Private option falls short

House vote 5 shy, riles Democrats

State Rep. John Burris, R-Harrison, (standing) talks with House Majority Leader Bruce Westerman after speaking in favor of continued funding for the expanded, private-option Medicaid plan. Ann Clemmer, R-Benton, (front left) voted no, while Nate Bell, R-Mena, (front right) voted yes. State Reps. Butch Wilkins (back row), D-Bono, and Jody Dickinson, D-Newport, also backed the proposal.
State Rep. John Burris, R-Harrison, (standing) talks with House Majority Leader Bruce Westerman after speaking in favor of continued funding for the expanded, private-option Medicaid plan. Ann Clemmer, R-Benton, (front left) voted no, while Nate Bell, R-Mena, (front right) voted yes. State Reps. Butch Wilkins (back row), D-Bono, and Jody Dickinson, D-Newport, also backed the proposal.

House Democrats are promising retaliation after Tuesday’s failure to approve funding for Arkansas’ private option Medicaid expansion plan.





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After spending the day counting votes and strategizing about whether to hold a vote, House leadership failed to persuade enough representatives to support the measure.

The bill needed approval from 75 of the 100 members to clear the House and make its way to the Senate, but the 70-27 tally fell five votes short.

Five Republicans who supported the private option in 2013 voted no this time, while only one negative voter from 2013 supported the measure, which uses federal dollars to provide private health-insurance plans to more than 100,000 poor residents.

All 48 Democrats voted for House Bill 1150, which would fund the state Department of Human Services’ Medical Services Division, which includes the private option. Twenty-two Republicans voted yes, while 27 Republicans voted no.

House Speaker Davy Carter, R-Cabot, said the House will vote on the bill again today and every day if it doesn’t pass, until the end of the session.

House Democratic leaders moved to hold up two separate appropriations after the failed private-option vote Tuesday, and they said more appropriation bills could be blocked if the health plan isn’t approved today.

“There very easily and likely will be other [appropriations] if we don’t get the private option passed,” said House Minority Leader Greg Leding, D-Fayetteville. “We’re done playing nice. We compromised beyond what we were comfortable with and beyond what we thought was right, because that’s the only way we were told the private option would pass. The vote today was a waste of our time.”

Leding had scrambled Tuesday to arrange a phone call with Arkansas Blue Cross and Blue Shield representatives to explain a compromise reached on the next fiscal year’s reimbursement levels for primary-care physicians and specialists. The current Blue Cross, Blue Shield reimbursement scheme funds specialists at a lower percentage of reimbursement than primary-care physicians for both office visits and procedures. The rates that are scheduled to go into effect July 1 will reimburse specialists and primary-care physicians at the same rate - 90 percent of base fees for office visits and 80 percent of base fees for procedures.

Arkansas created the private option after receiving a waiver from President Barack Obama’s administration to use funds provided by the 2010 Patient Protection and Affordable Care Act to expand Medicaid health-care coverage in the state.

The expanded Medicaid extends program eligibility to adults with incomes of up to 138 percent of the poverty level - $15,860 for an individual or $32,500 for a family of four.

In making their case for approving private-option funding, supporters of the program have stressed the adverse effects of dropping the more than 100,000 people newly enrolled in insurance plans. Opponents say, among other things, that the Affordable Care Act will drive up the national debt and that the state can’t afford to pick up 10 percent of the program’s cost, which it will have to do beginning in 2020.

Gov. Mike Beebe has predicted that canceling the program will put an $89 million hole in the state’s proposed $5 billion budget for fiscal 2015 if it gives up hundreds of millions in federal Medicaid dollars. Critics have said they haven’t seen strong evidence that the effect will be that dramatic on the budget.

Leding and other Democrats said they wouldn’t block appropriations that Beebe has said would be worst hit by a failure to pass the private option, including money for prisons and higher education.

Rep. Joe Jett, D-Success, made the motion Tuesday to send House Bill 1141, sponsored by House Republicans to fund the Medical Services Division’s Office of Inspector General, back to the Joint Budget Committee. Jett also moved to hold up Senate Bill 3, which funds a minor part of the secretary of state’s budget, at Leding’s request.

“If we don’t have the private option, we don’t need the inspector general’s office,” Jett said after the session ended Tuesday. “That was a conscious strategy on our part. It’s likely if the private option were to pass, we would be willing to let that bill [funding the inspector general] move forward.”

Leding said the Senate bill funding a part of the secretary of state’s budget was held up as a symbolic gesture because many House Democrats were uncomfortable with the voter-identification law that passed in 2013 that went into effect this year. That measure has been funded through the secretary of state’s office.

“Depending on how things move forward [today], we will be actively looking at other appropriations in the Joint Budget Committee that we feel comfortable as a caucus putting our foot down on,” he said. “And, depending on Wednesday’s vote, we may move to eliminate the amendments [to the private option] approved last week. We were under the impression that those would move Republican votes, and many of us made compromises we were not entirely comfortable with because of that. We saw one vote move and that is not acceptable.”

