Arkansas Just Funded Its Medicaid Expansion — but the Fight Isn’t Over

The state Legislature narrowly renewed the “private option” plan, but the program’s future remains uncertain.

National Journal
March 4, 2014, 11:21 a.m.

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.

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