When the U.S. Department of Health and Human Services gave Arkansas the green light for a deal that would allow for expanded “Medicaid coverage” via enrollment of the uninsured in private insurance plans created by Obamacare’s health exchanges, I wondered if this might reflect a sort of Plan B for conservative health policy. It is certainly consistent with the much-discussed strategy recently laid out by Douglas Holtz-Eakin and Avik Roy, in which minimization of the “public” elements of Obamacare was step one.
To be a bit more cynical about it, this approach gives Republicans at the state level the best of both worlds: a rejection of the original Medicaid expansion scheme but then also vast federal subsidies that will benefit not just hospitals and other health care providers but private health insurers as well. Again, there’s nothing new and dramatic about Medicaid beneficiaries being enrolled in private health plans (an estimated 70% nationally already are), but it seems some GOPers are actually using the ACA-sanctioned “Medicaid expansion” to kill off traditional Medicaid almost entirely.
In any event, Arkansas’ plan (a compromise between Republican legislators who wanted to reject the expansion entirely and a Democratic governor who wanted to accept it) was approved; Ohio is seeking a similar arrangement; and now that may be where Florida is headed as well, per action by a state Senate committee rejecting Gov. Rick Scott’s proposal to just go along with the original Medicaid expansion for a limited time.
If an Arkansas-style privatized-Medicaid plan is what ultimately emerges in Florida, it’s a lot better than the status quo. But some of the cheerleading we hear for the irresistible progress of the Medicaid expansion should probably be muted just a bit.