Arkansas lawmakers are in the final stages of deciding whether to let 250,000 poor Arkansans obtain private health insurance that will be paid for with federal Medicaid dollars - something that is referred to at the state Capitol as the “private option.”
But first, some legislators say they need to convince their constituents that the private option is the right thing to do.
Last week the House voted 62-37 to approve House Bill 1143 by Rep. John Burris, R-Harrison, and voted 63-35 to approve Senate Bill 1020 by Sen. Jonathan Dismang, R-Beebe. Both private-option bills are identical. The Senate approved SB1020 in a 24-9 vote on April 5.
The final hurdle in the process is the Department of Human Services appropriation bill, which needs approval from three-fourths of the lawmakers in the House and the Senate to pass. The bill gives the Human Services Department authority to spend the federal Medicaid money. The House delayed voting on the bill Friday after a handful of representatives insisted that they first needed to talk with constituents this weekend. The Senate has not considered the bill yet.
House Speaker Davy Carter, R-Cabot, said the weekend delay will give legislators a chance to check in with constituents about their concerns before voting on the appropriation Monday.
“I refuse to believe that we’re not going to pass it,” Carter said. “I really think we are beyond the question of what’s the best choice.
It’s more than that now. It’s about Arkansas taking control and trying something different.”
Opponents stress that the federal dollars that would pay for expansion stem from the Patient Protection and Affordable Care Act that was pushed through Congress and signed by President Barack Obama in 2010. Many Republican state legislators were elected after campaigning against what’s been labeled Obamacare.
Several House members have said that until all of their questions have been answered, they are reluctant to start a multi-billion dollar state and federal program that will fundamentally change how Arkansas provides health services to its poorest citizens.
The legislative session is scheduled to end Friday. Some lawmakers have asked previously for a Medicaid special session to be held later this year. Others have asked for a recess in the current session and the opportunity to return to the Capitol in a few weeks to address the issue. Both of those ideas have been shot down - at least so far - by Gov. Mike Beebe, who has said the matter should be addressed during this session.
The private-option idea surfaced after the U.S. Supreme Court decision last June to strike down part of the 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 Affordable Care Act also calls for states to set up private-insurance marketplaces called exchanges from which people can pick their own insurance plans.
Arkansas lawmakers proposed the “private option” as an alternative to adding that group to Arkansas’ traditional Medicaid program, which faced a shortfall estimated at as large as $300 million at the beginning of the legislative session. That shortfall estimate has been reduced to $61 million, and leaders say it could be resolved by passing the private option, which will draw hundreds of millions of additional federal dollars to Arkansas.
Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, said in March that she will help Arkansas craft its private-option model.
Republicans who have pushed the idea call it the best way to mitigate the federal health-care law’s adverse effects on businesses, while overhauling the state’s Medicaid program and getting more of the poor on private insurance.
Those who plan to vote against it say it gives the federal government too much control and is short on specifics.
“What are these plans actually going to look like? What is the [federal government] going to require in terms of benefits?” Rep. David Meeks, R-Conway, said. “It seems like what we’re wanting to do and what [Health and Human Services] is willing to do is two different things. There’s a lot of assumptions and not enough concrete answers.”
Rep. Reginald Murdock, D-Marianna, said the private option is causing angst for those who campaigned against the health-care law in 2012 or fought its implementation during the 2011 session.
“That’s the underlying part of this. The elephant in the room, if you will, that they are dealing with,” Murdock said. “It’s the part that they have such disdain for, such angst for. A lot of them campaigned against that, [promised] that they were going to fight against [Medicaid expansion].”
Carter said he thinks that confusion about the private option and why it isn’t Medicaid expansion is the biggest concern that lawmakers are still trying to resolve with their constituents.
“We cannot stop the implementation of the Affordable Health Care Act here in the state of Arkansas,” Carter said.
Several of the sponsors of the health-care expansion bills were the most outspoken critics of the Affordable Care Act in the 2011 legislative session. Several voted against appropriating money for the Arkansas Insurance Department that year in a bid to keep the state from creating an insurance exchange.
But after the U.S. Supreme Court upheld the law in June and President Barack Obama secured a second term in office in November, those Arkansas lawmakers moved to the forefront of trying to craft an alternative that would work for the state.
They were the ones who suggested that Beebe ask Sebelius in February about the possibility of a private option.
Rep. Charlie Collins, R-Fayetteville, compared his support of the private option to the grieving process when he encouraged members Thursday to vote for the enabling legislation on the House floor.
“I hate Obamacare more than anyone in here,” he said. “Obamacare is coming, whether you are in denial, anger or whether you are in the bargaining stage like me.”
Expanding traditional Medicaid hasn’t been an acceptable option for most of the legislative session. Burris said Arkansas is down to two choices: the private option or nothing.
“There are drastic costs to doing nothing,” Burris said. “We have a chance to take away the most harmful affects of [the Affordable Care Act]. We have a chance to turn it into something that’s good for the state, good for the consumer. We’ve done all we can, and I think this is the best vote for the people we represent.”
According to 2010 estimates from the U.S. Census Bureau, 47.5 percent of Arkansans ages 18-64 who earn less than 138 percent of the federal poverty level are not insured.
Of the state’s 75 counties, 17 had more than 50 percent of their working-age residents uninsured. The counties with the highest percent of uninsured who would qualify for help under the private option were Carroll (58.3 percent), Howard (55.3 percent), Sevier (63.9 percent) and Yell (57.4 percent).
Pulaski County had 48.1 percent of residents who fell in that category.
Rep. Nate Bell, R-Mena, campaigned against expanding Medicaid and said his district has urged him to fight it. He said Friday that, based on his constituents’ concerns, he will likely vote no on the appropriation bill.
“I agree with them, I believe it’s bad policy. But at the end of the day, at least a major portion of it’s going to be enacted. It’s the law. So the question becomes, how do we mitigate that damage?” Bell said.
The problem, he said, is explaining to voters that the private option is the best alternative, especially considering that about 53 percent of residents in Montgomery and Polk counties fit the eligibility criteria for the government to pay for their insurance.
“Frankly, most of my constituents are going to be affected,” Bell said. “This has a very large impact on the folks that I represent.”
He said the positive and negative financial aspects of the option essentially balance out, and the decision has become a moral one, as he weighs increasing the size of government versus ensuring access to health care.
“I really despise making law on the basis of moral judgment. It’s very difficult to do,” Bell said. “I’m going to push a button on Monday, and at this point, what I hear from my folks is going to have a big impact on whether I push red or green.”
Co-sponsor Sen. David Sanders, R-Little Rock, said people opposed to expanding government health care tend to change their minds when they understand what the private option does.
Front Section, Pages 1 on 04/14/2013