Chesterfield and Sanders

The Political Animals Club hosted a panel today at the Governor’s Mansion, featuring Democrats Sen. Linda Chesterfield and Minority Leader Greg Leding and Republicans Sen. David Sanders and newly elected Speaker-designate Jeremy Gillam, discussing “The Private Option: How The Deal Was Done And What The Future Holds.” I may post more on that topic this weekend, but in the mean time, a few highlights from today’s event: 

Chesterfield expressed some of the difficulties for Democratic lawmakers who chose a strategy of remaining mum as Republicans hashed out the health care debate among themselves:


Let me say how frustrating it was to deal with this issue. It was very frustrating because when the Affordable Care Act was passed, the only thing I could think of was how many people it would help. And it became extremely frustrating during the time before the regular session, as we were changing from being in the majority for a period of time to being in the minority, and all I could hear was why it should not pass. And I could not understand in a state that needed this health care coverage so very much, why anybody would think it wouldn’t be okay to make Arkansans healthier. 

Chesterfield praised Sanders, Sen. Jonathan Dismang and Rep. John Burris [ed. note: she actually called him “Johnny Burris,” which kind of fits] for coming up “with a very innovative approach.” However, she added, “those of us who are of a certain age want to make sure that some of those things we have fought for are not swept away in the name of innovation.”

Democrats were willing to compromise, Chesterfield said, but had to be careful about giving up too much. “There comes a time when you must say, ‘I’m not going to compromise on this’ rather than putting things on the table that will eventually hurt those people who we hope to help the most,” she said. In particular, Chesterfield expressed concern about the amendment which will limit the non-emergency medical transportation (NEMT) benefit for the private option (see here for our report yesterday on concerns that limiting NEMT could harm the most state’s most vulnerable patients). “When you live in places in this state where people don’t have access to automobiles, the travel aspect was essential,” Chesterfield said. 


The issue came up again when Ann Gilbert, director of the Arkansas Transit Association, criticized the amendment limiting NEMT. Sanders argued that “most of the [private option beneficiaries] have access to transportation.” The state should seek to limit the amount of “wraparound” services it would be on the hook for outside of what the private insurance companies provide, Sanders said. “Ultimately we are responsible for this in terms of a portion of the payment, so we want to be good stewards and oftentimes — I think we’ve seen it in the Medicaid program — there are services and things that are being provided which quite frankly aren’t a necessity.” That said, Sanders said the state would seek a “customized approach” to protect those in need rather than ending the NEMT benefit altogether. “What we wanted to do is to make sure that as we develop this, if there are those situations…we want to make sure there is a way for [beneficiairies] to get to the doctor,” Sanders said. 

Chesterfield responded: 


I was extremely disappointed when the travel piece was cut. … The question became do you throw the baby [the private option] out with the bathwater. I’m very, very upset about it because once again, the poor have to prove that they need something. … I hope that we will come up with a plan.

As usual, Sanders made the pitch for the private option as a whole as an “innovative, transformative” reform of health care policy. He discouraged people from viewing the status-quo private option as a fixed “landing point” — the policy will evolve, with many additional reforms to come, he said. That will, no doubt, include ideas that Chesterfield and folks like me won’t like. Still, I think it’s worth noting that several times during today’s discussion, Sanders directly acknowledged the value of expanding coverage to those who desperately need it. “You know what happens to a lot of people who can’t get health care coverage,” Sanders said. “We’ve seen that — we know those people, we know what their lives are like. It has been a major contributor to poverty, not only in our state but in the country.” 

Boston University health economist Austin Frakt has written, “Conservative means to progressive ends is the best bet for evolution of health policy.” I’d say the private option is a particularly potent example. 

The elephant in the room, answered today mostly in generalities: Are we going to have to re-hash the fight over the private option all over again in January? For all of the talk of policy details and long-term vision, can the private option even survive the supermajority threshold next year and in the years to come? 

Gillam said that if the policy was working as intended and members were involved in the process and had access to the data they needed, “hopefully they’re going to be able to get their questions answered and be able to have their input as we go in to it, and we won’t see as much drama as we may have in the past.”


Gillam met with the press afterwards and I asked whether his hope for “a broad consensus” and no “drama” and “a path for everybody to get behind” might  run in to a problem with members of his own caucus dead set against the private option.

“At this point, I think there are members that are still open minded to it,” Gillam said. “I haven’t seen anybody that’s absolutely going to turn a blind eye to empirical data that shows it’s working. …They’ll be open minded as we come to it and if it’s working, I think they’ll get on board. And they may find ways to really improve the product for the state, so we’re going to make sure we’re there for that.”

That sounds like just the sort of unwarranted optimism that will serve him well if Gillam ends up becoming Speaker.