A solid 70 percent of the state Legislature voted in special session last week to continue in mildly revised form the expansion of Medicaid that we have called the private option.
Thus the program, now renamed "Arkansas Works," is the bona fide law of Arkansas.
It authorizes the state to continue accepting federal money to expand Medicaid by purchasing private insurance policies for the working poor, defined as those living below 138 percent of the federal poverty line.
Understand, though, that this new law merely creates and defines--but does not actually fund--the program. The money for legally created programs gets released by separate appropriation bills.
So now the Legislature is to assemble Wednesday for the constitutionally mandated off-year budget session to approve spending for the new fiscal year beginning July 1. Pursuant to the new law, the appropriation bill for Medicaid in the state Human Services Department, to be introduced in that session, will contain, among much more, the Medicaid expansion money.
People ask me why we keep having this fight. It's because appropriation bills, unlike general laws, are only effective for a year at a time. "Arkansas Works" as a program is the law until repealed. The money for it, alas, is an annual ordeal.
And here is the complication in that: Under the state's 1874 Constitution that was written by people who feared government authority and wanted to make it hard for government to spend money, the appropriation bill requires a three-fourths vote of the House and Senate for passage.
So the solid 70 percent majority that created Medicaid expansion last week is not quite sufficient this week actually to get the expansion money released. Passage of the appropriation will require 75 votes in the House and 27 votes in the Senate. It got 70 and 25 last week.
It may be that the House will come up with the additional five votes, acceding to the time-honored notion that the relevant policy fight took place last week and that the budget is no place to continue the battle--that, otherwise, small minorities of 26 House members or nine senators could wreak havoc by stymieing or holding hostage virtually any function of state government.
The Senate seems to be a more difficult matter. There are nine members, maybe 10, all Republicans, of course, who mislabel obstruction as principle. They insist they are duty-bound to use their constitutional leverage to vote against the spending bill for all of Medicaid, even though it includes money for grandmothers in nursing homes and developmentally disabled youth.
So you're thinking that--right or wrong--we could always extract the expansion money from the Medicaid appropriation bill and pass the vital rest.
Not necessarily.
The consequences would be dire for:
• The more than a quarter-million poor people suddenly without health insurance.
• The state government budget, which is buoyed by and dependent on the federal money and would face a hole of at least a hundred million dollars without it.
• Hospitals, which are in some cases saved by the existence of insurance in place of formerly uncompensated care.
• All of us who are privately insured in Arkansas, considering that our premiums have been held down by the addition of more than a quarter-million mostly healthy people to the pool.
As state Sen. Larry Teague of Nashville, co-chairman of the budget committee, told me Monday: "If you don't go with the moral implications to pass this appropriation, then the fiscal implications alone ought to be reason enough."
On a more basic procedural level, there is this complication: If we tried to take the legally approved expansion money out of the Medicaid appropriation to oblige the obstructionism mislabeled as principle, then, most likely, all Democrats and several Republicans who had duly enacted "Arkansas Works" would oppose such a stripped-down bill and balk, taking the legislative chambers further from the essential three-fourths majority.
We'd move closer to July 1 without any money for any Medicaid for any human need.
What the nine or 10 senators are threatening is akin to shutting down public-school funding because you got badly voted down on your bill to do away with public-school football programs.
The policy debate is fair. The loser's abuse of the budget system isn't.
I am told that intense discussions are ongoing and that we may not get any good indication until Thursday of next week--which is probably the earliest date the Medicaid appropriation would get voted on.
So the only thing left is to list the 10 obstructionist senators: Terry Rice of Waldron, Bryan King of Green Forest, Missy Irvin of Mountain View, Alan Clark of Lonsdale, Blake Johnson of Corning, Gary Stubblefield of Branch, Scott Flippo of Bull Shoals, Linda Collins-Smith of Pocahontas, Cecile Bledsoe of Rogers and--most infamously--Bart Hester of Cave Springs, who said last week that he's willing to "crash" state government.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at [email protected]. Read his @johnbrummett Twitter feed.
Editorial on 04/12/2016