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Citizens in western states aim to expand Medicaid via ballot iniative

Posted: 28 Apr 2018 01:39 PM PDT



Speaking of Medicaid expansion, reports came in this week out of Idaho that a campaign to put the question on the ballot before voters is just 1,200 valid signatures away. They've already cleared the more difficult hurdle, Boise State Public Radio reports:

It's taken months, but Medicaid for Idaho organizer Sam Sandmire says the group has met one of two requirements to get the group's initiative on the ballot in November.

They gathered enough signatures across different legislative districts, but they still need about another 1,200 valid signatures from anywhere in the state.

"Gathering six percent of registered voters' signatures in 18 different districts in a rural, spread out state like Idaho is an extraordinary task," Sandmire says.

The group hopes voters will get a chance to decide whether or not to extend Medicaid coverage to up to 62,000 Idahoans who currently earn too much to qualify for the program, but earn too little to get a subsidy for a health insurance plan offered under the Affordable Care Act. 
Meanwhile, campaigners behind a ballot initiative for Medicaid expansion in Utah recently got enough signatures to put the question on the ballot this November, and a similar campaign has just begun collecting signatures in Nebraska, Huffington Post reports. It's a clever maneuver by enterprising citizens to get around Republican legislators too frightened of Obamacare politics and advocacy groups like Americans for Prosperity to accept billions of dollars in federal money to provide health insurance for their states' poorest citizens.

The same approach was taken in Maine, which approved Medicaid expansion via a popular ballot initiative last year. However, Gov. Paul LePage, one of the most unpopular governors in the nation, is attempting to use procedural maneuvers to block its implementation in a sad, doomed, bitter attempt to overrule the will of the people and deny health insurance to poor people in the final year of his term.

Currently, thirty-two states have expanded Medicaid since the option first became available in 2014, along with the District of Columbia. Virginia may well be on the cusp of joining them.

For all of the sound and fury from the refusnik states back in the debates of 2013, we're seeing a pattern that is somewhat similar, if a bit slower, to the original Medicaid program. When Medicaid was enacted as a federal-state partnership in 1965, some states dragged their feet. When the funds first became available, half of states participated. That was up to 37 two years in. By the time the program had been running for four years, nearly all states had signed up. Alaksa held out until 1972 and Arizona until 1982.

As for Medicaid expansion, as I've noted in this space before, the latecomers have missed out on three years of 100 percent federal funding. States that waited left billions of dollars on the table for no reason, trying to cut off Obama's nose to spite the face of their own citizens. Sad! In Arkansas, the pragmatists won the day, and the state benefited from billions of dollars to provide coverage to its poorest citizens.

How Arkansas Republican primary voters learned to stop worrying and love Obamacare

Posted: 28 Apr 2018 12:28 PM PDT

Don't miss Jay Barth's column in this week's Arkansas Times on the evolution of opinion on Medicaid expansion among Arkansas GOP voters. Barth digs in to a doozy of a finding in a recent Talk Business poll, one I also noted last week: A substantial plurality of Arkansas Republican primary voters now support Medicaid expansion.

The Talk Business poll found that 41.5 percent of likely Republican primary voters in the state support "Arkansas Works," the Medicaid expansion program that uses Medicaid dollars made available by the Affordable Care Act to purchase private health insurance for low-income Arkansans (this is the same program once known as the "private option" until Governor Hutchinson re-branded it, concluding that the old name had become "politically toxic"). That's compared to 25.5 percent who oppose it and 33 percent who don't know.

That represents a dramatic reversal from the beginning of the Medicaid expansion debate, when GOP primary voters strongly opposed the policy. The Affordable Care Act passed in 2010 and Republicans put every ounce of their political energy into a crusade against "Obamacare." When the Supreme Court kicked the decision on Medicaid expansion to the states in 2012, the leader of the new Republican majority in the Arkansas House, Bruce Westerman, stated flatly, "our view is that supporting Medicaid expansion is really embracing President Obama's law." In 2014, Republican candidates continued their mantra as they rode a wave election to total dominance of state politics.  "There are only three things for certain in life," GOP strategist Bill Vickery said at the time. "Death, taxes and the unpopularity of Obamacare in the South."

