Arkansas's version of Medicaid expansion under the Affordable Care Act is weakened, but safe ... for now.
After several weeks of uncertainty, the Arkansas House and Senate each approved funding for the state's "private option," which takes federal dollars for Medicaid expansion and uses them to buy private insurance plans for low-income individuals on the exchange.
The Senate approved the legislation first on a 27-8 vote Feb. 20. After four failed votes, the House passed the bill Tuesday on a 76-24 vote.
However, the action renews the program for only a year, and opponents remain committed to continuing the fight.
The replacement of a Democratic senator by a Republican who opposed the private option in a special election earlier this year, plus one or two other members switching their vote, brought the future of the program — which has to be reauthorized annually — into question.
The bill had been held up in the House for the past few weeks, a few votes shy of the supermajority required to pass spending bills in the Arkansas Legislature. The state requires three-quarters approval for passage, or 75 out of 100 votes in the House and 27 out of 35 in the Senate.
To achieve the necessary vote count, the original compromise plan was amended this time around to appease opponents, and these changes target the future of the plan, as well as the overall health care law in the state.
One of the main amendments, written by Republican state Rep. Nate Bell, prohibits any state funds from going toward promotion or outreach of the ACA in the state. This includes enrollment in the private option, as well as the overall exchange. Bell — an unabashed critic of the private option and the health care law — has said he ultimately wants the program to fail, and that this amendment is intended to stymie enrollment.
"I believe it's important as a conservative that we recognize the situation we're in," he said on the House floor during an earlier vote last month. "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."
Funding for the private option is included in the larger appropriations bill for the state's Department of Human Services, which means that either way, a supermajority had to agree to pass the bill — with or without the private option — by the end of the legislative session.
The amendments were intended to make funding the private option more palatable to members who oppose further spending on a program they see as implicitly linked to Obamacare, and avoid what Bell called the "impasse" in the budget standoff.
Bell and other Republicans who supported the bill but oppose the private option have already vowed to continue the fight against the program next year.
Given the experimental nature of the private option in Arkansas, it will continue to be evaluated regularly. The amendments passed Tuesday are intended to weaken the future of the program while maintaining it for current enrollees, until opponents gain more leverage against it.
"For those who feel like I've betrayed you, we'll be back next year," Republican state Rep. Kim Hammer said ahead of the final vote. "If the program doesn't work, I'll vote against it." Hammer was one of three no votes to flip Tuesday, along with fellow Republicans Les Carnine and Mary Lou Slinkard.
For now, the bill will be sent to Democratic Gov. Mike Beebe, who plans to sign it. The legislation's passage ensures that the approximately 100,000 Arkansans who have already enrolled in the private option will keep their insurance coverage another year. If the Legislature failed to renew funding for the program, these individuals would have been kicked off their plans after June 30.
We can expect a potentially even bigger fight next year, when the private option will need to be renewed once again.