The fate of a program providing federally subsidized private health insurance to poor Arkansans depends largely on the outcome of the November general election, the state Senate’s leader said.
Senate President Pro Tempore Michael Lamoureux, R-Russellville, said it’s going to be “very difficult” for the Legislature to sustain the votes required to reauthorize the private-option program in the future.
“The second time was harder than the first time, and there is essentially no room for error,” he said.
“[For] even some of the people who voted for it this time, it is very questionable whether they would continue to vote for it, so I think a lot will depend on the governor’s race and how the new governor handles that issue,” Lamoureux said.
“I think leadership from the executive branch is so critical to how it is done because they are the ones executing it,” he said.
House Speaker Davy Carter, R-Cabot, said he’s concerned that the private option “continues to be such a polarizing and divisive issue.”
“I think two years from now, six years from now, 10 years from now, we’ll all look back and see that this issue was of great importance. I would never say it’s perfect, but I truly believe it is the foundation of something that is good that can be built upon for years to come,” he told reporters.
Carter said he wants a House subcommittee - to be appointed by Rep. John Burris, R-Harrison - to look into questions raised by some representatives, including the possibility that the federal government won’t follow through on its promises to pay its share for the private-option program in the future.
The panel’s work would be completed before next year’s legislative session and would be helpful in developing contingency plans if the federal government ever fails to honor its agreement with Arkansas, he said.
“I hope it doesn’t happen, but I think that’s just good business to make sure the state is prepared for that,” said Carter, a banker.
State Rep. Nate Bell, R-Mena, who won legislative approval this year of an amendment barring the state from using funds to advertise or promote the private-option program, said: “At this point, what we can’t have is political posturing.
“We have got to have people who are going to come to the table and offer solutions and offer ideas and then be willing to understand that they are one of 135 [senators and representatives] and that they are going to have to temper their views, whatever they happen to be to, to actually get something that you get a three-fourths majority on [in the 100-member House and 35-member Senate],” he said.
Bell added, “All policy is ultimately developed at the ballot box.”
The expansion of the Medicaid program, approved by the Legislature last year, extends coverage to adults with incomes of up to 138 percent of the poverty level - $16,105 for an individual or $32,913 for a family of four.
An estimated 250,000 Arkansans are eligible for coverage. Enrollment began Oct. 1.
Opponents of the private option often call it Obamacare since funding was made possible by the Patient Protection and Affordable Care Act of 2010. Supporters maintain that it’s not Obamacare because it was created by Arkansans and because the state obtained waivers from the federal government to offer it. The program has deeply divided Republicans in the Legislature.
Legislators spent most of the legislative fiscal session that started Feb. 10 haggling over whether to reauthorize funding for the private option. Private-option backers needed a three-quarters supermajority in both chambers to advance the measure.
The Senate approved the private-option measure in a single vote, with 27 senators voting for it. But it took five votes in the House before the private-option measure passed with 76 representatives favoring it.
Passage of the measure means Arkansas can accept $915 million in federal funds for the private option in fiscal 2015.
It also cleared the way for the Legislature last week to approve a $5 billion general revenue budget that increases state spending by $109 million over current levels in fiscal 2015 with most of the increased spending going to public schools, prisons and human services programs. That budget factored in $85 million in general revenue reductions from tax cuts enacted by the 2013 Legislature and up to $89 million in savings from the private option, state officials said.
More than 137,000 people have been approved for coverage in the state’s expanded Medicaid program, a spokesman for the state Department of Human Services said last week.
Those who have been approved for coverage included 97,934 who have signed up for Medicaid-funded plans offered on the state’s health insurance exchange under the private option, Human Services Department spokesman Kate Luck said. In addition, 13,410 people were assigned to the traditional fee-for-service Medicaid program because they were considered to have exceptional health needs, and there are more than 20,000 people who had not yet completed enrollment.
The federal government is expected to pay the full cost of the private-option program until 2017, then the state will begin paying 5 percent of the cost. The state’s share will then increase every year until it reaches 10 percent in 2020.
The private option is an issue in the governor’s race as well as races for the legislative seats, and other state and federal offices.
Republican gubernatorial candidate Asa Hutchinson of Rogers likened his position on the private option to that of state Rep. Kim Hammer, R-Benton, who has said the private option is a test that will be great if it works, but he’ll be the first one to push to end it if it doesn’t work.
“My job as governor will be to measure how it performs and watch its costs and continue the efforts to reform it,” said Hutchinson, a former 3rd District congressman and former federal homeland security undersecretary.
“If it is not accomplishing its objectives and it costs too much, then we need to end it because it is a pilot [program],” he said, adding it’s important to evaluate whether the program provides an incentive for Arkansans to work or not to work.
Republican gubernatorial candidate Curtis Coleman said he wants to “end the private option, a dramatic and unnecessary expansion of Medicaid, entirely.”
“We can provide much better and more affordable health care for those who may be enrolled in the private option through a combination of a federal block grant giving Arkansas administrative control of Medicaid, and an entirely private-sector solution designed by Arkansas healthcare providers and patients,” said Coleman, a businessman, of Little Rock.
Democratic gubernatorial candidate Mike Ross of Little Rock “supports the bipartisan Medicaid private option and its continued funding and will continue to do so as governor, because it is an Arkansas-specific and market-based solution that will help thousands of working Arkansas families obtain private health insurance,” said Ross spokesman Brad Howard. Ross is a former 4th District congressman and a former state senator.
Democratic gubernatorial candidate Lynette Bryant of Little Rock, who has been a substitute teacher, declined to comment about her position on the private option, saying her views will be posted on her campaign’s website soon.
Front Section, Pages 1 on 03/16/2014