The word "Obamacare" is still unpopular among Arkansas Republicans, of course (and poll findings consistently tilt quite a bit depending on whether that word, or Obama's name, is used in the question). But when it comes to Medicaid expansion — a policy funded by the Affordable Care Act and an important component of the law — opinion has softened. Barth traces the evolution:

In 2012, as debate over Medicaid expansion began, 64 percent of GOP respondents opposed the notion of Medicaid expansion with only 21 percent supportive. During the debate on reauthorization of the program in Beebe's last fiscal session in the spring of 2014, GOP voters still opposed the program by a healthy 54 percent to 23 percent margin. Two years later, with Governor Hutchinson having become a strong supporter of the program rebranded and somewhat restructured as Arkansas Works, Republicans were split with 34 percent in opposition, 32 percent favoring, and the final third unsure about their views.
And now here we are, with a strong plurality supporting Medicaid expansion. The Talk Business poll is especially striking because primary challenges were supposed to supply the pressure that would push the legislature to roll back the policy despite the obvious political risks of booting hundreds of thousands of people off of their health insurance. Leading this charge has been Joe Maynard, a Fayetteville businessman who has poured money into campaigns for candidates opposing Medicaid expansion via a dizzying array of PACs and other entities. Barth notes that a few Republican lawmakers or candidates have lost primaries in part because of their support for the Medicaid expansion (though others survived just fine). But it does seem like the tide has turned at this point. Lately, Maynard-backed candidates have been trounced again and again.

If Medicaid expansion has the support of GOP primary voters  — or no longer fires them up enough to swing primaries — it's here to stay. (This dynamic might be worth remembering as Sen. Tom Cotton continues to try to repeal the coverage expansion in Congress and Attorney General Leslie Rutledge tries to kill it via the courts.) 

What accounts for the shift in opinion? Part of it may be influenced by the benefits of the policy, which was enacted by the state in 2014. Hundreds of thousands of Arkansans have gained coverage, the uninsured rate has been cut in half, hospitals have reduced uncompensated care costs by hundreds of millions of dollars, and billions of federal dollars have flowed into the state's health care system.

Part of it, also, is the embrace of the policy (with some re-branding and conservative alterations) by Republican lawmakers. Arkansas became one of the first states in the South to move ahead with Medicaid expansion in large part because a group of key Republican lawmakers took ownership of the "private option." And Hutchinson, after bobbing and weaving on the issue throughout his campaign for governor, has steadfastly fought to keep it in place since taking office.

Hutchinson, in addition to lending the policy a new name, has also managed to create bureaucratic hassles for Medicaid beneficiaries, including a new mess of red tape this year in the form of work requirements. He has made the program worse in the name of stale Republican talking points. Those alterations themselves probably help move the needle on GOP public opinion. But Hutchinson also given the core policy — coverage for hundreds of thousands of poor Arkansans, mostly funded by the federal government — the imprimatur of a popular GOP governor. It's hard to overstate the power of that. I can still recall reporting at Republican victory parties in November 2014. The diehard opponents of Medicaid expansion were giddy. Meanwhile, many moderate Republicans who backed the private option, who ostensibly should have been happy that night, looked like they had just seen a ghost. The private option had barely gotten the legislative supermajorities it needed in 2013 and 2014. The enormous wave that November, including a large number of candidates who had campaigned specifically on ending Medicaid expansion, seemed to spell doom for the policy.

But then, a few months later, Hutchinson gave a speech announcing his intention to keep Medicaid expansion around. He appointed a task force to spend a great deal of hours and expense in order to conclude what was plainly obvious at the time: The policy was a good deal for the state and there was no alternative that would maintain coverage for the citizens who depended upon it for health insurance. The right-wing legislature went along. Hutchinson backed primary candidates who supported the policy and in 2017, he stuck with it through yet another dramatic uphill battle to secure approval (he even helped engineer an unprecedented procedural move to get it over the finish line). Thanks to Hutchinson, Medicaid expansion lives on in Arkansas. Long live Obamacare.

