Why is it so important for the Arkansas House of Representatives to approve the funding for the private-option Medicaid expansion this week after it had been passed by the Senate? That’s the question I asked Sen. Bruce Maloch, D/Magnolia, who represents District 12 that includes Arkadelphia and other communities in Clark County.

MALOCH: “First of all, because it provides health care for working people of Clark County who are working for an employer and who earn about $15,000 for a single person or up to about $32,000 for a family of four. It’s important for people to know that this is not for those who are just out there and not working or who are not trying to get a job. Those people are already covered by our Medicaid program. This program is for the working poor or for people who are now working but do not have access to health care.”
DOWNS: Why has the House voted against this bill?
MALOCH: “I think the confusion that a lot of people have is the idea that a vote against the private option is a vote against Obamacare, and that is simply not the case. A person can be against the Affordable Care Act (ACA) but still vote for the private option. A vote against the private option does not do away with the ACA or Obamacare in the state of Arkansas. Another point that is important to Clark County because of your hospital, is that when the ACA was passed, a part of the way it was paid for was a reduction in Medicare reimbursement rates. That directly impacts your hospital, your doctors and other health-care providers.”
DOWNS: How will this be done?
MALOCH: “One of the ways they were going to make up that reduction was through Medicaid expansion, and hospitals would have people who are currently being served through uncompensated care. They come and the hospital takes care of them but ultimately does not get paid. But with Medicaid expansion, many of those people would end up being covered. So Medicare rate reduction would make up the difference with Medicaid expansion.
“When the U.S. Supreme Court ruled on ACA, they said the law was valid but you can’t force the Medicaid expansion on the states. And, of course, our private option is a Republican-crafted version of Medicaid expansion that introduces the marketplace to it. But if we do not pass that, our hospitals that are already struggling financially get an even lower rate of reimbursement and they don’t pick up any of the benefits of the expansions, so they will really be struggling. And if you lose your hospital, not only do you lose the needed health care for your current citizens, it affects your industrial recruitment and your economic development because an industry may not want to come to an area that doesn’t have health-care available for their employees. That creates a ripple effect on our smaller communities that will go down if we don’t provide available health care for their citizens.”
DOWNS: “One of the objections I have heard is that a lot of people who have chosen the private option are still going to the hospital’s emergency rooms rather than using their cards in a physician’s office because medical clinics cannot serve that many people.”
MALOCH: “I’ve run into some of that and I think that is still the case right now. I think this takes time, and I think it takes education to move those people who just have a bad cold or maybe the onset of the flu from going away from the emergency room and over to a doctor. And I also think, particularly in areas of the state like Arkadelphia or Magnolia where I am from and towns of those sizes, that we are going to have to build health providers, nurse practitioners, and physicians assistants into the systems.
“Many of the doctors in our communities have a full patient-load. This is why we are going to have to expand the clinics with health providers like these who will work under the supervision of doctors. This must take some time to educate the public by letting them know that such services are available at that level as opposed to the emergency room. It’s certainly an issue we will continue to work on.”
DOWNS: What do you hope readers will take from this column?
MALOCH: “I hope they will study the issue and will understand what the private option really is. A vote against the private option is not a vote against Obamacare. A vote against the Private Option takes $89 million out of the budget.
“This would not only significantly affect the hospitals because it doesn’t help with their uncompensated care, but another negative would be its effect on education. We can’t cut grades K-12 because that is a constitutional responsibility. So one of the few other places we have to go is higher education. We can’t cut prisons or corrections. We are limited in what we can cut from human services. So that leaves higher education.”