Us, a prototype?

LITTLE ROCK — The big story of the looming Arkansas legislative session-other than the historic Republican control-will be whether to accept federally funded Medicaid expansion.

It will be a big story on many fronts.

Many in the new Republican majorities reject the idea outright. They argue that the federal government can’t responsibly afford to send full federal funding to expand Medicaid to a quarter-million more of our residents.

They point out that we run a deficit in Arkansas on Medicaid already.

Anyway, they say, we won’t be able to afford the expansion at the state level when, after three years, the federal government begins reducing its full funding toward 90 percent.

But hospitals need the expansion badly. Nationally, they made a deal with the Obama administration to take less in reimbursements for Medicare on the assurance that they would get that money back in expanded Medicaid.

So then the U.S. Supreme Court said states could opt out of Medicaid expansion, and Republican states-like ours-started talking about doing just that.

Hospitals are laying people off and pairing up in operating alliances, or trying to do that.

For his part, Gov. Mike Beebe is an utterly pragmatic governmentalist. He thinks it’s nuts not to take full federal funding to get more of our people insured and more money percolating in our health-care economy, indeed the greater economy.

And let’s not forget those quarter million working poor people who, with Medicaid, could go to the doctor more readily, and stay healthier, if they chose.

So, in view of all that, the remarkable thing is that the inside talk emerging since the election has been that Arkansas, even with its new Republican legislative majorities, will, in fact, expand Medicaid.

The hospital concerns are pretty stout. So is the hospital lobby.

Both new Republican leaders-Sen. Michael Lamoureux of Russellville and Rep. Davy Carter of Cabot-oppose simple expansion. But they support some kind of compromise by which an increment of expansion would be accepted with stipulations and restrictions-maybe drug-testing, maybe co-pays.

Could a state do that?

Could Arkansas agree to take some of the federal expansion at full federal funding, but not all, and attach riders not contemplated in the federal law?

I can only tell you what a leading Republican told me last week. It was that Beebe is well-wired with federal Health and Human Services Secretary Kathy Sebelius, and we can count on him simply to get her to go along with whatever self-styled expansion we devise.

This Republican said the Obama administration will need to see some workable middle ground between outright acceptance of the expansion in liberal states and outright rejection of it in conservative states.

Isn’t that ironic?

Here we have, in little ol’ Arkansas, a severely term-limited Legislature just taken over by novice Republicans. And someone is talking about our devising a middle-ground template for other states on Medicaid expansion.

How might all this play out?

Before we get to the appropriation process requiring a three-fourths majority, we would confront authorizing legislation outlining the state process for Medicaid expansion.

It likely would be referred to the respective public-health committees.

Democrats will actually control the public-health committee in the House. Membership will be evenly split, four to four, in the Senate.

I’m wondering if that seemingly deadlocked Senate committee-with a Republican doctor’s wife, Cecile Bledsoe of Rogers, as chairman, and a Democratic hospital employee, Paul Bookout of Jonesboro, as vice-chairman-wouldn’t be the logical place to piece together the compromise legislation.

One more thing: It is unlikely, but possible, that, in negotiations to avoid the fiscal cliff, the federal government would put more of the eventual burden of expansion on states, something different from the long-term 90-10 arrangement.

That would change everything.

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John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. Email him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.