LITTLE ROCK — Gov. Mike Beebe emerged from a “productive” meeting with U.S. Health and Human Services Secretary Kathleen Sebelius on Friday, saying he felt good about Arkansas’ options for expanding its $5 billion Medicaid program by 250,000 people.
Beebe’s spokesman wouldn’t reveal Sebelius’ reaction to Beebe’s pitch. The governor prefers to wait until he returns to Arkansas from Washington, D.C., on Monday night to discuss Sebelius’ “feedback” with top lawmakers, said Matt DeCample.
What’s clear is that Beebe, a Democrat, floated Republican ideas about allowing individual Arkansans earning somewhere below 100 percent of the federal poverty level, or $11,170, to purchase health coverage on the state’s insurance exchange as part of a possible deal.
How far below the federal poverty level wasn’t specified, DeCample said.
Also still on the table is whether some portion of uninsured Arkansans earning between $1,899 and $15,415 will have the choice to buy federally subsidized private insurance or be forced to do so, DeCample said.
GOP leaders in Arkansas increasingly say that any Medicaid expansion deal is contingent on providing a greater role for private insurance.
They’ve also voiced support for a possible “sunset” clause to give lawmakers a chance to reduce the rolls when the federal government stops paying for every dollar of expansion in 2017.
Any Arkansas legislative deal expanding Medicaid requires the approval of 75 House members and 27 senators. Republicans hold majorities in both chambers, and they have been skeptical of enlarging the rolls of the federal-state partnership that already covers about 780,000 poor Arkansans.
But leading Republicans said they were encouraged by Beebe’s optimism after his meeting with Sebelius.
“It’s better than pessimism,” said Rep. John Burris, R-Harrison, chairman of the House Public Health, Welfare and Labor Committee.
Several GOP lawmakers said they were looking to Florida’s and Ohio’s negotiations with the federal government as signposts to a possible solution.
Beebe met with Sebelius in her office for about 20 minutes during a visit to Washington, D.C., for a meeting of the National Governors Association. Arkansas Department of Human Services Director John Selig, state Medicaid Director Andy Allison and state Surgeon General Dr. Joe Thompson also attended the meeting.
Selig was on a plane Friday evening and unavailable for comment, said state Human Services Department spokesman Amy Webb. Thompson wasn’t immediately available for comment.
The recent decision by Republican Florida Gov. Rick Scott to endorse Medicaid expansion came up during the meeting, DeCample said.
Scott has called for a “sunset” provision allowing Florida lawmakers to vote to continue the expansion when states start shouldering some of the costs. States will have to pay up to 10 percent of expansion costs by 2020.
Arkansas Senate President Pro Tempore Michael Lamoureux, a Russellville Republican, said Florida’s sunset provision appeals to him.
“I’ve never been optimistic that we could vote to remove people from the rolls. But if the program is supposed to do wonderful things in three years. And if they don’t do wonderful things, then it’s a reasonable basis on which to reevaluate,” Lamoureux said.
Arkansas House Speaker Davy Carter, R-Cabot, voiced similar approval of a possible sunset provision to reporters at the Capitol on Friday afternoon before Beebe’s announcement. Carter said he had been thinking along similar lines for several weeks.
Beebe is willing to discuss a sunset provision, DeCample said.
“It’s another option that’s out there,” he said. “What you’ve seen in Florida has a lot of people’s minds cranking.”
House Minority Leader Greg Leding, a Fayetteville Democrat, said he’s willing to listen to any deal that Beebe, Lamoureux and Carter hammer out.
“My number one goal is just making sure we get as many Arkansans as possible health coverage,” Leding said.
Burris said he’s not sold on the idea, but left some wiggle room.
“If you’re going to do something unreasonable, that seems about the most reasonable way to do it,” he said.
A sunset clause would be “a basic building block for anything we do,” said Sen. Jonathan Dismang, a Searcy Republican.
Dismang, who first floated the idea of pushing more of the expansion population toward the exchange, said he’s confident the idea has legs.
Giving private insurance more of a role would accomplish two objectives already supported by the Human Services Department, he said.
First, it would encourage providers to contain costs, as they have already been encouraged to do with the state’s Medicaid-payment overhaul.
Second, private insurance coverage would require Medicaid recipients to “have more skin in the game,” another frequent goal of Beebe’s administration.
“That’s big transition in what’s happened over the last couple weeks,” Dismang said. “Proponents for expansion were pretty dead set at first on full expansion being the only solution. Now providers are coming to the table.”
Gov. John Kasich of Ohio also recently announced his support for expansion. So far, seven Republican governors have thrown their support behind expansion. Dismang said he thinks Ohio is pushing for the same kind of deal that he advocates.
“It’s almost shocking what the feds have been willing to do [to get states to go along with expansion],” Dismang said.
Burris thinks all of the 250,000 expansion population might end up on the exchange. He said private insurance would provide better care and better reimbursement rates for providers.
“Never say never. They said a lot of things weren’t going to happen that have,” he said.
Sen. Larry Teague, a Nashville Democrat, said he still has concerns about the exchange premiums being too expensive, even with federal subsidies, especially for older Arkansans whose health costs are usually higher.
Premiums for those earning between 100 and 138 percent of poverty would likely fall between $19 and $26 a month.
But Teague said he’s happy to hear that Beebe is feeling good about his meeting with Sebelius.
“I’ve been saying for the last two or three weeks that I didn’t see legislation moving forward unless the governor got significant give from Sebelius at their meeting,” Teague said. “So I’m hopeful that’s exactly what happened.”
Teague said he wants the expansion debate to draw to a close sooner rather than later. Republicans have floated the idea of settling the issue in a special session later this year or even the fiscal session in early 2014.
“I’m at a point where I want to say yes or no,” Teague said.
Information for this article was contributed by Sean Beherec of the Arkansas Democrat-Gazette.
Front Section, Pages 1 on 02/23/2013