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Doug Thompson: Nuts and bolts reform

State cost-control efforts worth noting

This month, the governor announced that his budget request for Medicaid would be $478 million less than anticipated and $55 million less than it was last year.

A thriving economy certainly helped. Medicaid is a government program to assist the poor in getting health care and covering the costs. The more people who are employed in decent jobs, the fewer will need Medicaid. But this bending of the cost curve is also an administrative victory for the state's Department of Human Services. I called the governor to ask specifically about that.

Before going on, a disclaimer: The debate on whether the state should have accepted federal taxpayer money to expand Medicaid is five years old. I do not think very many people have changed their minds on that topic in the last four years, but the argument will go on anyway. That debate is not my topic today. It is the state Department of Human Services' job to implement the policy enacted by the state. My topic today is on how well the department implements the policy the state has now.

"That is a huge success story," Asa Hutchinson said of DHS efforts in this area. "First they worked very hard to clear the Medicaid backlog" of pending requests and issues to be resolved. "Then there were improvements in the IT [information technology] system, including sharing information with other agencies." His remarks were in a telephone interview Friday.

The department made big improvements in coordinating with other agencies to verify employment and other factors that go into determining whether people were still entitled to benefits. The result was far less lag in leaving people on Medicaid rolls when they should be moved off it. "That was a very big administrative lift," he said.

To his credit, Hutchinson noted that this kind of speed will work just as quickly the other way if the economy goes sour. Medicaid rolls will grow just as fast in bad economic times as they shrank in these good times. I was primed to ask about that but never got the chance. He brought that fact up first.

"Now a very good point to realize is that if the economy tanks in two or three years, this process will work just as fast," Hutchinson said. "People who become eligible will be enrolled faster. What we need to realize is that we have a good system in place and that is fair to the taxpayer."

"That is one of the reasons I'm focused on economic development," he said, to forestall such a downturn in the economy and shifting in Medicaid costs as long as possible and mitigate the effects if it happens. Helping to make it more realistic and affordable for more employers to offer insurance is a priority, too, Hutchinson said.

Much of the governor's own Republican Party points out that the cost curve for Medicaid would be a lot lower still if Medicaid had not been expanded. In the simplest terms, that would be true, Hutchinson said. But that would have left a lot of people without needed care. "We're managing care instead of ending it, and I believe we're managing it the right way," he said. Notably, many of the Republicans who do not agree with him are not willing to buck him. Many who were willing to buck him lost GOP primaries.

Certainly the governor was taking credit for the efforts of his own administration in praising DHS efforts. The Human Services department works for him, after all. There are tangible results to show here, though. That bears pointing out. Those tangible results were created by people who follow orders, not just those who give them. That bears pointing out, too.

Very early in his first term, the governor made the point that the growing cost of Medicaid is more of an issue than an expansion of it. Bending the curve of the program's cost growth is both the most important and challenging thing he and lawmakers faced, he said. Ever since, however, whether to continue the expansion has generated both the most heat and noise.

I agree that Medicaid expenditures need a whole lot more scrutiny than they get. I have written news stories about the use of money illegally skimmed from Medicaid-funded health care providers being used for illegal lobbying. I expect to write more. But a big, difficult job to curb costs is something noteworthy, too. That is today's topic. Tomorrow, back to scandal and dispute.

Commentary on 01/13/2018

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