Arkansas at Standstill Over Medicaid Expansion

The state House failed to pass a bill Tuesday that would renew funding for the state’s “private option.”

AURORA, CO - DECEMBER 01: Dental hygienist Denise Lopez cleans the teeth of Ashleigh Britt at a community health center for low-income patients on December 1, 2009 in Aurora, Colorado. 
National Journal
Sophie Novack
See more stories about...
Sophie Novack
Feb. 18, 2014, 11:40 a.m.

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.

What We're Following See More »
WORDS AND PICTURES
White House Looks Back on bin Laden Mission
3 hours ago
WHY WE CARE
NO BATTLE OVER SEATTLE
SCOTUS Won’t Hear Appeal of Minimum-Wage Law
4 hours ago
THE DETAILS

"The U.S. Supreme Court on Monday rejected a sweeping constitutional challenge to Seattle’s minimum wage law, in what could have been a test case for future legal attacks on similar measures across the country. In a one-line order, the justices declined to hear a case by the International Franchise Association and a group of Seattle franchisees, which had said in court papers that the city’s gradual wage increase to $15 discriminates against them in a way that violates the Constitution’s commerce clause."

Source:
DOWN TO THE WIRE
Sanders Looks to Right the Ship in Indiana
4 hours ago
THE LATEST

Hillary Clinton may have the Democratic nomination sewn up, but Bernie Sanders apparently isn't buying it. Buoyed by a poll showing them in a "virtual tie," Sanders is "holding three rallies on the final day before the state primary and hoping to pull off a win after a tough week of election losses and campaign layoffs." 

Source:
CONSTITUTIONAL CONVENTION IN JUNE
DC to Release Draft Constitution as Part of Statehood Push
5 hours ago
WHY WE CARE

"The New Columbia Statehood Commission—composed of five District leaders including Mayor Muriel Bowser, D.C. Council Chairman Phil Mendelson, and D.C.'s congressional delegation—voted today to publicly release a draft of a new constitution for an eventual state next Friday, at the Lincoln Cottage." It's the first step in a statehood push this year that will include a constitutional convention in June and a referendum in November.

Source:
ALZHEIMER’S OUTCRY
Will Ferrell Bails on Reagan Movie
5 hours ago
THE LATEST

Amid outcry by President Reagan's children, actor Will Ferrell has pulled out of a movie that makes light of Reagan's Alzheimer's disease. A spokesperson for Ferrell said, “The ‘Reagan’ script is one of a number of scripts that had been submitted to Will Ferrell which he had considered. While it is by no means an ‘Alzheimer’s comedy’ as has been suggested, Mr. Ferrell is not pursuing this project."

Source:
×