Almost two years ago, our colleague Linda Gorman was cautiously optimistic about Arkansas attempted Medicaid waiver. Instead of just expanding Medicaid, the state would take the federal funds that Obamacare offered, but use them to subsidize the newly eligible to buy commercial insurance on the Obamacare exchange.
Two years later, a new governor wants to do something a little different. The new governor, Asa Hutchinson, appears to have confused a lot of people in a recent speech about Medicaid, the joint state-federal welfare program for poor people’s health coverage.
According to the Washington Post’s Jason Millman, “Republicans are finally learning they can’t undo Obamacare“, because the governor wants to do something different to Medicaid than what his Democratic predecessor wanted. Politicos’ Sarah Heaton, on the other hand, reports that the new governor wants to “end his state’s Obamacare Medicaid experiment.”
Wheaton’s description is more accurate. The previous Democratic governor hammered out a deal with the Republican-majority legislature to take Obamacare’s federal money for Medicaid expansion, but use it to allow the dependents to buy health insurance on Obamacare exchanges, rather than go into Medicaid.
However, the deal has to be renewed every year by three quarters of the legislature. So, of course the governor has to keep revisiting the issue!
The key thing that the governor wants to add is a work requirement. This hardly implies that he is “learning he can’t undo Obamacare.” The governor does not have a vote on Obamacare.
What the governor is doing is recognizing that Medicaid is welfare, a recognition that too few politicians appreciate. Few things in American health policy are more frustrating than seeing Medicaid dependents described as “insured” exactly like those who pay for their own health insurance, at work or otherwise.
This small surge of governors requesting a work requirement for Medicaid bodes well for taming the welfare state, and dovetails with my recommendation to bundle Medicaid funds with money from other welfare programs in Opportunity Grants.