LITTLE ROCK — State lawmakers approved a $1.2 million contract Friday to study how to coordinate the fluctuation of lower-income Arkansans between Medicaid and private insurance offered on the state’s fledgling insurance exchange.
But members of the Arkansas Legislative Council wrangled for more than an hour about a rule change that would have required fewer votes to review items, such as that exchange contract, in the council’s subcommittees.
Republicans defeated the proposed rule change in the latest skirmish over implementing aspects of the federal Patient Protection and Affordable Care Act in Arkansas. The state’s insurance exchange is required by the federal health-care law, one of President Barack Obama’s signature achievements, upheld in large part by the U.S. Supreme Court in June.
“Let’s be honest, this is about an agenda to block the expansion of the Medicaid program. It’s a minority [party] using the rules to determine the outcome,” said Sen. Jim Luker, D-Wynne, after the meeting. Luker led his party’s efforts to require fewer votes for the council’s subcommittees to review items. The council “reviews” or approves state business when the Legislature is out of session.
The proposed rule would have required a majority of those members present to take action on a matter. Currently, a majority vote of the full membership is necessary.
On Sept. 5, the state Insurance Department’s contract was stalled when too few lawmakers were in a subcommittee to review the item.
Rep. Terry Rice, R-Waldron, who will be House speaker if the GOP captures that chamber in the Nov. 6 election, said the rule change was unnecessary. He said major decisions on aspects of the health-care law should wait until after the election.
“I think the election will make the decisions. Elections are about what’s acceptable and what’s not,” Rice said.
Earlier this week, Insurance Commissioner Jay Bradford said he would likely wait until after the election to seek legislative approval for an $18.6 million federal grant to continue setting up the exchange. He said he thought political emotions surrounding the health-care law would likely have cooled by that time.
Luker said Friday that he had advised Bradford to do just that.
“It won’t get better until after Nov. 6 and then we’ll see,” Luker said.
Bradford told lawmakers Friday that the study was necessary to make sure that people don’t fall through the cracks if their health-care coverage switches from private insurance to Medicaid or vice-versa. Many Arkansans, including seasonal workers or other low-income workers would likely fluctuate between coverage over the course of a year. Exchange planners want to make sure those workers don’t have to find new doctors or interrupt treatment.
“My fears on this [is] if somebody is in the midst of being treated by their physician ... and loses their job and have to migrate to a different plan,” Bradford said Friday.
Rep. John Burris, R-Harrison, said Republicans are satisfied that the study also would address the migration of ARKids First, the state’s health-insurance program for children in lower-income families, between Medicaid and private insurance.
“That problem exists currently and would exist even if we don’t expand Medicaid,” Burris said.
The contract was approved by a voice vote.
The state’s $4.6 billion Medicaid program covering about 780,000 Arkansans could be expanded by about250,000 if three-quarters of state lawmakers vote for it.
The federal government would pay about $900 million a year for the expansion, picking up all costs until 2017. By 2020, the state would pay for 10 percent of the bill.
Although the state would be expected to contribute about $273 million to Medicaid expansion between 2017 and 2021, the state Department of Human Services has estimated those costs would be offset by a wide range of savings, including fewer dollars spent on uncompensated charity care, greater federal subsidies for some state Medicaid programs and increased tax revenue. In all, the Human Services Department estimates $372 million in net savings between2014 and 2021.
Right now, the state pays about 30 cents of every Medicaid dollar.
The exchange, which begins in January 2014, is expected to enroll about 326,000 when it begins accepting applications in October 2013.
Those with incomes between 100 percent and 400 percent of the poverty level will receive federal subsidies to help purchase private insurance offered in the exchange.
Insurance Department officials have said that the exchange will reduce the state’s uninsured population - put at about 500,000 - by 60 percent.
Rice said he recognizes the value of the exchange, but it is part of the federal health-care law, which he opposes.
“The exchange is not a bad thing. It’s just what it facilitates is what’s the problem,” he said.
Front Section, Pages 1 on 09/29/2012