To the mystery persons who visited with state Sen. Bart Hester, R-Cave Springs, about the potential impact of a vote to shut down Arkansas' entire Medicaid system, we offer sincere appreciation.
The state Senate on Wednesday voted 27-2 for a bill that will keep the overall Medicaid program funded for the 2017 fiscal year, along with an amendment that would kill the state's Medicaid expansion -- Arkansas Works -- at the end of the year. This was done with the full knowledge Gov. Asa Hutchinson would (and did) veto the program-killing amendment, thereby preserving Arkansas Works.
What’s the point?
State Sen. Bart Hester resisted Arkansas Works with vigor, but acted responsibly in helping to clear a path forward for the governor’s Medicaid expansion program.
It's unfortunate the governor had to turn to parliamentary sleight-of-hand politics, but a handful of senators could have derailed everything, because 27 of 35 votes were needed to pass the expenditure. Once senators passed it with the "sunset" amendment, the state House of Representatives quickly got behind it and sent it to the governor, where the line-item veto saved Arkansas Works funding through the end of fiscal 2017.
It was a procedural shell game. Like a legislative version of Twister, the strategy separated the traditional Medicaid program -- which pays for medically necessary services for needy and low-income persons -- and the Obamacare-inspired Arkansas Works, which subsidizes private health insurance for another 267,000 low-income Arkansans who do not qualify for traditional Medicaid. A vast majority of lawmakers back continuation of the program, but because spending authority requires a 75 percent supermajority, a group of 10 state senators have held the power to kill it all if they wanted.
Hester was one of those 10, having stood firm against Arkansas Works funding. On Wednesday, after days of negotiations in Little Rock, Hester and Blake Johnson of Corning became the critical switch votes. They voted against the Medicaid spending authority the prior week, but were convinced to support the amended version last week. That meant they got to stand against Arkansas Works again, but in a way that didn't hold the entire state Medicaid program hostage and gave their fellow Republican governor a way to move forward.
Arkansans won't find a more conservative member of the General Assembly than Bart Hester, yet some in the conservative camp grouse at his participation in a strategy that allows the governor to maintain Arkansas Works. Before Wednesday's vote, Arkansas Works opponents sounded like the Rev. Jerry Falwell in his "Silent Majority" heyday, claiming to represent the majority of Arkansans even though a majority of state lawmakers reflected otherwise.
"The vast majority of Arkansans has said over and over that they don't want Obamacare in Arkansas," said David Ray, director of Americans for Prosperity Arkansas. "It's toxic. Its supporters know that. That's why they keep changing the name."
Except it's not toxic. The reason former Democratic Gov. Mike Beebe and now his GOP successor have been able to keep the Medicaid expansion alive is many Arkansans see their neighbors in need and see no gain in denying health care to them or their families. Arkansans are often neighborly that way.
The critics failed -- despite valiant campaign spending in the last election cycle to defeat those not staunchly opposed to Arkansas Works. In most instances, their efforts didn't work out.
As Ray's comment reflects, opponents want the debate to be about Obamacare, which plays significantly in Arkansas' custom-made approach to Medicaid expansion. What the last governor and the current one have done is operate within the options presented by Congress through Obamacare. The fight to end or replace Obamacare belongs in Washington, D.C., and conservatives can continue to wage that battle. But hurting Arkansans and the state's hospitals to make some kind of statement about Obamacare? That's ineffective, because it would hardly move the needle in the national debate.
Hester explained that he fought "as hard as you possibly fight this."
"When you are outnumbered and out-manned, and you don't have the governor's office and you ain't got the rules in your favor, at some point you understand that I am down to the choices of shutting down [the entire] Medicaid [program] or finding a different solution," he said. "And shutting down Medicaid wasn't an option for me. We wanted to find a different solution for Arkansas, so we could move forward."
Both Hester and Johnson said it was up to the governor to decide whether to use his veto power. The governor's veto was assured as Hutchinson contends a failure to embrace the state savings realized through Arkansas Works would put a $100 million hole in the state budget, severely limiting other vital programs.
Hester went on: "Voting 'no' to end Medicaid is not being a statesman and representing the people of Arkansas. That was the message that was delivered to me from anybody of any significance that came to see me," Hester said. He declined to name anyone.
Whoever gave the advice did Hester a service, and Hester showed wisdom in recognizing the limitations of a state lawmaker in the minority to affect change to the national health care picture.
The fight over the future of Obamacare can continue, but that will not be resolved by a self-inflicted wound that will cause the most harm to thousands of Arkansans who can least absorb it or to a state budget that doesn't need a huge round of budget cuts.
Hester and Johnson did what politicians are often incapable of: They wielded the power they had, but recognized when doing so was going to cause more damage than good. They were ready to kill Arkansas Works, but realized doing broader damage to achieve that end was not worth the trade off. Unlike some of their anti-Obamacare colleagues, they were able to separate what was best for Arkansans from the national debate.
In doing so, they embraced stability over budgetary chaos. In doing so, they reached toward the ideal of statesmanship. In doing so, they truly worked for the good of Arkansans.
Commentary on 04/24/2016