Sen. Missy Irvin, R-Mountain View, shared a long embrace with her dad in the hallway outside the Senate chamber Wednesday night and then wiped her eyes.
Moments earlier, the Senate had passed House Bill 1219, the bill funding the so-called Medicaid private option, after months of debate and discussion. This was the session’s big issue.
The private option came about because, under the Affordable Care Act (Obamacare) and a subsequent Supreme Court decision, states had the option of expanding Medicaid so that it would be available to people whose incomes equal up to 138 percent of the poverty level. Medicaid is the health care program for the poor that is mostly funded by the federal government and mostly managed by states.
That expansion was never going to pass the Arkansas Legislature, now led by Republicans.
However, a few Republican lawmakers had come up with a creative idea.
Instead of adding more Medicaid recipients, they wondered if that money could be used to buy private insurance through the state’s insurance exchange. Created by the Affordable Care Act, the state exchanges will oft er private insurance options that are mostly for small business employees and for individuals who buy insurance on their own.
To just about everyone’s surprise, the Obama administration gave the go-ahead.
Some Republicans remained firmly opposed to anything connected to Obamacare. Under the private option, up to 250,000 Arkansans - for a family of four, those with incomes up to $32,499 a year - would be eligible for government-funded health care. The Democrats were fine with it. Many of those Arkansans are working but simply can’t afford health insurance.
The rest of the Republicans, including the ones who came up with the idea, were left with a diff cult choice. Continue to resist Obamacare, or accept that it’s coming and try to make it better, even if that allows it to expand.
House Bill 1219 had already passed the House and needed 27 votes to pass the Senate. When Irvin went to bed on Tuesday night, it had 26yeses, and she was not one of them. But she was a soft no, as was Sen. Eddie Joe Williams, R-Cabot.
She did not sleep that night. The wife of a doctor, the daughter of a doctor, and a mother of four, she had first-hand experience with the struggles of health care providers and small businesses.
She thought the private option might improve the system. But she also was deeply opposed to Obamacare. In 2011, she had unsuccessfully sponsored a bill calling for the state to resist it. The next morning, she arose and began working on the process of becoming a yes.
When senators arrived in the chamber at 11 a.m., the galleries were standing room only. Spectators had come to see the big vote.
It didn’t happen. Instead, Irvin and other legislators worked through the day on amendments that would strengthen the legislation’s language.
Those amendments gave Arkansas more flexibility, made it clearer the state would back out of the deal if the federal government tries to change the plan, and clarified that employers would not face penalties if their employees obtain insurance through the exchange rather than through their jobs. It was a chaotic day.
At 7 p.m., the Senate finally convened. A few speeches were made for and against. Among them, Sen. Jim Hendren, R-Gravette, described how the private option would add to the national debt his infant granddaughter would be required to repay.
Sen. Jeremy Hutchinson, R-Benton, who himself had wrestled with the decision, said he was voting yes because this was a much needed opportunity for reform.
Then Irvin explained her actions. She had listened to her constituents and to both sides. The private option allowed Arkansas to control its destiny and improve the system. She was fi rm.
It was a little after 7:30 p.m. when legislators finally voted on House Bill 1219. It passed, 28-7, with Williams joining Irvin. A few minutes later, Irvin was hugging her dad.
I caught her just as she was about to leave the Capitol about an hour later. She looked drained as she described the “excruciatingly tough” decision-making process.
After an exhausting and emotional 24 hours, she walked out of the door and into the Little Rock night.
The long, long day at the Capitol was over. I hope she and the other senators, regardless of how they voted, slept well.
STEVE BRAWNER IS AN INDEPENDENT JOURNALIST IN ARKANSAS.
Opinion, Pages 5 on 04/23/2013