Private Options Survives Odds For One Year

Sunday, March 9, 2014

"Those that respect the law and love sausage should watch neither being made."

-- Mark Twain

What’s The Point?

After much political theater and teeth-gnashing, the Arkansas Legislature did the right thing and passed the private option. The future of the ground-breaking program, however, remains in doubt.

We'll stop short of saying that the Arkansas General Assembly's approval of the "private option" for another year was as stomach-turning as Twain's observation suggests. But it did have its share of unsavory moments.

The Legislature narrowly approved an appropriations bill that preserves the so-called private option in the upcoming fiscal year, clearing the way for Gov. Mike Beebe's assent. "Narrowly" in this context is a relative term. The bill passed 27-8 in the Senate and 76-24 in the House. Those totals would be considered landslides under usual circumstances. But they represent only one vote to spare, as such appropriations bills are required by the state's arcane constitution to pass with 75 percent.

That's a pretty close call for a legislative initiative that was, just a year ago, hailed as a remarkably creative and responsible compromise between the political factions.

A number of other states are so intrigued by the private option that they're taking it up themselves. It's ironic, then, that Arkansas almost killed it just as others are figuring out it could work.

The private option means this: Arkansas will use millions of dollars in federal subsidies to help low-income Arkansans buy private health insurance. That's in lieu of using the money to simply add them to Medicaid rolls, as envisioned by the Affordable Care Act. See, using money from "Obamacare" to expand Arkansas' Medicaid program was a non-starter in the Republican-controlled General Assembly last year. So instead of just walking away from the money (and thousands of Arkansans who can't afford medical insurance and don't qualify Medicaid) a handful of Republican lawmakers took up the old idea of helping those folks buy private insurance instead. For most lawmakers (more than 75 percent of them, anyway), that seemed like a fine idea. It controlled the growth of an ongoing program, but it also helped lots of people access affordable health care.

And it was a fine idea, except to the conservative ideologues who wanted no part of the feds' borrowed money, or the political pulse-takers, who are just as likely to make decisions based on expediency as the soundness of policy.

Some in the latter group -- only a handful of lawmakers, but enough to make a difference given Arkansas' goofy constitutional requirements -- got the political pants scared off of them last spring when they voted for the private option. Hard-line conservatives, equating the vote to supporting Obamacare, said they'd find like-minded candidates to run against those traitors in the next election if they didn't undo it all in the 2014 fiscal session.

That caused a number of lawmakers to publicly flip against the private option. It also brought on some furious legislative deal-making. Supporters of the plan in the Legislature -- buoyed by the state Chamber of Commerce and hospital associations -- kept assuring the public that it would eventually pass, even as it failed four times in the House.

Finally -- not coincidentally the day after filing for the 2014 elections closed -- the last three yes votes fell into place and the House joined the Senate on the same side of the sausage grinder.

Of course, the Legislature will meet again in regular session next year, and the debate will rage again. Depending on how the 2014 elections come out, it may be an easier sell, or a harder one. At least for the next fiscal year, however, we'll get to see how compromise and reasoned discussion works for the people of Arkansas.

Commentary on 03/09/2014