Whether the state extends government-funded private health insurance to 250,000 low-income Arkansans is largely in the hands of the 51 Republicans in the Arkansas House of Representatives.
Democratic House members have largely rallied around the idea; as has the Senate, which approved it 24-9 on Friday. House Speaker Davy Carter, R-Cabot, said Saturday that he wants the House to approve Medicaid expansion by the end of this week.
But dozens of House Republicans told the Arkansas Democrat-Gazette last week that they need more information before they decide how to vote.
The House is scheduled to meet at 3 p.m. Monday in a “committee of the whole” to pepper Department of Human Services and Insurance Department officials with questions about the cost and design of the program.
Called the “private option” at the Capitol, the proposal has been endorsed by Gov. Mike Beebe, a Democrat, and the Republican heads of the House and Senate, as well as the state Chamber of Commerce and other interest groups.
In July, the U.S. Supreme Court struck down part of the 2010 federal Patient Protection and Affordable Care Act and let states choose whether to extend Medicaid access to individuals who make up to 138 percent of the federal poverty level, or $15,145 annually. The same act calls for states to set up private-insurance marketplaces called exchanges from which people can pick their own insurance plans.
The estimated 250,000 eligible Arkansans would purchase insurance plans from private companies on the exchange using federal funds.
In February, Kathleen Sebelius, the secretary of the U.S. Department of Health and Human Services, told Beebe that the state could look into using federal Med-icaid dollars to pay premiums on private insurance policies.
Draft language of the bill began circulating at the Capitol on March 22, but a modified version wasn’t put forward publicly until Monday.
Those are Senate Bill 1020, sponsored by Sen. Jonathan Dismang, R-Searcy, and House Bill 1143, sponsored by Rep. John Burris, R-Harrison. The bills are identical. The Senate approved SB1020 last week. Burris said HB1143 will go to the House Public Health, Welfare and Labor Committee on Tuesday.
Legislation enabling the creation of the private option only needs a simple majority in each chamber, but the appropriation bill giving the state Department of Human Services authority to spend hundreds of millions of dollars in fiscal 2014 needs approval of 75 percent of members in each chamber.
Some Republican members have insisted that their vote to approve the plan is contingent upon passing other legislation to eliminate waste, fraud and abuse within the current $5 billion Medicaid program that serves 780,000 Arkansans. These Republicans are also insisting on approval of $100 million in tax cuts, including changes to the income-tax structure and capital-gains taxes.
Many of those items are moving slowly through the Legislature, and with the session scheduled to end April 19, some at the Capitol question if it all will be accomplished.
Rep. Reginald Murdock, D-Marianna, said Republicans, who gained a majority of seats in the Legislature for the first time in 138 years, are trying to transform the whole system at once.
“I just think it’s too much they are trying to do toofast. Some of it is not good policy for the state. It’s not what we need to do, not the direction we need to be going and it could have some unintentional, negative consequences,” Murdock said.
More than a dozen Republican lawmakers told the Arkansas-Democrat Gazette this week that they need more answers before deciding how to vote.
“I’m waiting to hear the committee of the whole,” Rep. Andrea Lea, R-Russellville, said. “I have heard all the final tie-ups from all over so I’m just waiting to sit here and hear the committee of the whole and find out.”
Others said they are for the option, pointing to estimates from a Department of Health actuarial consultant’s report that the private option will actually take people off of the traditional Medicaid program and have a $670 million positive effect on the state’s economy within a decade.
Rep. Charlie Collins, R-Fayetteville, said he’ll vote for it because it’s the best option available to phase out traditional Medicaid. He called the private option a model for the country.
“I’m sick and tired of Arkansas being last in everything,” Collins said. “Arkansas policymakers are on the vanguard of leading to a solution for this country.”
A handful said they already know they cannot support it.
Rep. Richard Womack, R-Arkadelphia, called the private option a “massive entitlement” that won’t work.
“I despise it,” he said.
One House sponsor doesn’t seem sure about his support.
House Republican leader Rep. Bruce Westerman of Hot Springs has said he could take his name off of the bill if he’s not satisfied there is enough legislative oversight.
“There’s just a lot of things that have to happen. If we pass this bill right now and go home, we’re going to trust and we’ll have no chance to verify,” Westerman said.
On Friday, Westerman said he planned to file his own version of the private-option bill, though he wasn’t sure if he’d take his name off of the other bills.
Also an issue for some Republicans is newly announced opposition from the conservative lobbying group Americans for Prosperity, which is urging legislators totake more time before making a decision. The group played a role in securing a majority of legislative seats for the Republican Party this session.
Burris said the group’s concerns have merit.
“Members, especially Republican ones, respect their organization,” Burris said. “It certainly is a big factor in the discussion.”
Some House Republicans have suggested holding a special session to decide the issue, or delaying a decision until the 2014 fiscal session, neither of which the governor supports.
The federal government is expected to pump billions of dollars into the state to pay the premiums, especially in the first three years. By 2020, Arkansas will take on 10 percent of the cost.
Beebe said the state should take advantage of the chance to help its poorest citizens as long as it can.
“I don’t want to give away a year’s worth of free money,” Beebe said. “You can do thejob right now. The information next year is not going to be any different than it is right now.”
More than $500 million of the $670 million economic boost to the state would occur in the first three years while the federal government assumes the entire burden of health-care costs.
Rep. Mark Lowery, R-Maumelle, said there are too many unknowns to say “yes” this year. “I favor the option, I just don’t want to be rushed into it,” Lowery said.
Rep. Charlotte Douglas, R-Alma, said she feels rushed.
“This is not a simple issue. We’ve got to do what’s best for all of Arkansas, as far as do we have the money long term,” Douglas said. “I want to take it slow, I want to look at it thoroughly and make sure I don’t make a mistake.”
Dozens of candidates in the 2012 election campaigned on not expanding Medicaid, a potential problem in getting approval of an appropriation from 75 percent of lawmakers.
Rep. Karen Hopper, R-Mountain Home, who had no opponent in November, said she is glad she didn’t take a position on health care during the election.
“I’m not bound by any commitments that I think some of my colleagues are,” Hopper said. “We all know down here your word is your word, and it’s not just among your colleagues, but it’s with your constituents back home. I can’t fathom where those individuals are.”
Hopper said she hasn’t decided how she will vote yet.
“It’s just by far, I believe, the most difficult decision I have had to make in three terms,” she said.
Front Section, Pages 1 on 04/07/2013