Medicaid Expansion’s Broken Promises: A Decade Later

Op-ed submitted by AR State Senator Bryan King (R – Green Forest)

In 2013, I had just transitioned from the House of Representatives to the Arkansas State Senate. One of the major issues on the agenda: Arkansas to expand the Affordable Care Act, aka Obamacare, or reject Medicaid expansion to able-bodied working-age adults.

At that time, expansion supporters like current State Senator Jonathan Dismang (R – Little Rock), along with former legislators Senators David J. Sanders and Michael Lamoureux, and Representative John Burris, made many promises to support expansion. Their idea was to use tax dollars to purchase insurance instead of the traditional Medicaid system of fee-for-service. They did say a very small amount would be paid on the traditional Medicaid fee-for-service.

Now today, because of the Big Beautiful Bill, we are debating this issue again.

Now let’s look at what was promised and what actually happened.

1. Those promises included reducing spending on Medicaid. The state would “save” so much money that it would allow other state dollars to be used for other purposes. We were told that if we didn’t expand or reduce enrollees, it would cause a hole in the budget. The facts are the opposite. This insurance purchase is twice as expensive as the traditional fee-for-service program. In fact, the extra cost has hurt many other state programs. Simply put, we were lied to about the real financial burden.
   
2. We were promised a great verification system to keep waste, fraud, and abuse out. The truth is, this system is riddled with waste, fraud, and abuse. Enrollees can stay on the system despite being dead, in prison, or not even living in the state. This fact proved true in a review: 40,000 people who showed up on Medicaid rolls were either dead, in prison, or lived in other states.

3. We were promised that five to six carriers would be competing for plans. The truth is that only one insurance carrier, Blue Cross, is providing plans. There is literally zero competition going on.

4. Senators Dismang, Sanders, Lamoureux, and Rep. Burris said Arkansas would greatly improve the state’s health ratings, thus making our state healthier. The facts show Arkansans have not improved despite spending billions more in taxpayer money.

Blue Cross is the only insurance carrier. Today, Arkansas is one of the worst-rated states, having the highest percentage of income paid for health insurance. Why would we want to send billions more to a mismanaged, controlling monopoly that is hurting hard-working, private-pay Arkansas citizens, paying more for less coverage?

Cronyism is rampant since this more expensive program was passed. After the Private Option Medicaid expansion was passed, Blue Cross hired Senator Dismang’s best friend, the bill’s sponsor, as their lobbyist. So, after voting for Blue Cross to pocket billions of taxpayer dollars, Blue Cross then used that taxpayer money to hire the best friend of the senator who ran the legislation.

Senator Sanders later left the Arkansas Senate for a job at a nonprofit that receives millions of Arkansans’ tax dollars.

Senator Lamoureux is now, you guessed it, a lobbyist.

Representative John Burris is now a lobbyist and was hired by Centene Insurance, which, yes, pocketed hundreds of millions off the program. Ironically, Centene recently pulled out of the program, which was touted by their lobbyist.

What about relying on the federal government? Right now, the match is 90 percent federal and 10 percent state. With the spending crisis in Washington, D.C., why would we trust that? I would rather jump out of an airplane wearing a parachute with a hole in it than trust the federal government.

What about our ballooning, out-of-control federal debt and deficit? The choice of this program over the less costly fee-for-service option will only balloon the debt and deficit far worse. So much for the false clamor by Republicans who campaigned on less government and only shout about how much President Biden was spending.

Also, all these groups wanting to continue getting these payments should explain their cuts to essential services. The more expensive the program, the more other needs are cut.

As Yogi Berra famously said, “It’s Deja Vu all over again.”

We must have a real debate about the consequences, not just cherry-picking points for certain aspects and political profiteers.

Most importantly, the political profiteers and the terrible stewards of public money who made such disastrous decisions about our state budget should be held responsible. 

We shouldn’t trust them again. 

*these opinions are that of the author and not necessarily the publisher