Blake Rutherford
The 2014 fiscal session of the Arkansas General Assembly is coming to an end after a tense five weeks.
As expected, the session was dominated by the private option, an Arkansas-centric alternative to Medicaid expansion under the Affordable Care Act, President Barack Obama’s sweeping health care legislation passed in 2010.
To try and put the matter to rest (for ten months at least), the passage of the private option is a very good thing. It is beneficial for business and for low-income Arkansans who can now participate in a program that allows them access to affordable health care. As Governor Mike Beebe said in his radio address last week, “Making available preventive medicine and regular checkups will stop illnesses from becoming chronic and halt certain conditions from occurring. This decreases health costs for everyone, particularly by reducing uncompensated care in our State.”
But this hardly puts an end to any future fight over health care reform in Arkansas, which is the first of many lessons of the 2014 session.
Let’s review the key takeaways:
First, the private option remains in a perilous state. The bill to reauthorize private option funding achieved the two-thirds vote in both houses as required, but only narrowly. And state Rep. Kim Hammer, whose switch from “no” to “yes” was key to its passage in the House, was quoted by National Journal as saying, “For those who feel like I’ve betrayed you, we’ll be back next year. If the program doesn’t work, I’ll vote against it.”
With those words, Hammer aligned himself with fellow Republican Rep. Nate Bell, who also voted for the private option this session but wants to revisit it in next year’s general session.
“We have a program created in Arkansas that I would like to see go away,” Bell said in an interview with Fox News Radio last week. “But given the fact that it’s just not possible to do that in one of our fiscal sessions. We had to be able to pass something.”
Later in the interview, Bell added, “Right now, what I want us to do is hit the pause button. Let’s hold where are. Let’s continue the program that we have in place. It’s a great experiment. Let’s continue it.”
What that means as a matter of policy is unclear. Needless to say, a vigorous re-examination of the private option awaits.
Second, experience in state government counts for something. The private option wouldn’t exist without the ingenuity of state Sen. Jonathan Dismang, a Republican. But it couldn’t have evolved from an idea to a legitimate solution endorsed by the federal government without the political will of Gov. Mike Beebe. No governor in the modern era has proven more adept at managing the legislative process, but particularly the budget, and this session is no exception.
As the fiscal session reached its end, Beebe commented that he was surprised to be working so much on health care after his administration had focused primarily on economic development and education.
Fortunately, Beebe recognized that health care’s relationship to both is symbiotic. The next governor will be required to manage the evolution of the private option and other health care challenges during the 2015 general session. And to that end, good ideas, along with an ability to execute, are warranted.
Third, there is much more to health care reform than blind-faith opposition to the Affordable Care Act. Despite the partisan rhetoric, there are aspects of the Affordable Care Act that are quite good, like encouraging the shift from a “fee for service” to a “fee for results” model. Of course, there are aspects of it — like President George W. Bush’s Medicare Part D prescription drug program, which was widely unpopular at the time and is quite popular now — that merit review and reform at the federal level. It’s up to President Obama and Congress to sort that out.
At the state government level, Arkansas would be well-served to shift its focus so it can proactively and positively affect the health care sector.
For example, Dr. Stephen Klasko, the new President and CEO of Thomas Jefferson Health System in Philadelphia, which includes Jefferson Medical College, argued in an op-ed last year that, “Health care is on the brink of its largest metamorphosis in our lifetime. Inherent in this transformation are abundant new technologies and companies and, along with them, new jobs and capital investment.”
Innovation and collaboration, between government and private enterprise, are critical if states want to get ahead, Klasko observed. And because health care accounts for $2.7 trillion in spending each year, the economic boon to those that invest in new strategies and technologies could be, in Klasko’s words, “huge.”
One of those key areas is nanotechnology, which is already changing the health care landscape for the better. In Arkansas, this sophisticated research is being done at the University of Arkansas, the University of Arkansas at Little Rock, Arkansas State University and the University of Arkansas for Medical Sciences. The nanotech triangle, from Little Rock to Fayetteville to Jonesboro, could have a dramatic effect on the future of health care and the state’s economy.
Next month, the Winthrop Rockefeller Institute will host the Nanotechnology for Health Care Conference, which will bring together leading researchers to “bridge talents in science and engineering in nanotechnology with talent in health and medical sciences.” Leading researchers from America’s most prominent private universities will join those from Arkansas’ state universities to discuss ways to apply nanotechnology in the health care arena.
For Arkansas this is a very good thing, but it’s only one example. And true collaboration requires a deep dive by the General Assembly. So in a political context, there should be room to talk about “health care” without it devolving into an impertinent or vertiginous anti-Obama sideshow, much like those town hall meetings from a few years ago that became the fetish of cable news. Legislators’ responsibility, irrespective of the president, still exists.
And finally, bipartisanship is not completely out of style. I think history will demonstrate that Democrats were clever and right to line up behind Republican Rep. Davy Carter after the 2012 elections gave the GOP a narrow majority in the House.
Through a general and a fiscal session, more was accomplished in significant part because of Carter’s steady hand. He also had the difficult task of managing factions within his Republican caucus. Still, Carter was able to preside over continued balanced budgets, tax cuts, and (for now) the private option, among other notable achievements, in a worthwhile tenure as speaker.
I suspect there’s a good deal of analysis to come about the political state of things in the aftermath of the candidate filing deadline. Be that as it may, these four lessons, if also considered collectively, suggest a climate of possibility.
If seized upon by both parties, Arkansas might find itself 15 months from now less plaintive about what could have been.
(Blake Rutherford is vice president of The McLarty Companies and previously was chief of staff to the Arkansas attorney general. You can follow him on Twitter at BlakeRutherford. His column appears every other Wednesday in the weekly Government & Politics e-newsletter. You can subscribe for free here.)
Sign up for Daily E-news
