Gov. Asa Hutchinson will apparently have two budgets ready for the Arkansas General Assembly's consideration later this year.
One budget embraces continued expansion of Medicaid under a planned new name, "Arkansas Works," and tighter restrictions in a Medicaid-financed insurance program. The more than 200,000 Arkansans served could still get health insurance under that scenario.
The other budget leaves what has been known as Arkansas' "private option" -- and the federal dollars that support the private insurance program-- out of the picture.
There is a stark difference since more than $100 million is involved here. If those dollars are gone from the overall revenue picture, there must be cuts to offset the loss. Presumably, fewer, if any of those getting the expanded Medicaid now would continue to be covered.
The governor recently sat for one of those New Year interviews with The Associated Press, outlining how he's approaching this and other issues.
This being an even-numbered year, the General Assembly will meet in a fiscal session that begins in mid-April. Hutchinson may also call the lawmakers into special session sometime this year specifically to consider the future of Medicaid expansion and the chances for a possible highway improvement program. The issues could be taken up in separate special sessions or in one. Plus, a special session could take place when the Legislature is already in Little Rock for the fiscal session.
He may have some idea about the timing, but all of it is more or less on hold until and unless the governor can get the federal government to go along with some proposed changes to how Arkansas might use the Medicaid expansion money.
Although no one involved likes to use the words, this money was made available to the states through the federal Affordable Care Act, or "Obamacare," as it is better known.
Anything with the Obama name on it is anathema to some in the Arkansas Legislature and has been since the Medicaid expansion program's inception.
However, recognizing the value of those Obamacare dollars to a state like this, some Arkansas lawmakers, working with former Gov. Mike Beebe, a Democrat, fashioned the "private option," which allowed the state to use those dollars to buy private insurance for newly qualified people. (The newly qualified included those with incomes up to 138 percent of the federal poverty level.)
The plan worked and drew a lot of praise for its creators. But funding, which has to be appropriated annually by a whopping three-quarters of each house of the Legislature, has been hard to come by in the Republican-controlled Legislature.
Enter a new Republican governor in 2015 and an even more Republican Legislature. Gov. Hutchinson managed to keep the private option alive through 2016 but helped create a task force to recommend changes for its overhaul.
While Democrat Beebe got the federal government to go along with the private-option plan and secured the necessary waiver, there's no guarantee the feds will do what Hutchinson wants. He is asking for different controls for what he calls "Arkansas Works."
There's no signal yet as to how receptive the feds may be to amending the waiver, which is due to expire at the end of this year.
But Hutchinson is scheduled to meet Feb. 1 with officials about proposed changes. They include a variety of steps intended to reduce the cost of the program.
Some participants (those above poverty level) would be charged premiums. Some would have to enroll in employer-provided insurance but have Medicaid subsidize their premiums. Others would be referred to job-training programs as a condition of enrollment.
The list of new controls is longer and more complicated, but little can happen until federal officials react.
Whatever they might approve must still win legislative endorsement to replace the private option, which is otherwise scheduled to disappear at year's end.
Commentary on 01/13/2016