Rep. Nate Bell, R-Mena, who proposed the amendments approved last week after voting against the private option in 2013, backed the private option this time - the only “no” voter to switch.

B ell’s private-option amendments ban the use of federal and state funding to to actively solicit new enrollment or to advertise the private option in any form. It also bans state employees from pursuing federal grants for those uses.

The amendments raised the hackles of Democrats and some Republicans who said the changes went against the very goals of the program. Carter said he could live with them but didn’t like them because having more people in the insurance pool would lower the cost for everyone.

Bell had said he was afraid the federal government would eventually slash funding, and the state would have to foot the bill for the new enrollees.

He said on the House floor Tuesday that representatives who hate the private option don’t have a lot of options to get rid of it all together.

“It is important as conservatives that we recognize the situation we’re in,” Bell said. “There are 60 members of this body that wouldn’t vote for any proposal that completely defunds the private option. I can do basic math … and we’re at an impasse.”

He said that even in the “rosiest of scenarios,” the votes to defund the private option don’t exist in the House.

But Bell’s speech, one of a half dozen for and against the health-insurance plan Tuesday, did not pick up any additional votes for the bill.

The other votes that changed Tuesday included Rep. Ann Clemmer, R-Benton; Rep. Les “Skip” Carnine, R-Rogers; Rep. John Hutchison, R-Harrisburg; Rep. Allen Kerr, R-Little Rock; and Rep. Mary Lou Slinkard, R-Gravette, who changed their votes from yes to no.

Rep. Fred Smith, G-Crawfordsville, and Rep. Jon Eubanks, R- Paris, were present Tuesday but did not cast a vote. Both voted for the measure last year.

Eubanks, Carnine, Hutchison, Kerr and Slinkard did not return phone calls seeking comments on their votes. Smith and Clemmer said they would not discuss their votes Tuesday, with Clemmer saying simply, “Not today,” when she was approached in the Capitol after the vote.

Smith said Tuesday that “I won’t give an answer on that today. I’m not going to discuss it,” adding that he wanted to do more research.

Carter said he wrote down the names of the Republican members who changed their votes as the ballots were cast on the House floor.

“I’m curious to read about some of the members’ comments to all of you later today on why they even changed their vote or what their game plan is for getting this issue resolved. Because I’m not hearing any other game plan,” Carter said at a press briefing after the session closed.

House Majority Leader Bruce Westerman, R-Hot Springs, who made the first plea on the House floor Tuesday- and who made a similar plea via telephone to the Virginia General Assembly urging them not to pass a similar program in their state - said he was one of the few members happy with Tuesday’s vote.

“I will count it as a victory today, but I don’t know if it will be a long-term victory,” he said. “In the end I do think we need to defund it. I do think there is an alternative we will need to look at. But, like last time, we’ll likely keep voting on this until it passes.”

Rep. Mark Lowery, R-Maumelle, was the sole member who voted present, saying afterward Tuesday that his vote was a protest.

“I still believe in the basic merits of this, but there has been too much politics in this decision - part of that being a push for the House to vote first,” Lowery said. “Two senators were the architects of this thing and the Senate should have voted first. I’m hearing in discussions that might happen. I felt like that message needed to be sent.”

Senate President Pro Tempore Michael Lamoureux, R-Russellville, said it’s “not a real surprise” that the House failed to get 75 votes to approve funding for the private option, adding that the measure failed last year before being approved. He said Senate Bill 111 to authorize funding for the private option could arrive on the Senate floor before the House passes its version of the bill.

“We haven’t decided yet what we are going to do, if we are going to wait or if we’re going ahead,” he said.

“I am not sure what is best, whether to go ahead or not,” Lamoureux said. “I am going to see if there is any kind of consensus.”

Lamoureux said that with the announcement of a deal struck with Sen. Jane English, R-North Little Rock, Tuesday to fund a workforce development program, he has lined up the necessary 27 votes in the 35-member Senate required to approve funding for the private option in fiscal 2015.

A spokesman for Beebe said the governor also wasn’t surprised by the House vote.

“We always had a better feeling of where folks stood in the Senate than in the House and, with this vote, you got a clearer picture,” said spokesman Matt DeCample. “And the governor always says it is trickier to track the House because you have got 100 of them versus the Senate [which has 35 members]. … We’ll see what tomorrow brings.”

Meanwhile Carter said he was disappointed but not deterred Tuesday.

“I still am 100 percent confident that that bill will pass. How many times we have to vote, I’m not sure. Maybe once we get through hearing all the campaign speeches, we’ll vote [on] it,” he said.

Carter reiterated that the time for negotiations on the bill had passed.

“There aren’t enough votes to send that bill back to budget, or to amend it, it’s not going to happen. So I would ask what the plan is for this small minority of members who want to hold everything up,” he added.

Front Section, Pages 1 on 02/19/2014

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