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
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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.

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