Calling a special session is the best way to address potential health-care funding for an additional 250,000 Arkansans, House Republican leader Bruce Westerman said Monday.
There is too much to accomplish - and too much approval still needed from the federal government- to resolve the matter in the four weeks left before the legislative session is scheduled to end April 19, said Westerman of Hot Springs.
“I don’t think it’s fair to ask us to approve an appropriation on a program that we don’t really know what it’s going to be like. We won’t know what the answers are from the federal government unless they work at breakneck speed to get those questions answered and give us approval to do whatever we want to do, and we’re not counting on that,” Westerman said.
Gov. Mike Beebe, who has the authority to call a special session, rejected the idea. He’s not interested in calling lawmakers back, he said.
“Let’s don’t waste taxpayers’ dollars. Let’s make a decision,” Beebe said. “Deal with it, and if you don’t want to deal with it, then tell the folks no. If they don’t want to pass it, we’ll send our money to Michigan or wherever.”
Under the 2010 Patient Protection and Affordable Care Act, states could choose to extend Medicaid coverage to those making up to 138 percent of the federal poverty line, or $15,145 annually for an individual. But in late February, Beebe secured an unprecedented deal with U.S. Health and Human Services Secretary Kathleen Sebelius: The federal government will pay premiums for private companies to provide health coverage through the state’s private insurance exchange to an estimated 250,000 of the state’s poorest residents.
On Friday, Beebe gave lawmakers a rough draft of legislation to extend private health insurance to that population, a method called the “private option.”
A separate appropriation bill would be necessary to authorize the state Department of Human Services to spend the billions in federal money. It takes approval from three fourths of legislators in each chamber to pass an appropriation.
There is no point in creating a program without giving the department the authority to pay for it, Beebe said.
Included in Beebe’s draft legislation is the creation of the Health Care Access Assurance Program. It would petition the federal government for waivers necessary to implement a program to funnel federal Medicaid money to insurance companies to buy coverage for eligible Arkansans. The program, and the access for those Arkansans, would end January 1, 2017, unless the General Assembly extends it.
The draft also specifies that the program will end within 120 days if the federal government breaks its promise that the state will never be required to pay more than 10 percent of the cost. The federal government is expected to pick up the full cost of newly eligible patients until 2017. By 2020, the state will be responsible for 10 percent of the costs.
Legislators called the draft a framework Monday. The draft is not part of an actual piece of legislation. Once lawmakers decide on the wording, an existing bill will be amended.
“We’ve marked it up and made quite a few changes to it,” Westerman said. “There could still be some more revised language that goes into the bill.”
House Republicans won’t accept the current form of the bill, Westerman said.
“We’re working on options on that bill that could possibly make it more acceptable,” Westerman said. “I want to stress that we’re not going to be pushed, we’re not going to be rushed, and we’re not going to make a bad decision on something that’s literally a multi-billion dollar decision for our state.”
He suggested the Department of Human Services could apply for federal approval of the waivers necessary to approve the new program and then have the governor call legislators back for a special session to approve the funding.
“It would be tough just to get the legislation tweaked and improve on what the private option would look like [before the session ends],” Westerman said. “There’s no conceivable way to implement and get all the approvals and waivers that would be necessary for the private option.”
Other Republicans echoed Westerman’s reluctance to move too quickly but said they want to resolve the issue before the end of the session.
Lawmakers can readdress the issue each year if they want to, but shouldn’t hold back now, Sen. David Sanders, R-Little Rock, said.
“My hope would be that we can actually get it done and that we can get the buy-in and the commitment that we need. The fact of the matter is in Arkansas is that we have annual sessions now, so there will be another appropriations bill that has to be passed [in a year],” Sanders said. Lawmakers “need a solid indication from the federal government on the waivers,” he said. “I don’t necessarily need the approval, but I think we need to be able to submit the waivers.”
House Speaker Davy Carter, R-Cabot, and Senate President Pro Tempore Michael Lamoureux, R-Russellville,have said they want lawmakers to finish addressing expansion by the time they leave Little Rock.
“I personally would like to see us resolve this during the session. Only the governor can call a special session … and he’s indicated that is not his intention, and so I think we may be discussing an option that isn’t available to us,” Lamoureux said.
House Republicans proposed changes to the draft legislation Monday.
Their draft would name the new program the “Health Care Independence Act” and would include deductibles in the list of things the eligible individuals might have to pay for.
The draft also adds language calling for a program to eliminate waste and fraud.
The governor’s draft tells the Department of Human Services to encourage parents and “caregivers” to include their children on their health plan, including when the child is eligible for the ARKids B program. The Republican draft adds that the department should do that “only where cost effective.”
Beebe’s draft states that eligible individuals enrolled in the program must acknowledge it is not a perpetual federal or state right or “guaranteed entitlement” and is subject to cancellation. The Republican draft adds a line reiterating that eligible individuals must acknowledge that the expansion is not an “entitlement” program and that federal Medicaid rules do not apply to it.
Beebe’s draft states that the department should seek approval from the Center for Medicare and Medicaid Services for a program to test the viability of a health savings account or a medical savings account. The Republican draft adds that the other methods should also promote employment.
The Republican draft would require the Department of Human Services and the state Insurance Department to provide a written report to the Joint Budget Committee or the Arkansas Legislative Council each year. The report would include expenditures, growth, enrollment and the economic effect of enrollment distribution, carrier competition and uncompensated care. The governor’s would have required a semiannual report.
Front Section, Pages 1 on 03/26/2013