James H. Cone dies at 81

Posted: 28 Apr 2018 10:38 AM PDT

Arkansas native James H. Cone, an Arkansas native often considered the father of black liberation theology, died today. He was 81.

Cone, a giant in American theology and one of the nation's most bracing thinkers on race, had been the Bill and Judith Moyers Distinguished Professor of Systematic Theology at the Union Theological Seminary in New York City, where he had taught since 1970. Cone was also an ordained minister in the African Methodist Episcopal Church.

One of the most consistent themes in the Hebrew Bible as well as the Gospels is reversal, an overturning of the present order. Isaiah prophesied to "send good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners." Jesus told his followers, "so the last will be first, and the first will be last." In the longings of the ancients, practitioners of liberation theology heard a message of revolution and hope for oppressed people in the modern world.

"Jesus himself has defined humanity's liberation in the context of what happens to the little ones," wrote Cone in "God of the Oppressed."

"[T]he gospel means liberation ... this liberation comes to the poor, and it gives them the strength and the courage to break the conditions of servitude."

Beginning in the 1960s, Cone used the perspective of liberation theology to examine the black experience in the United States. In the 1969 classic "Black Theology and Black Power" Cone wrote, "It is ironic that America, with its history of injustice to the poor, especially the black man and the Indian, prides itself on being a Christian nation."

Later, in his 2011 best-selling and award-winning book "The Cross and the Lynching Tree" Cone wrote, "The crucifixion was clearly a first-century lynching. Both are symbols of the death of the innocent, mob hysteria, humiliation, and terror. They both also reveal a thirst for life that refuses to let the worst determine our final meaning and demonstrate that God can transform ugliness into beauty, into God's liberating presence."

Cone was born in Fordyce, Arkansas and grew up in Bearden, where he attended the Macedonia Methodist Epsicopal Chuch. He attended Shorter College in North Little Rock  and Philander Smith College in Little Rock, before earning his Master of Divinity from Garrett Theological Seminary and his doctorate from Northwestern University.

Cone's work was heavily influenced by his experiences growing up in Arkansas. He was in college during the 1957 desegregation crisis at Central High. He wrote his doctoral thesis on Karl Barth, but later commented, regarding his experience teaching theology at Philander Smith, "What could Karl Barth possibly mean for black students who had come from the cotton fields of Arkansas, Louisiana and Mississippi, seeking to change the structure of their lives in a society that had defined black as non-being?" One might see his work as an effort to provide a lens and a theology to anchor that seeking.

From his biography at the Union Theological Seminary's website:

Dr. Cone is best known for his ground-breaking works, Black Theology & Black Power (1969) and A Black Theology of Liberation (1970); he is also the author of the highly acclaimed God of the Oppressed (1975), and of Martin & Malcolm & America: A Dream or a Nightmare? (1991); all of which works have been translated into nine languages. The 30th Anniversary of the publication of Black Theology & Black Power was celebrated at the University of Chicago Divinity School (April 1998), and a similar event was held for A Black Theology of Liberation at Garrett-Evangelical Theological Seminary (April 2000) and at the Catholic Theological Society of America (June 2001). His research and teaching are in Christian theology, with special attention to black liberation theology and the liberation theologies of Africa, Asia, and Latin America. He also teaches 19th & 20th century European-American theologies. His latest book is entitled The Cross and the Lynching Tree and received the 2012 Nautilus Silver Award in Religion/Spirituality-Western Traditions. It was an Amazon.com #1 best seller in religion in February 2012. Naming it one of the top religion books of 2011, Huffington Post editors said: "One of the great theologians of the late 20th century, Cone forces us to look hard at suffering, oppression and, ultimately, redemption.

Medicaid advocate criticizes Arkansas Works' email-only reporting for work requirements

Posted: 28 Apr 2018 06:00 AM PDT


Beginning in June, many beneficiaries of Arkansas Works, the state's Medicaid expansion program that provides health coverage to over 280,000 low-income adults, will have to begin fulfilling a work requirement or else prove an exemption. Arkansas received a waiver from the federal Centers for Medicare and Medicaid Services in March to begin imposing work requirements on Medicaid expansion recipients.

