Gov. Asa Hutchinson averted one showdown Tuesday when he abandoned, at least for now, a controversial plan for managed care within Arkansas' expanded Medicaid coverage.
When the governor issued the call for the special legislative session that begins today, only one issue made the cut.
Arkansas lawmakers will decide only whether to continue an expanded Medicaid program that purchases private health insurance for more than 250,000 low-income Arkansans. It's been called the "private option" since its adoption. Hutchinson wants to call a revised model "Arkansas Works.
Lawmakers will not be asked to embrace managed care for people who are developmentally disabled or mentally ill.
Hutchinson had been expected to include the managed care question for this first of two special sessions he has said he will call this year. Another session is planned later to address highway funding and possibly other issues.
In the meantime, the regularly scheduled fiscal session of the Legislature is set to begin April 13. That's when lawmakers will consider funding for the renamed and reworked program for expanding Medicaid in Arkansas -- depending on how lawmakers handle what was actually on the governor's call for this week.
Hutchinson delayed the call until Tuesday, the day before lawmakers convened. A spokesman had said the governor was awaiting "technical edits" to his proposed legislation.
He must also have been counting votes as he decided to focus this session on passing Arkansas Works.
The governor apparently faced strong opposition from some Republicans and Democrats to the administration's plan to use managed care firms to provide care for developmentally disabled and mentally ill clients.
Clearly, the opposition was significant enough to persuade House and Senate leaders to warn that the votes might not be there for that part of his plan.
Hutchinson said Tuesday that his reform effort will continue, although he was holding off on that particular legislation.
Even without that controversy in the call, this session is a major test for Hutchinson.
The budget he will present to lawmakers in the fiscal session is predicated on continuation of Medicaid expansion. Without the federal dollars that come through the program, the state will face a $100 million hole in that budget, he has said.
He needs a strong vote for the program in this session, if he's to have any chance to get the funding approved later.
Legislative leaders are hoping this will be a three-day session.
That's the minimum timetable for legislation to get through both chambers of the Legislature and is the common length of special sessions.
But that's when there is agreement to whatever the administration proposes.
What Hutchinson proposes are cost-cutting reforms that could still allow the state to receive federal dollars for Medicaid expansion. The funding is part of the federal Affordable Care Act, or Obamacare.
Approval of the Arkansas Works program requires only a simple majority of House and Senate members. And many of them participated in the task force that came up with the basic reforms Hutchinson proposes. He should find enough support to continue a revamped Medicaid expansion program.
But remember, the private option has barely survived in recent legislative sessions because its funding requires a three-quarters vote of both houses of the Legislature.
This has long been expected to be a contentious debate, however the program might be changed.
Although it may sound as if the conflict is all about the state's bottom line, the underlying issue is still health care.
The decisions affect whether these 250,000-plus Arkansans will continue to have insurance and what kind of health care they will ultimately receive.
That's what ought to be lawmakers' primary motivation, but it doesn't seem to be guiding all of them.
The reform the Hutchinson administration offers include charging premiums to enrollees with income above the poverty level, subsidizing employer-based insurance plans for qualified particants who work and referring unemployed enrollees to job training.
The changes are supposed to appeal to money-conscious Republicans inclined to oppose anything remotely related to Obamacare or even to Arkansas' private option.
The special session is about accepting the reforms. And, again, approval requires only a simple majority vote.
The Legislature will consider funding the program in the April 13 fiscal session, when that daunting three-quarters' vote in required in both chambers.
Even then, the fight won't be over.
Assuming the Legislature accepts the reforms and agrees to fund the program, Hutchinson will still have to secure federal waivers to continue getting the Affordable Care dollars.
But he has already met with the federal officials and knows what is likely to meet approval. Surely the legislation he's offering fits that bill.
The question today is whether he can convince enough Arkansas lawmakers to go along.
Commentary on 04/06/2016