IRVIN: Unhappy with Blue Cross reimbursement cuts to specialists, says she will vote against private option appropriation.

As we reported this weekend, Sen. Missy Irvin said, “I’m not happy with the way [the private option] is going – right now I cannot support it.”

Now she has issued a statement to the Arkansas Project (perhaps elsewhere too) — the blog affiliated with conservative advocacy group the Advance Arkansas Institute — which articulates her opposition in stronger language:


I am opposed to moving forward and will not vote to fund the appropriation for the private option. 

Irvin’s statement re-hashes much of what she told us — her chief frustrations are about the reimbursement cuts to specialists that Blue Cross Blue Shield has enacted for coverage on the exchange (Arkansas Health Insurance Marketplace), including the private option patients…and what she says is a lack of progress and clarity on the Health Savings Accounts (HSAs), which are set to be enacted in 2015, pending federal approval. Irvin has been particularly vocal in her concern that the legislature has little control over reimbursement rates, which private insurance companies set themselves under the private option. 

Both lawmakers and groups advocating for the specialists have been in ongoing talks with BC/BS so perhaps a solution on that front is forthcoming; the HSA amendment will likely be submitted to the feds during the fiscal session. Perhaps circumstances with one or both of those may impact Irvin’s vote in the coming months. She has gone back and forth in the past, including a last-minute switch to voting for the appropriation after amendments she wanted were included. Many lawmakers on both sides of the debate have mentioned the possibility of tweaks or adjustments to the private option, so that too may have an impact. 


All of that said, issuing a statement staking a clear position suggests that Irvin is solidly in the NO camp. When we talked, she strongly objected to the notion that she’s a swing vote, or that the fate of the policy sits in her hands. But the truth is that the private option is now one vote short in the Senate, and those that oppose it are by all accounts hardened in their position. Irvin’s vote appears right now to be the difference maker. There’s a long road ahead, but the private option, at least in its present form, appears to be in serious trouble. 

*worth noting: Republican Phil Grace of Heber Springs is said to be considering a primary challenge to Irvin. Grace describes himself as a private option opponent. 


Irvin’s statement after the jump. 

Amending the private option legislation and in the end voting for it, was one of the most difficult decisions of my life. And now deciding to vote to discontinue it’s funding is equally as difficult. But with the policy decisions that have been made which we don’t have much control over, and the ever-changing tides from the federal government, I am opposed to moving forward and will not vote to fund the appropriation for the private option.

While opposed to further public dependence on government programs, I had been convinced that the private option might be a first step in the right direction. I now see it is leading us in the wrong direction.

Let’s look at it this way. Imagine the government forced everyone to buy milk from one grocery store. And they guaranteed that the grocery store would get paid every month with taxpayers’ money for the milk. The grocery store decided to cut the workers’ wages from $10 an hour to $8.50 an hour and asked them to work twenty hours a week more to handle the increased customers that had to come buy milk. The real slap in the face is the fact that the workers who are now being paid less and working harder, are paying the taxes that pays the grocery store for the milk.


Working harder and getting paid less isn’t right for the grocery store worker, the firefighter, the electrician, the construction worker, and therefore, it’s not right for our doctors. I certainly do not want the doctor who holds the life of my child in his/her hands to be tired from being overworked, troubled from declining reimbursements and increased costs, when what he/she is doing is priceless. Yet, this is how the largest insurance company interpreted the private option legislation by cutting reimbursement rates to physicians. The other participating insurance companies did not reach this conclusion. This was not my intent as a legislator when I voted for it.

In fact, before the private option was passed, I was opposed to it and very adamant about the fact that we had little control over the reimbursement rates or policy decisions. It directly affects quality of care and access to care. It is one of the largest problems we currently have with Medicaid. The reimbursement rate is so low for providers that it limits access to care. Yet, here we are going down the same path. The policy decision to cut rates with the private option sets a precedence with all providers in the healthcare industry, including and especially for hospitals. If we are mandated to spend taxpayers’ money on healthcare, then it should be spent on healthcare, not health insurance.

In addition to this major concern, was the pilot program for the Health Savings Accounts, which was simply inadequate. For three years, I have advocated for Medicaid reforms that allow individuals to know how much their health decisions cost. I believe the principles of consumerism should be applied. Quite simply, if you know how much it costs and you have an incentive to save money, you will make the better decision with!your money, or with the taxpayers’ money if you are on Medicaid. It is common sense. It is also called accountability. I believe in these common sense, conservative reforms to control costs, and I fought hard to include them in the private option legislation.

However, via Presidential executive orders and decisions, Obamacare is a moving target and the mandates appear increasingly likely never to be enforced, which gives us a policy that cures a problem we really don’t have. It will be a constant moving target that can only be fixed at the federal level through legislative action. The information and facts we had then, are not what we have now. The reality is that approval of Health Savings Accounts is entirely in the hands of the federal government, and we have yet to have any meaningful plans on how this will be implemented, how people auto-enrolled with an insurance plan will transition to these accounts, and if the amendments will actually be approved by the federal government. I’m not going to sign a check if I don’t know exactly what I’m getting.

In the last legislative session, we were faced with an impossible situation. The Obama administration successfully passed the Affordable Care Act, aka Obamacare. President Obama was reelected. The US Supreme Court ruled that it was Constitutional. It was here to stay and we had to deal with it. The US Supreme Court ruled that states could not be forced into expanding Medicaid. This decision left states in a precarious position. Funding drives policy nowadays, particularly at the federal level. So would we accept funding & the policy attached to it, or not? Arkansas decided to seek a waiver and try something that granted the funding, but without the attached policy, or so we thought. We are having to provide certain wrap-around services required under Medicaid.

If we embrace the idea of federalism, that states are the laboratories of democracy, then we should also accept that in laboratories, there is a constant evolution of experimentation. When something isn’t right, we pause, we step back, assess, re-evaluate. We should have the courage in Arkansas to do what they can’t do in Washington.

I have been elected to represent my district, to make the best decisions can with the information I have, and to make sure that taxpayers dollars are spent wisely. I am committed to public policy that ensures and protects the ideas this country was founded upon. Government should not be the destination. Government should be the vehicle to achieve life, liberty and the pursuit of happiness.