Hill taking a side in Arkansas’ Medicaid mess thanks to Trump? Nah. – The Arkansas Democrat-Gazette

OPINION

I was wondering if the state’s Republican congressmen, who helped give us the big, ugly bill that made steep cuts in the state’s health-care infrastructure, were going to lend their voices to Gov. Sarah Sanders’ request for a two-year extension to build a new Medicaid system for 207,000 of our poor people.
We must do that rebuilding now that the Trump administration is destroying the innovative, successful and bipartisan Medicaid expansion program we had. The federal Centers for Medicare and Medicaid Services denied Sanders’ request for a renewal of the waiver won by Mike Beebe and again by Asa Hutchinson to use Medicaid expansion dollars to buy private health insurance for Medicaid enrollees.
The waiver is to expire at the end of the year. The state would like some time. It could simply default to the traditional fee-for-service model, but defaulting to an entirely different way of paying for tens of thousands of people’s health care is not simple. Some legislators want to look at managed care. I fear some of them simply would reject Medicaid expansion altogether, turning down $9 from the feds to $1 for the state.
This “private option” Medicaid expansion system, an Arkansas original and exclusive, was my favorite government program ever–or at least the most clever in my view. It used public dollars–90 percent from the feds, and 10 percent from the state–to buy private health insurance for the low-income. In the process, it fattened the state’s private insurance pool, which held premiums for everyone lower than they would have been otherwise.
The rest of the country could argue about socialism versus capitalism. Down here we were taking semi-socialist safety-net dollars to pay the private sector for insurance coverage for poor and disabled people and helping everybody with health insurance, not to mention rural hospitals, indeed all hospitals. Medicaid coverage is better for a hospital than unrecovered expenses–reimbursement being better than no reimbursement.
So, owing to Arkansas’ unique situation and particular predicament, I kept wondering: Did the state’s four members of the U.S. House of Representatives–that being, after all, a house filled with people nominally representing their districts in their states–intend to lend whatever help or encouragement they might in the effort to persuade the CMS to grant the two-year extension?
I never have much luck asking elected Republican representatives basic questions, and, truth be known, I asked only one, mine, U.S. Rep. French Hill in the 2nd District. I asked his communications person and was pleased to get a prompt and cordial reply.
No. That was the answer. This program is a federal-state partnership, and the particulars of the matter were entirely the purview of state government, so there was no role for a congressperson. That’s what I was told.
Here is the communications aide’s written statement: “This specific waiver request is a matter between the state and CMS, and Congressman Hill is confident that Gov. Sanders and her team are working with CMS to do what is best for Arkansas.”
Again, I was asking about the extra time to deal with the matter. And I was not aware that matters between the state and the federal government were no business of persons elected to represent the state in that federal government.
Yes, the “private option” expansion program was a state government creation, and the permission to use Medicaid dollars for it was granted by the feds’ approval of the state’s request for a waiver. But a waiver has an expiration date and must be renewed. That is the decision of the federal government. And it has been made. It will not be renewed. Now the state wants two years rather than a step off a December cliff.
Ostensibly, that’s because, in keeping with the spirit of the big, ugly bill our congressional representatives unanimously supported, the feds have put their pencil to the costs of our private option and determined they were higher than regular fee-for-service Medicaid expansion would have been.
I’m not asking French Hill or any congressperson to stick his nose into state Medicaid practice. I’m not asking him or any congressperson to ask, much less pressure for, changes in a federal decision on the state’s waiver. I am saying that whether the federal agency grants the state’s request for a two-year grace period is something an elected representative of the state could and should support if only in the form of a public letter explaining the special circumstance of switching from health insurance to something else, and of designing and getting a new program passed legislatively in the first year and set up to operate for the worried people the second.
I wonder if any Republican congressperson is hesitant to stand up for the state against a Trump federal agency. Surely not. That would suggest a misplaced priority and misplaced loyalty, at least when specific urgent matters arise in the state.
Hill’s communications aide is right that members of Congress have no authoritative role in this matter. I was merely thinking he might take a side. And he did, via straddle–with the fine work he is confident of both from the governor’s team and the CMS team.
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers’ Hall of Fame. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett feed on X, formerly Twitter.

jbrummett@arkansasonline.com

John Brummett’s career in news began when he was in high school, as a part-time reporter for the Arkansas Democrat. He moved to the Arkansas Gazette in 1977.
He wrote a political column for the Gazette from 1986 to 1990. He was an editor for the Arkansas Times from 1990 to 1992.
In 1994, his book, “High Wire: From the Back Roads to the Beltway, the Education of Bill Clinton,” was published by Hyperion of New York City. He became a columnist with the Arkansas Democrat-Gazette in 1994. In 2000, he signed a deal with Donrey Media Group, now known as Stephens Media, and wrote for them for 11 years.
He rejoined Democrat-Gazette as a columnist on Oct. 24, 2011.
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