Gov. Butch Otter's administration is not, I repeat, NOT interested in expanding Medicaid this year. Keep reminding yourself of that, because if you watch a hearing of the House Health and Welfare Committee recorded Wednesday—it is on the Legislature's website—you will come away with a different impression entirely.
Otter's Health and Welfare director, Dick Armstrong, waxed glowingly/lovingly/passionately about Medicaid expansion, another spoke in the wheel of Obamacare implementation.
Armstrong is pitching "the Arkansas plan." That's the plan Arkansas once adopted (I'll explain that in just a minute) in which the state expands Medicaid under a special arrangement with the federal government using federal money to buy insurance policies for the state's newest Medicaid recipients.
Armstrong called it "the private option" and "free market," two descriptors that are easily disputed. Armstrong's slide deck included slides that explained the "advantages of private option" telling lawmakers that accepting the Arkansas plan, among other things, "reduces costs shifting (and) increases payments to providers."
So what is the Otter administration trying to say anyhow? In January, Otter told lawmakers he's a "no" on Medicaid expansion. Now, his top health care lieutenant is banging a different drum.
I asked the governor's spokesman, Jon Hanian, to explain.
Said Hanian: "I spoke with Director Armstrong and he says he is not 'pitching' any plan. He said what he did before the committee today was attempt to answer a lot of questions from committee members many of which were hypothetical and speculative in nature about what this may look like in the future. ... The administration's position on this issue has not changed."
But I wasn't the only one confused.
Hanian said Spokesman-Review reporter Betsy Russell also wrote that Armstrong was "pitching" the Arkansas Medicaid expansion. She later changed a headline to say Armstrong was explaining the Arkansas plan, as Hanian put it, "to more accurately reflect what he was doing which was 'explaining' and answering THEIR questions."
All right. But then there's this: Remember when I mentioned Arkansas' "once adopted" approach to Medicaid expansion? That's because even the politicians in Arkansas aren't terribly excited about the "Arkansas plan." As of this writing, the Arkansas House of Representatives has thrice voted against continuing with the experiment, including one vote that occurred before the Armstrong presentation.
Yet, according to IdahoReporter.com, it was Rep. John Rusche, D-Lewiston, who brought the Arkansas House misgivings to the committee's attention.
Later, Armstrong told the news website, “I was certainly aware of it. I saw the news (Tuesday) and I was prepared to answer any questions about it." But why not just address it upfront?
Department of Health and Welfare spokesman Tom Shanahan explained: "Providing daily updates on the political maneuverings in other states on the private option is irrelevant unless Idaho lawmakers want to consider the private option. If they do, there would undoubtedly be discussions about the successes and challenges in other states—what worked, what didn’t and what Idaho can do better."
I'm sure he's sincere, yet I find the explanation implausible, if a little naive. Irrelevant? A major vote by the state for which "the Arkansas plan" is named, the very plan on which the director was presenting, irrelevant? Huh. Interesting, if true.
A Lewiston Tribune article, which also included "pitching" in a headline to describe Armstrong's presentation on Medicaid expansion, quoted Armstrong saying this about Arkansas' lawmakers: "It’s baffling to me what their Legislature is doing,” Armstrong said. “They’ve enrolled more than 100,000 people, who for the first time in their lives have health insurance."
When I worked in state government in 2005 and 2006, I knew that I represented the Kempthorne and later the Risch administrations. Back then, agencies knew to sing the song of the governor, because the governor is in charge.
Otter says he opposes Medicaid expansion. If he means it, he'd be wise to make sure his Health and Welfare director conveys that message at every opportunity.