge the law is having positive effects.

The latest example comes from Iowa’s third congressional district, where David Young (R) is facing former state Sen.Staci Appel (D) to replace retiring-Rep. Tom Latham (R-IA) in a toss-up seat.

...BORG: Did you favor the expansion of Medicaid, which was included in Obamacare?

YOUNG: It seems to be working in Iowa. I would make sure in any regards to Medicaid they would have some kind of flexibility.

...Still, Young was asked twice by Borg whether he would support repealing Obamacare, as has been the Republican mantra for the past four years. Both times, Young refused to say he wanted to do so.

My last official update of Medicaid expansion in Arkansas (via their "private option" system) had the number at 192,210 as of 8/08. They've added nearly 13,000 more since then:

Thru 8/31 205,097 Arkansans have gained coverage via the "private option" for Medicaid expansion.

— David Ramsey (@ArkDavey) September 8, 2014

UPDATE: More details from Ramsey re. the 205K breakdown:

  • 172,761 are enrolled in private QHP plans via Medicaid funding (the "private option" part)
  • 21,496 were routed over to "regular" Medicaid due to the specifics of their situation
  • 10,840 are still being processed; they're covered by Medicaid until their status is resolved

Just two weeks ago, Sen. Mark Pryor (D-Ark.) surprised much of the political world with a powerful television ad. Though the conventional wisdom was that Pryor, facing a tough re-election fight, would avoid talking about the Affordable Care Act, but the senator neverthelessdid the opposite, boasting about the benefits he’s delivered for Arkansans through the ACA.
 
...Would Pryor back down? As it turns out, no. MaddowBlog received an exclusive first look at the Pryor campaign’s new campaign ad, which is the second spot in which the Arkansas senator boasts about ACA benefits.

BLAM! The infamous "$700B cut from Medicare!!" lie has been festering since well before the 2012 presidential election. The $700 billion in question refers to savings from cutting waste, fraud and abuse from the Medicare system (this is a good thing, folks).

Kudos to Sen. Pryor for debunking this garbage head on.

Greg Sargent has more:

A few days ago, David Ramsey of the Arkansas Times reported about a leaked document with the proposed & approved private QHP premium rate changes for 2015. At the time, he calculated the weighted average of the approved rates to be a drop of around 3.5% overall.

Today he reports that the official rate approvals have now come out, and while there was a slight error in the original numbers, the final weighted average is still excellent news: An overall weighted drop of 2%:

Insurance companies have proposed a net reduction in premiums of 2 percent next year for the Arkansas Health Insurance Marketplace, the health insurance exchange created by the Affordable Care Act. The Marketplace includes all of the plans used for the private option, the state's unique plan which uses Medicaid funds to purchase private health insurance for low-income Arkansans.

That "private Medicaid option" factor is important as well, because...

The Invisible Hand of the Free Market slaps "ACA = Socialism!" claims upside the head, Part 8

Carriers have submitted proposed 2015 rates for the Arkansas Health Insurance Marketplace — the health care exchange created via the Affordable Care Act — to AID for review. According to information previously available online via the Arkansas Insurance Department, the news is good: if the proposed rates are approved, they will lead to an overall decrease in insurance rates on the Marketplace. 

...Blue Cross Blue Shield, which currently has the largest market share on the marketplace, proposed a rate increase of zero...Celtic, selling in Arkansas as Ambetter, which currently has the second largest market share, proposed a rate decrease of 12 percent. Finally, QualChoice, which has the smallest market share, proposed a rate increase of 5 percent.

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick bits:

MARYLAND: An Amazing Healthcare Revolution Is Happening In Maryland — And Almost No One's Talking About It

The Maryland ACA exchange has been one of the "middle-tier" models in my view; not an utter disaster like the ones in Oregon or Massachusetts, but still riddled with technical problems like the ones in Minnesota & Vermont. However, the state has apparently had a different healthcare-related initiative which has been a huge success so far:

Through innovative methods and a data-centric approach, Western Maryland Regional Medical Center, has become the cornerstone in Democratic Gov. Martin O'Malley's ambitious makeover of the state's healthcare programs.

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