Arkansas on Tuesday inched closer to a Ted Cruz-style government shutdown over the state's plan to adopt Obamacare's Medicaid expansion.
The state House came five votes short of renewing funding for the state's "private option" plan. The plan is something of a public-private hybrid: It takes federal funds available to expand Medicaid under the Affordable Care Act, but instead uses them to pay for private plans on the insurance exchange for the newly eligible low-income individuals.
The House will likely vote on the measure again this week, and Republican Speaker Davy Carter has said the House will continue to vote on the plan until it passes.
The version being considered is a compromise on the original compromise plan. It includes amendments that are aimed at damaging the private option and the broader health care law in the state, without revoking funding for the overall plan at this time.
"This is an appropriations bill that I don't think anyone in this room really likes, but that most of us can accept," Rep. Nate Bell said Tuesday on the House floor. Bell — an outspoken critic of Obamacare and the private option — wrote one of the amendments to the original plan, which prohibits state funds from going to outreach or promotion of any part of the health care law.
"I believe it's important as a conservative that we recognize the situation we're in," he said. "When we can defeat bad policy, we should do so. When we can't defeat bad policy, it's our responsibility to do everything we can to influence it and make it as closely aligned with our philosophy and policy as we can."
The private option is beholden to annual reauthorization, as part of the state's budget for Department of Human Services, which runs Medicaid. Bell warns against reaching a budget standstill, and argues that the Legislature is at an "impasse" without enough votes on either side to approve or kill the private option without changes.
Arkansas's high vote threshold for spending bills makes the annual renewal of funding a persistent challenge: The state requires a three-quarters approval for passage — 75 votes out of 100 in the House and 27 out of 35 in the Senate. Because of the razor-thin margin the first time around, the shift of just a few legislators in the Senate last month brought the future of the program into question ahead of this week's votes.
The House vote in favor of the appropriations bill was 70-27 Tuesday, meaning no action was taken.
The original private-option plan appeased expansion advocate Democratic Gov. Mike Beebe and the wary Republican-controlled state Legislature enough to gain narrow approval last year. CMS issued the state a waiver in September, and Arkansans began enrolling in the program in October, with coverage beginning Jan. 1.
Thus far 96,950 have enrolled, according to the Arkansas Medicaid office. The state estimates that between 200,000 and 250,000 could be eligible for the program.
Opponents of Tuesday's bill largely tie the private option to Obamacare, and argue that spending should not continue on a program that they see as having an unstable foundation. Advocates argue that the program will be cost-effective, and that expanded coverage is needed in the state, which previously had a high rate of uninsured, and an extremely restrictive Medicaid program.
Revoking the private option would leave the nearly 100,000 Arkansans who have enrolled thus far without health insurance.
If and when the bill passes the House, it will be sent to the Senate for approval. According to the Associated Press, Beebee and Senate leaders believe they have just reached the necessary votes to renew the program, following negotiations.