Leader Blues

Wednesday, March 08, 2006

WED 3-8-6 EDITORIAL >> Health plan first in nation

We knew Mike Huckabee pretty well. When he is not in out-of-state Republican precincts bashing gays, abortion and Democrats, Gov. Huckabee is a big-government liberal working to preserve and expand the welfare state. But we frankly were surprised this week by the news that the Bush administration had signed off on a big expansion of government health care, even if it is to be undertaken exclusively in our little state. We thought we knew Bush, too. He has been trying in other ways to slash government health insurance for the poor, not enlarge it.

Let us be the first to congratulate both men on the pilot project announced yesterday to extend Medicaid health benefits to low-wage Arkansas workers and their families. It is a slight enlargement of the employer-based, single-payer system that one day will afford health security to every American. It is not a system that President Bush admires, but whatever the reason he approved Gov. Huckabee’s initiative, he deserves our thanks. Well, we assume the president was aware that his health and human services secretary was approving it.

The governor was allowed to announce Washing-ton’s consent to the project, which will burnish his credentials as the good-health candidate for president. Now, he has more than his weight loss to crow about. Actually, he could already boast that he had beaten most other states in expanding Medicaid to cover tens of thousands of children whose families were above the federal poverty line. This little bit of socialized medicine may not endear him to conservative Republican audiences, but there are still a few Republicans who believe that government is supposed to solve problems and act as a tribune for the neediest. Huckabee will go near the top of their list.

We have an idea that far fewer Arkansans will get the coverage than the 80,000 workers and their families that Huckabee predicts. The conditions that small businesses will have to meet to get the government insurance for their low-wage workers will be too daunting for many (they will have to go into the commercial market and insure every higher-income workers as well). Our pessimism notwithstanding, it is a salutary effort.

Dr. Joe Thompson, now the worthy state health director, developed the program. He was searching for a way to insure the state’s largest uninsured group: the families of low-wage workers in small businesses, very few of whom can afford health insurance. Their employers can’t either.

So now the employers can get the federal government to pick up roughly three-fourths of the tab. That is the rate at which Washington matches Arkansas’ Medicaid coverage for the poor. But instead of the state government putting up the other 25 percent, which Arkansas does for other Medicaid beneficiaries, the employer would in effect do it. The business would pay $15 a month for each worker whose earnings are below twice the federal poverty line, which is about $26,400 for a family of two.
The coverage would be much skimpier than that of other Medicaid beneficiaries — a sizable deductible, limited hospital and physician visits each year and only two prescriptions a month. But barebones is better than they have and it will provide some security for families who have none.

But a condition of an employer’s participation is that every single employee would have to have insurance coverage of some kind, including higher-salaried workers who do not qualify for the Medicaid plan. Our hunch is that will keep hundreds of employers away from the plan and tens of thousands of workers and their families uninsured.

The Arkansas Legislature enacted the plan three years ago and Huckabee submitted it to the Department of Health and Human Services seeking a waiver from the usual rules for Medicaid coverage. The Bush administration rejected it, reportedly because the state government was putting up not a dime for a program that was supposed to involve states sharing the burden of public services. State Rep. David Johnson of Little Rock had the law amended last year to offer the Washington gods a little money from Arkansas’ annual cash bonanza from its settlement of claims against the big tobacco companies. Apparently, that was enough.
We suspect that the state will have to find still further inducements for businesses to participate, but meantime let us hope for their optimum participation. The good health of tens of thousands of children and adults depend upon it. Now what can we do about the uninsured at the megabusinesses, like Wal-Mart?