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like a teenager plowing through the “Twilight” series, and is passionate to the point of obsession about nearly every big-picture conservative reform idea ever. He speaks in manic bursts and thinks in very sweeping, very longrange, very ambitious terms (“We are just getting started in a brave new world of policy in the United States”). All of them are smart and a little bit wonky. All of them are politically combative. All of them are extremely conservative. And all of them — if you take them at their word — were never, ever going to vote for full expansion of the traditional Medicaid program. In the first few months after the election, legislators were met with a barrage of arguments from key political
that the Medicaid program simply didn’t work, and from their perspective, expansion would only exacerbate the problems. Meanwhile, any talk of “free money” from the federal government was anathema to conservative dogma. When Beebe met with a group of legislators from both parties on Feb. 11, the meeting began with much the same dynamic as the state of the state — the governor making the hard sell, Republicans crossing their arms. Republicans saw it as an opportunity, as Burris puts it, to say, “No, and here’s why.” From their perspective, this meeting was the moment when the governor understood that traditional Medicaid expansion simply wasn’t on the table (expansion proponents
the wrong behavior among beneficiaries; they think it will inevitably lead to runaway costs; they think it gobbles up taxpayer money while delivering low-quality service. One can argue with them until the cows come home on these points, but once you realize how deeply held their worldview is, it becomes clear why Medicaid expansion as traditionally conceived was always going to be a nearly impossible sell to this crew. But this was also the key to unlocking a third way in Arkansas: This group of Republicans turned out to be much more open to government spending to increase healthcare access if it came as part of a transition from a public program to a more market-based
BRIAN CHILSON (2)
+++ e cannot know for sure what would have happened in a counterfactual, but it’s highly likely that without the “private option,” Medicaid expansion would have been impossible. And the “private option” came to be in large part because of pushback from three key Republicans. Dismang, a jovial backslapper by disposition, is a hard-handed negotiator; he faced political pressure with White County Medical Center in his district, but was one of the most forceful lawmakers in the early going, tangling with the stakeholders pushing for Medicaid expansion. He’s viewed as one of the legislature’s hardest workers and has been open to pragmatic problem-solving despite his consistently hard-right political orientation. Back in November, when many in his party were still relying on ready-made slogans, Dismang was researching the ins and outs of the Affordable Care Act. His comfort getting into the weeds of policy detail established him as a key voice of Republican opposition to expansion even before the session started. Burris is a 27-year-old political wunderkind who first ran for office in 2008 at the suggestion of Sen. Michael Lamoureux, who happened to see him at the drive-thru at Wendy’s where Burris, then a College Republican at Pulaski Tech, was working as a manager. He was elected as the youngest legislator in decades and has devoted himself to the General Assembly full-time ever since. He’s quick on his feet, with a sharp, biting sense of humor, but if someone like Beebe was looking for compromise, Burris was probably not the first person he thought of. He is an aggressive, bullheaded legislator who likes to pick fights with liberals and has the talent to spar with the best. He once asked why the media portrayed him as angry (Democrat-Gazette columnist John Brummett rarely mentions his name without including the apt “pugnacious” as modifier). A reporter suggested that it looked like he wanted to punch someone during committee meetings. He responded that people should stop saying things that made him want to punch someone. Sanders practiced his policy chops as a conservative commentator for local television and print media before going into politics. He inherited the passion for right-wing ideas of his hero William F. Buckley, and also the cosmopolitan flair — his dapper getups even feature matching socks for his colorful collars and pocket hankies. He digests material from conservative blogs and think tanks
LAMOUREUX: “The principal” had a good working relationship with Beebe (right).
insiders, hospitals, and the business community. While the makeup of the legislature — and at least in some districts, the electorate — was ideologically opposed, the major interests in the state were united in support of Medicaid expansion. Because the fiscal case for the state was so strong, many expansion proponents felt that once the facts were digested, they would win the argument. In the final analysis, was the legislature really prepared to turn down billions in federal stimulus money? But Burris, Dismang and Sanders believed that they had as good a handle on the facts as anyone, and they were absolutely prepared to turn down the feds’ offer. They were true believers
view it differently, saying they were not ready to give up hope if that was the only way forward). In any case, hearing the Republican arguments also represented an opportunity for Beebe and his team. His staff took notes on their questions and concerns. They knew what Republicans were saying no to. Was there anything they would say yes to? +++ f you’ve ever heard a conservative rail against Medicaid, or any public program for the poor, you’ll be familiar with the complaints lodged by Burris, Dismang and Sanders. They think the program is rife with waste and inefficiency; they think it incentivizes
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approach using private companies. Liberals were motivated by the expansion part of Medicaid expansion — access to healthcare for the poor. If they could take out the Medicaid part, Burris, Dismang and Sanders were willing to be partners. This isn’t really so surprising. Before Obamacare got labeled socialism, healthcare exchange marketplaces were once considered a conservative alternative approach to expanding healthcare coverage (made famous by Republican Mitt Romney when he was governor of Massachusetts). As Sanders is fond of mentioning, ideas about “premium support” have often come from the Republican side. Congress