The transcript of our interview is below.
J.R. Davis: Why was the private option the right step for Arkansas?
Rep. John Burris: Because there were a lot of bad things going to happen no matter what. With the health care reform, or Obama care, being declared constitutional and taking full effect -- really next year -- tax increases that are happening, Medicare cuts that come straight out of the pockets of seniors in Arkansas or providers, be it hospitals or anybody else -- all those things were happening. We were also going to see a drastic increase in our Medicaid enrollment -- probably total Medicaid enrollment approaching 900,000 Arkansans within just a few years. All that [is] happening no matter what we did, even if we said "no" and refused to deal with the situation, that stuff happened. And, I think we had a chance to really do something completely different; reduce Medicaid rolls and then reduce what will be our eventual obligation whenever the federal government does get serious about entitlement reform.
JRD: This was something that drove a wedge between some members of the Republican -- or at least that's the way it seems -- in the Republican majority of the House and Senate. We saw [Rep.] Westerman give that fired up speech on the day of the vote. What does that do for the party as a whole? Is it a mend fences kind of thing? What goes on now?
RJB: I think we are all frustrated that we had to deal with the situation we had to deal with, and then we disagreed on how to deal with it. But at the end of the day, we all agree that health care reform [that was] passed by Congress in 2010, was a bad thing, and that all of our congressmen, as they do, should support repeal, and that eventually we can get a president that repeals it and undoes a lot of the damage that's happening. So, I think, what disagreement there was, it was disagreement to the extent...on how to deal with the problem. But we all agree on what the real problem is, and it's a federal government that won't get serious about entitlement spending and reform. All we can do is handle -- as a state -- the best we can to protect our state budget and our state taxpayers. So, we disagreed on the solution, but I think we will all come together now to agree on the big solution, which is electing a Republican president, electing a Republican governor who can help lead the charge around the state -- in our state -- to reform the Medicaid system.
JRD: The two arguments within the Republican party: One was, "let's not do anything about this because we just don't trust the federal government." The other one was, "we have to make a decision, and not doing something is a decision." Is that what, basically the --
RJB: Right, because doing nothing did not mean that nothing happened. Again, you had massive tax increases, massive Medicare cuts, massive growth in enrollment in Medicaid... So, you know, we had a chance to take what was happening but get arms around it and approach entitlement spending in a completely different way; [a] market-based and conservative approach that I think protects the state of Arkansas, both its budgets and its taxpayers, long-term, and I think that's what the private option did.
JRD: What goes on from here? Obviously you giys are going to be doing more with this in the fiscal session in 2014, but what goes forward now with the implementation of the private option?
RJB: Well, first things first. We need to elect a Republican governor, a Republican Senator; a governor to manage this program effectively and then a senator who will vote to repeal. That's my primary hope and objective.
In terms of managing how this is implemented, I think that's key. Because even with a lot of conservatives, you had people that agreed that if we could accomplish what were talking about, it would be a good thing. What they had was a lack of faith in the federal government to actually allow us to do what we were saying we can do. The bill was written very strict in terms of waiver requests and different forms to the system. Now it's our job, as a legislature, to make sure that we follow through and get those things implemented in the right way. I'm committed to doing that. We start committee meetings next week, where we're going to monitor the process. We've got a great relationship with DHS and administration officials to make sure that this gets implemented the way that we want it to, because if it doesn't, they're not going to get three-fourths vote to re-approve this in the fiscal session or the session beyond, or any session after that. This takes three-fourths to implement. It takes three-fourths to continue, and it needs to be implemented in the conservative way the legislation was drafted, or else, I don't think it will get renewed.
JRD: So you're saying that this isn't a done deal by any means.
RJB: Not at all.
JRD: This was just in the general session, and now it still needs approval in the fiscal.
JRD: This process will start in 2014, correct?
RJB: You have enrollment actually starting in October of this year [with] coverage starting in January of 2014, so yes. I think the burden is very much on the federal government and then the state administration to make sure that the spirit and letter of the legislation that we drafted is implemented, because if it's not -- you know, when you had legislation pass with only two votes to spare in both chambers, I can promise you that it only takes one person to be disgruntled, or a couple of people to be disgruntled, for this not to get renewed and continued. I think if they do what they said they were going to do, then we won't have a problem. But we need to be involved in that process.
JRD: So in 2014, when it rolls around, the fact that you approved this plan in 2013 means the federal government will start picking up the Medicaid payments for 2014?
RJB: Correct. Because we passed a budget for FY14, with the coverage beginning in January, it will start in that half of the fiscal year. But if the federal government doesn't -- (pause). This is very important. The legislation is written with very specific triggers, and if the federal government changes the terms of the contract, or refuses to honor one of the requests that we've made that they've agreed to in spirit, then the whole act is void and not implemented, and that's very important. That includes the waivers, the transfer of people off of Medicaid onto the private market, the match rates, etc., etc. So, the legislation is written very strict.
JRD: So, as written, if it is not approved by the federal government as written, that whole contract is void for the state of Arkansas?
RJB: That's right.
JRD: What happens at that point?
RJB: We're back at square one, but we're there because the federal government refused to give the state the flexibility it needed to offer affordable coverage to its citizens and salvage the state's budget, in terms of entitlement spending. But the ball is in the federal government's court. It's really not even a negotiation. They just need to say "yes" or "no", and they have to say yes to all of it, or the act isn't implemented. And I'm comfortable with that.
JRD: One thing I want to hit on really quick is the conservative argument. We've hit on this before. Some are saying that the federal government [can't be trusted -- that the deal will be taken back and that it's going to cost the state in the end]. [For this argument, see House Majority Leader Bruce Westerman's interview HERE]
JRD: Why do you think they are wrong in that? Or, at least, why did you feel like that was not what you wanted to do?
RJB: Well, they're right in their distrust. There's no handshakes with the federal government. But, again, I would ask anybody to read the legislation. It's House Bill 1143. It is written very, very strict, and so if the federal government refuses to honor any of the things they've said they would, it's void. It's written as tightly as it could possibly be written. We're not trusting the federal government to do anything. We're saying "do it, or we're not going to implement this act", and the legislation is incredibly clear.