The Arkansas Senate voted 24-9 Friday to approve a program that would expand health-care access to a quarter-million poor Arkansans by letting them use government funds to purchase private health insurance.
Senate Bill 1020, by Sen. Jonathan Dismang, R-Searcy, next goes to the House.
Before voting, the Senate held an hour-long discussion,called a “committee of the whole,” where all senators had a chance to quiz directors of the state Insurance Department and the state Department of Human Services on what’s been called the “private option.” No senator spoke against the bill.
A handful of House members watched the proceedings from the back of the Senate chamber. The House is expected to take up the bill and its identical House counterpart, House Bill 1143, in the coming week. The session is scheduled to end April 19.
Some Republicans have said their support for the private option hinges on other overhauls to the state Medicaid program. One of those bills failed to get out of a House committee Friday. House Republican leader Bruce Westerman of Hot Springs warned that the bill’s “partisan rejection seriously puts at risk House Republican support of the private option.”
In July, the U.S. Supreme Court struck down part of the 2010 federal Patient Protection and Affordable Care Act and let states choose whether to extend Medicaid access to individuals who earn up to 138 percent of the federal poverty level, or $15,145 annually.
The same law calls for states to set up private-insurance marketplaces called exchanges from which people can pick their own insurance plan. If the Legislature goes with the plan contained in the House and Senate bills, low-income Arkansans would be able to buy government-subsidized insurance through the exchange.
In February, U.S. Health and Human Services Secretary Kathleen Sebelius told Gov. Mike Beebe that he could pursue a method of using federal Medicaid funds to pay premiums on private insurance policies. Arkansas was the first state to propose such a plan.
On Tuesday, Sebelius wrote in a letter to Beebe that the Health and Human Services Department will help Arkansas provide government-funded private health insurance to those who qualify.
Dismang said Arkansas is stuck with the Patient Protection and Affordable Care Act and should make the best of it.
“It is our responsibility to do what we can … to take care of our citizens,” Dismang said.
Several senators who voted against the private-option bill would not comment on why they cast a no vote.
Those who would comment said they are concerned about increasing the federal budget.
Sen. Jim Hendren, R-Sulphur Springs, said that, while the bill is probably the best option available, he is looking at the long-term consequences.He said he voted against the bill because he’s worried about his granddaughters’ future.
“I think we’re on an unsustainable path as a country with increased spending and increased entitlements and increased programs, and I think we’re hastening the day when the whole thing is going to collapse,” Hendren said. “I wish we could give insurance to everybody, but we just can’t afford to keep adding spending like this.”
He said those who wrote the bill did a lot to make it palatable.
Before the program could move forward, legislators would have to approve a separate appropriation bill to give the state Human Services Department authority to spend the billions in federal funds.
It takes approval of 75 percent of lawmakers in each chamber to pass an appropriation, a hurdle lawmakers and the governor acknowledge will be difficult to surmount.
“A lot of the members have a lot of things to work through on this bill,” Dismang said.
The appropriation will likely be inserted into the Human Services Department’s budget, meaning that if it were to not pass, there would be no department budget in fiscal 2014, which begins June 30.
The appropriations bill will make clear that the program will end if the federal government fails to fund the program or honor the terms of the agreement, Dismang said.
Beebe said he is not worried about inserting the private-option appropriation into the department’s budget.
“I don’t think anybody wants to go home without a Human Services budget,” Beebe said. “We’re going to fight like the devil; that’s all I can tell you.”
On the House end of the Capitol on Friday, Westerman said he plans to amend House Bill 1965 with his own version of the private option that would put nearly all of the state’s current 780,000 Medicaid recipients on private insurance. He didn’t know when it would be ready.
“It’d be an option that I’ve alluded to before that would truly revolutionize the Medicaid health-care-delivery system,” Westerman said. “It wouldn’t just affect the expansion population; it would affect the population that’s currently on Medicaid.”
Democrats have largely rallied around the original private-option bill, as have Republican leaders, including House Speaker Davy Carter, R-Cabot.
Westerman said he doesn’t think the conflicting bills won’t cause friction among House Republicans.
“No, I think this issue causes friction any way you look at it,” he said. “It’s a really tough decision for members on how to vote for it and I want to make sure, as the caucus leader, that we have as many options available to them to consider and that they understand the facts and that they don’t make a rushed decision just because we’re wanting to wrap up and get out of here. I don’t believe we’ve got it all figured out yet.”
Earlier in the day, Westerman released a statement that failure of his House Bill 1256 - after Human Services Department Director John Selig testified against it- had cast doubt on whether the governor is serious about overhauling the current Medicaid program.
“It makes me real leery to trust … that they are going to be able to develop a plan after we go home,” Westerman said. “Today was somewhat of a verification that they are not committed to reforming the existing system.”
The bill would have created a program to use identification cards and fingerprint scanning to keep Medicaid recipients from sharing their benefits or providers from over billing Medicaid.
House Public Health Committee Vice Chairman Rep. Reginald Murdock, D-Marianna, said it’s “pretty serious” to threaten to defeat the private-option bill because a department director spoke against another bill.
“That’s not good practice to do it that way, that’s not what we should do up here,” Murdock said. “We’re not playing a game.”
Front Section, Pages 1 on 04/06/2013