The Legislature’s Joint Budget Committee endorsed identical measures Thursday that reauthorize the use of federal funds to buy private health insurance for low-income Arkansans but that bar the state from buying advertising to encourage enrollment in the fledgling program.
The measures - one from the House and one from the Senate - are the same bill, and their fate remained uncertain on the fourth day of the state’s fiscal session.
Sen. Linda Chesterfield, D-Little Rock - who maintained three weeks ago that the private-option program was at best on life support - said Thursday that “ we’re trying to get resuscitated.”
House Speaker Davy Carter, R-Cabot, said he expects that next week the House bill - HB1150 - will get at least the 75 votes required for approval in the 100-member House.
But House Republican leader Bruce Westerman of Hot Springs said he expects the bill to die in the Senate, even if it clears the House.
Senate President Pro Tempore Michael Lamoureux, R-Russellville, said he’s still trying to round up the 27th vote that will be required to get the Senate’s private-option funding bill -SB111 - through the 35-member Senate.
Sen. Jane English, R-North Little Rock, who voted against authorizing funding for the private-option program last year, said she hasn’t decided how she’ll vote on the funding bill this time around. Lamoureux said English has kept an open mind and has always been willing to listen to information on the subject.
HB1150 and SB111, sponsored by the Joint Budget Committee, are appropriation measures for the state Department of Human Services’ Medical Services Division. The identical bills authorize the use of $915 million in federal funds for the private option in the fiscal year that starts July 1.
Both bills cleared the Joint Budget Committee on Thursday in a 40-11 vote.
Last year, the Republican-controlled Legislature authorized the use of federal Medicaid dollars - made available under the federal Patient Protection and Affordable Care Act that was signed into law by President Barack Obama in 2010 - to pay for private health insurance for low-income Arkansans. That’s the private option, which basically expanded the Medicaid program.
The expanded program extended eligibility to adults with incomes of up to 138 percent of the poverty level - $15,860 for an individual or $32,500 for a family of four. Under Arkansas’ private-option program, most recipients can sign up for private insurance plans on the state’s health-insurance exchange and have the premiums paid by Medicaid.
Nearly 100,000 Arkansans have enrolled in the expanded Medicaid program, according to the state Department of Human Services.
Gov. Mike Beebe has repeatedly warned that there would be an $89 million hole in his proposed $5 billion general revenue budget for fiscal 2015, if the Legislature fails to reauthorize federal funding for the private option during this fiscal session. He said that’s because his budget, which would raise state spending by $105 million, counts on about $89 million in savings arising from the private option.
The Joint Budget Committee approved HB1150 and SB111 after voting to accept Wednesday’s recommendation from its Special Language Committee to add an amendment prohibiting the state Department of Human Services from allocating, budgeting or expending any money “for the purpose of advertisement, promotion or other activities designed to promote or encourage enrollment” in the private option or the health insurance exchange.
The prohibition would apply to “unsolicited communications mailed to potential recipients,” television, radio or online commercials, billboard or mobile billboard advertising; ads printed in newspapers, magazines or other print media; and Internet websites.
But the bills wouldn’t prohibit the Department of Human Services from having “direct communications” with licensed insurance agents or people licensed by the department; or from having “solicited communications with potential recipients,” responding to people’s inquiries about coverage eligibility or from using an Internet website to enroll people in the private option or insurance exchange.
The two bills also would bar the Human Services Department from applying for or accepting any funds for advertising, promotion or other activities designed to encourage enrollment in the private option or insurance exchange.
Rep. Nate Bell, R-Mena, proposed the amendment barring the advertising. He told lawmakers Wednesday that his amendment would impose “a barrier to enrollment” to keep the private-option program from growing, but it would comply with federal law.
Private companies still could advertise and promote the private-option program under his proposal, he said.
Sen. David Sanders, R-Little Rock, who is an architect of the private-option program, told reporters Thursday that Bell’s amendment barring the state from using funds to advertise or promote the private-option program probably will have “some impact” on program enrollment.
“A quick ramp-up [in the private option], I don’t think, is entirely in the best interest,” said Sanders. “I think where we are now is manageable.
Managed growth is a good thing.”
SB111 and HB1150 also include an amendment by Rep. John Burris, R-Harrison, that the budget committee approved Thursday that would eliminate the private option on Feb. 1, 2015, if the federal government doesn’t approve three waivers for it.
Under Burris’ amendment, the state Department of Human Services is required to request waivers from the federal government by Sept. 15. The waivers would allow the state to collect co-pays and other charges from certain private-option recipients; design its own limited nonemergency transportation program for private-option participants; and launch a health-savings account program for private-option enrollees.
Burris said his amendment would require the federal government to approve the waivers by Dec. 1, and, if it doesn’t, the private-option process would begin to wind down over the following 60 days, and termination notices would be sent out.
Having a Feb. 1 date for eliminating the program if the U.S. doesn’t approve the waivers would allow “a very small window for the Legislature and the next governor to make any changes or corrections that they feel are necessary before the program is absolutely terminated,” he said.
After Thursday’s meeting, Carter said he’s still confident that there are enough votes in the House to pass the amended private-option funding bill.
On Wednesday, Carter said- after the contentious debate - that he hoped to convene the House today to take a vote on the private option. That plan, however, fell through because of scheduling conflicts.
He said Thursday that the private-option matter won’t be dropped until its passage is secured.
“We’ll vote on Tuesday, and then if necessary we’ll vote [again] on Wednesday, and if necessary we’ll vote on Thursday,” he said. “But we’re going to take this issue up. It does not need to sit around, and we are not going to wait on the Senate.”
Carter said he’s not willing to negotiate any more changes to the program. He said the Senate has two choices in his opinion - pass funding for the private option or not pass a budget for the Department of Human Services.
“That’s not a threat, that’s just reality, that’s where we are. I’m not going to ask my House members to take this issue up again after we deal with it on the House floor,” he said. “This is already contentious enough over here.”
Westerman said he still plans to vote against funding the private-option, despite the amendments.
“What I will vote for is an appropriation that has an end date for the private option,” he said. “What I think will ultimately happen, is we’ll be back in the budget committee hearings looking at something like Sen. Jim Hendren’s amendment.”
Hendren, R-Sulphur Springs, proposed ending the private option effective at the end of this year. On Wednesday, the budget committee’s Special Language Subcommittee rejected Hendren’s proposal.
Hendren told lawmakers Wednesday that ending the program on Dec. 31 would be a fair and reasonable way to end the private-option program. He said he would be willing to vote for funding the private option if the funding expired on Dec. 31.
Westerman, who is a candidate for Congress from the state’s 4th District, said Thursday that the private option is certain to end because supporters lack the votes in the Senate to continue it.
“It won’t get through the Senate if it does make it out of the House,” he said.
Private-option foe Sen. Bart Hester, R-Cave Springs, said Thursday night that nine senators, who say they are “no” votes, met Thursday afternoon. Those nine are enough to stop the funding. But he’s not ready to declare funding for the private option is dead.
“The pressure is intense,” he said.
Front Section, Pages 1 on 02/14/2014