OPINION

OPINION | JOHN BRUMMETT: Moms and Medicaid math


Gov. Sarah Sanders has such an aversion to Medicaid, the federal-state partnership for poor people's health insurance, that she advocates putting our state's low-income new mothers on Obamacare instead.

As an unreconstructed Trump Republican, she probably still officially holds to the position that Obamacare--or the Affordable Care Act with subsidized premiums on the health-care exchange--is bad.

She probably also clings to the comical notion carried as a lie through the four years of Donald Trump's presidency that he would get Obamacare abolished and replaced with something better. That "something" was never clear, on account of never existing.

It's the same old pattern. Republicans oppose and demonize Democrats' health solutions until they need to stand up against one by hiding behind another.

Republicans get away with it in Arkansas where many people are eligible for Medicaid and either don't want it or don't know how to sign up for it or have no idea whether they're on it.

A savvy Arkansas politician was telling me recently about what he saw as the fatal tin ear of the Arkansas Democrats we have left.

He said the state Democratic Party called a news conference ostensibly to assail Sanders' $19,000 lectern but ended up spending more time lamenting the high number of people tossed off Medicaid in the state by the Sanders administration. Anyone understanding Arkansas politics, the man told me, would know that a $19,000 luxury a governor lavished on herself is a bigger story than $19 million in Medicaid money unspent on medical services for the state's unaware sick poor people.

Sanders understands that. But surely she also understands there is a bit of unease in looking callous toward poor new moms.

Arkansas has had in recent years the highest maternal mortality rate in the country. Concurrently, the federal government has declared that Medicaid benefits for an expanded-eligibility population of low-income new mothers may be extended by the choice of the states from the mandated 60 days post-birth to 12 months post-birth.

Forty-four states and the District of Columbia have taken the 12 months. Three more states are gearing up to take them. That leaves three others--one of them the same Arkansas with the highest percentage of dying mothers--that say they don't want them.

All our surrounding states--unprogressive environs like Louisiana, Mississippi, Oklahoma, Texas--have taken the math and the expanded Medicaid. A few states--progressive ones such as Massachusetts, Vermont and California--not only take the maternal-care extension under Medicaid but provide their own added state subsidies. It's part of being a healthy and compassionate state.

Sanders was on a panel about this subject late last week. She said there are plenty of other options for "transitioning" these poor moms after 60 days to other kinds of health coverage--which would cost these moms more, or maybe leave a few in a gap, but cost the state government less.

Sanders blamed a failure to communicate. She said we need to get the word out to these poor moms about other options.

If the state knew how to keep poor people informed of the services available to them, or was more committed to information about those services, it wouldn't have thrown so many off Medicaid blindly last year for not getting their paperwork in.

In a follow-up to the governor's statement, a press spokesman in her Human Services Department talked about those other options, with the most prominent being the federal health-care exchanges for subsidized policies through Obamacare.

About the only other thing he had was that maybe those moms have jobs with benefits.

Obamacare's subsidies on these exchanges are funded fully by the federal government. Medicaid requires out-of-pocket money from the states to go with a larger federal match.

So, by basic math, it's better for state government to pay no Medicaid match and let Joe Biden cover things entirely through Obamacare subsidies.

But, by considering modestly advanced math, the state comes out ahead on expanded Medicaid by taking more in from the feds than it matches, as well as in terms of more money moving about in the state's health-care economy helping to make sick people less so.

The spokesman with Human Services pointed out that most maternal deaths occur within 40 days of giving birth.

He said his point was that it seems more important to be thorough in the early services than to lengthen the time of services.

I'm sure there was no intent to say that Arkansas should just play the odds for its low-income mothers.

If they're looking for an issue, and if the fellow is right that Medicaid is not it, then Arkansas Democrats can wait for that lectern audit. They can hope it delivers at least a few euphemistic findings--"irregular" invoicing, maybe, or "ill-advised," or even the handy "mistakes were made."


John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at [email protected]. Read his @johnbrummett feed on X, formerly Twitter.


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