Work requirements tend to provoke strong reactions from both left and right. But the devil is in the details: Who gets an exemption? What activities count as "work"? And how do beneficiaries prove to the state they've met the requirement? This last question is especially crucial, since national studies indicate that most non-disabled adult Medicaid beneficiaries do work at least part-time. (Arkansas's requirement says beneficiaries must report at least 80 hours of qualifying activities per month, so many part-time jobs would count.) Yet if working people can't report their labor to the Arkansas Department of Human Services, they still could lose coverage.

Arkansas's waiver to implement work requirements contains an unusual wrinkle. It says beneficiaries must report their activities through an online portal created by DHS — not by physical mail, not by phone, but exclusively over the internet. The issue came up in a legislative meeting on Thursday, as reported by the Democrat-Gazette's Andy Davis. In a state where many residents lack access to broadband, why mandate online reporting for beneficiaries? Why close the door to other means of fulfilling the requirement?

I asked those questions of DHS Director Cindy Gillespie in March, soon after the waiver request was granted. She said the online-only reporting requirement was part of a concerted effort by her agency to move toward digital communications in general — but she also acknowledged it was simply more convenient for DHS.

"Our goal, long range, is hopefully to begin to move to where more and more communication between us and all of our Medicaid population can take place online, or through phone or through text or through other mechanisms besides snail mail," Gillespie said. "We get so much snail mail returned, and we all know we are living in a different age."

Mail is often a less reliable way of reaching people than email, phone or text, she said, and DHS needs to adapt.

Gillespie also framed the portal as a means of pushing beneficiaries into better communications habits, therefore acting as a supplement to the work requirement itself. "Having that little bit of computer or phone literacy is important if you are going to be able to be moving up the income ladder," she said. She noted that the work requirement only applies to beneficiaries between the ages of 19 and 49. "We are talking about 30- to 49-year-olds and next year 19- to 29-year-olds," she said. "I mean, a 19- to 29-year-old who in this day and age can't do that and is able-bodied? You know, they need — we need to help them learn to do that. We need to help them get an email and learn how to deal in that world, or they will never be successful."

The work requirement will apply just to the age 30-49 cohort in 2018 and expand to include the younger cohort in 2019; beneficiaries aged 50-64 will be exempt from the requirement entirely.

Yet Gillespie also said it would simply be difficult for DHS to allow everyone to report their information in a different way. "The other thing is, on a real practical level, this is the way the world works and we are moving into that. If you implement it in the old-fashioned way of 'Come into our county office,' we would have to hire so many people — and that just doesn't make sense," she said.

About 39,000 people are expected to be subject to the work requirement this year, DHS said in March. Gillespie and Governor Hutchinson have repeatedly said the work requirement is not punitive but is intended to help beneficiaries.

Judy Solomon, a senior fellow at the progressive-leaning Center for Budget and Policy Priorities in Washington, D.C. said Arkansas's requirement that individuals report only through the portal was "really unprecedented" in state Medicaid programs. Because Medicaid is a partnership between the federal government and states, there are rules that states must follow — laid out in the federal Social Security Act, which created Medicaid — when they manage their programs.

I spoke with Solomon in March soon after Arkansas received its waiver from CMS. (She's also been critical of Arkansas's work requirement more generally.)

Work requirements themselves are a new thing for Medicaid. But when it comes to reporting information in general, Solomon said, the law says "people can do whatever, whether by phone or mail or online, and you can't restrict those modalities." The online-only rule raises "questions about people with disabilities, without access to the internet, with limited literacy — how they are going to accommodate those people?"

"It's definitely extraordinary. ... I think there are real questions about whether [Arkansas] can even do that," she said.

Arkansas's waiver from CMS is what's called an 1115 demonstration, named for the section of the Social Security Act that allows states flexibility to experiment with their Medicaid programs. A Section 1115 waiver lets a state depart from certain parts of the Medicaid law if it comes up with an alternative way of doing business that meets the fundamental objectives of the program. But, Solomon explained, Section 1115 doesn't allow everything to be waived.

