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 »
LITTLE MARCO FOR SENATE
Trump to Rubio: Run for Reelection
1 hours ago
THE LATEST

Donald Trump may have defeated Sen. Marco Rubio's presidential ambitions, but he wants the man he dubbed Little Marco to keep his job in the Senate. "Poll data shows that @marcorubio does by far the best in holding onto his Senate seat in Florida," Trump tweeted Thursday evening. "Important to keep the MAJORITY. Run Marco!" Trump is not the first to urge Rubio to run, though the senator has said such a move is unlikely. The filing deadline is June 24. 

Source:
FIRST SITTING POTUS TO VISIT
At Hiroshima, Obama Calls For Nuke-Free World
1 hours ago
THE LATEST

President Obama called for an end to nuclear weapons Friday during a somber visit to Hiroshima Peace Park in Japan, where the United States dropped the first atomic bomb 71 years ago. "That is the future we can choose,” Obama said. “A future in which Hiroshima and Nagasaki are known not for the bomb of atomic warfare but as the start of our own moral awakening.”

Source:
AKNOWLEDGING THE INEVITABLE
UAW: Time to Unite Behind Hillary
19 hours ago
THE DETAILS

"It's about time for unity," said UAW President Dennis Williams. "We're endorsing Hillary Clinton. She's gotten 3 million more votes than Bernie, a million more votes than Donald Trump. She's our nominee." He called Sanders "a great friend of the UAW" while saying Trump "does not support the economic security of UAW families." Some 28 percent of UAW members indicated their support for Trump in an internal survey.

Source:
AP KEEPING COUNT
Trump Clinches Enough Delegates for the Nomination
21 hours ago
THE LATEST

"Donald Trump on Thursday reached the number of delegates needed to clinch the Republican nomination for president, completing an unlikely rise that has upended the political landscape and sets the stage for a bitter fall campaign. Trump was put over the top in the Associated Press delegate count by a small number of the party's unbound delegates who told the AP they would support him at the convention."

Source:
TRUMP FLOATED IDEA ON JIMMY KIMMEL’S SHOW
Trump/Sanders Debate Before California Primary?
22 hours ago
THE LATEST
×