Expect the fight to renew the "Arkansas Works" health care program in this year's legislative session to be tougher than in 2019, said the incoming chairwoman of the Senate Public Health, Welfare and Labor Committee.
And the 2019 effort was no cakewalk, said state Sen. Cecile Bledsoe, R-Rogers.
Bledsoe will preside over the committee, which will oversee efforts to extend the program. "Arkansas Works" uses federal taxpayer money from the so-called "Obamacare" federal legislation of 2010 to help pay for private insurance for lower-income Arkansans.
Arkansas Works covers those who earn enough money to render them ineligible for Medicaid. The program provides health insurance to about 290,000 Arkansans. Medicaid was an already existing state-administered program largely financed with federal taxpayer money. It pays a portion of health care expenses for the poorest Arkansans.
Opting into Obamacare was left to the discretion of state government. As designed, the program expanded Medicaid to those making up to 138% of the federal poverty level. The current threshold for a household of four is $26,200.
Arkansas accepting the program created controversy from the beginning. Opponents criticized the measure as a government takeover of health care and an increasingly expensive proposition, as federal support for it is scheduled to be reduced over the course of years. The current two-year budget for the program is $1.945 billion, which includes both state and federal taxpayer money.
The measure went into effect in 2014 after the federal government allowed Arkansas to use the Obamacare money to subsidize private insurance policies.
Renewing the program faces a challenge every regular legislative session. Gov. Asa Hutchinson first proposed a work requirement in March 2017, to require beneficiaries to hold a job or seek one to participate, with exceptions. The federal government approved adding the requirement a year later. Adding the work rule garnered enough votes to win renewal of the program in 2019.
The incoming administration of President-elect Joe Biden will likely not approve any such waiver, Bledsoe said.
Approval to renew the program without the requirement will be challenging, Bledsoe said. Sen. Greg Leding, D-Fayetteville, agreed with Bledsoe's assessment.
"I don't want to doom it by saying it can't pass without the work requirement, but it's a huge hurdle," Leding said. He opposes the work requirement and would "like to see it go away," but acknowledged it was the political price of passage in the last renewal.
Cindy Gillespie, secretary of the Arkansas Department of Health, is working on changes to the program to render it more acceptable to opponents, Bledsoe said. Those proposals are a work in progress, the senator said, and no details have been released.
"I have a lot of confidence in Cindy Gillespie," Bledsoe said.
The growing strength of the Republican Party at the statehouse adds to the challenge of renewal, Leding said.
"The governing Republican Party added to their majority," he said. The Senate will have nine Democrats among its 35 members when the session begins, while the House will be down to 22 Democrats out of 100. Democrats generally supported the health care expansion plan.
"This is the governor's final session," Leding said, referring to the two-term limit Hutchinson faces. "We've already seen the Legislature asserting itself a bit," being less deferential to the governor, he said. The governor's influence in 2019 was a big help in getting renewal passed, Leding said, and that influence is waning.
Both Bledsoe and Leding said the ongoing covid-19 pandemic could weigh in on lawmakers' decision on renewal, but whether it will and how much are unknown. Opponents might be more reluctant than normal to reduce health care coverage while the disease is so widespread. The pandemic has placed health care providers around the state under economic strain while dealing with the crisis, they said.
Underlying Arkansas Works and most issues coming up in the legislative session will be the overall budget picture, Sen. Lance Eads, R-Springdale, said in a separate interview about the session in general.
Overall revenue appears strong now, but those figures are skewed by federal pandemic relief, both directly to the state and indirectly through tax collections relief provided to businesses and individuals.
Biden's incoming administration will likely change future relief efforts, which will change the fiscal picture, Eads said. The Legislature will have to outguess what changes the administration and Congress will make before making up its own mind about the budget, he said.
"The budget appears to have held up really well, but is it a little inflated? It's hard to tell," he said.
Doug Thompson can be reached by email at [email protected] or on Twitter @NWADoug