"There's a very long list of state plan requirements … and that's what you can waive. Now, there's a lot of other sections of the Social Security Act," she said. Arkansas cited "expenditure authority" when it sought — and received — permission from CMS to require beneficiaries to report online. Yet it's not clear that "expenditure authority" applies to the question of how beneficiaries report their work activities. "This has nothing to do with expending money. It's just about reporting ... and I think ultimately these things will be decided in court," she said.

DHS spokesperson Amy Webb said in an email on Friday that the agency had vetted its 1115 waiver request extensively and noted federal authorities did the same.

"Our waiver request had extensive legal review not only from Arkansas DHS but also the general counsels of both HHS and CMS as well as Department of Justice," Webb wrote. "Ultimately CMS was comfortable with and approved our request for online-only reporting."

"We are providing additional support to individuals who need it and are making reasonable accommodations for people who need them. It's important to point out two other things: the HHS Secretary has broad discretion and that would cover this area; and the online-reporting is not for enrollment. It's for reporting work activities/exemptions, which is an important distinction."

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

Art in its Natural State at Winrock: Sculpture to be revealed tomorrow

Posted: 27 Apr 2018 04:04 PM PDT


Nine temporary installations by sculptors from Arkansas, Tennessee, Florida, Texas and Missouri will be unveiled on Petit Jean Mountain Saturday — seven on the grounds of the Winthrop Rockefeller Institute —  and two in Petit Jean State Park, amid a day of arts-related activities.

The event begins at 9 a.m. at WRI; shuttles will take folks to the sculptures, where they can meet the artists and hear about their works. Food trucks will provide the nourishment and art demonstrations, performances and interactive events will be on the Institute's front lawn.

To give you an idea of the work that artists put into this effort, check out the collaborative project by Laura Terry and Phoebe Lickwar of the University of Arkansas, Fayetteville, "Visible Invisible."

Other artists whose work was selected for the yearlong show are Lee and Betty Benson of Jackson, Tenn.; Monica Dixon of Kansas City, Mo.; Heather Joy Puskarich of Houston; Karina Pais (collaborating with Edwin Penick), Miami, Fla.; Nathan Pierce of Cape Girardeau, Mo.; Don Wilkison of Kansas City, Mo.; Sabine Schmidt of Fayetteville; Russell Lemond of Little Rock; and Marshall Miller of Hot Springs.

A reception on the tennis court at 5:30 p.m. will feature music by the Arkansas Symphony Orchestra's Rockefeller Quartet and Bonnie Montgomery. Tickets are $50. Register for both free and paid events on eventbrite.com.

Selecting the works, to be reflective of Arkansas's natural beauty, were representatives from the Arkansas Arts Center; the Arkansas Arts Council; the Arkansas Department of Parks and Tourism; Crystal Bridges Museum of American Art; UA Fayetteville; UA Fort Smith; UA Little Rock; and representatives from the Institute and the park.

The Baphomet Is Real Edition

Posted: 27 Apr 2018 03:45 PM PDT


The new Ten Commandments Monument and coming legal challenges, the abrupt closure of the Arkansas Repertory Theatre and Lakeview and the Arkansas Supreme Court's recent ruling on sovereign immunity — all covered on this week's podcast.

Subscribe via iTunes.

Come get lit with the Arkansas Times

Posted: 27 Apr 2018 01:58 PM PDT

Thursday kicked off the Central Arkansas Library System's 15th Arkansas Literary Festival. This Saturday, April 28, the Arkansas Times is proud to once again sponsor the Pub or Perish event connected to the Literary Festival at Stickyz Rock n Roll Chicken Shack in Downtown Little Rock.


The Pub or Perish host will be our own Traci Berry. She will be introducing you to some of the best authors/poets from around Arkansas as they unite to read works in this literary showcase. The 2018 Pub or Perish will be featuring: Kai Coggin, Caroline Earleywine, Karen Hayes, Kate Leland, Peter Mason, Suzi Parker, Molly Bess Rector, Jeannie Stone, and Brandon Thurman.

Don't miss out!

View the Facebook Event