The state Legislature assembles today for a special session that could begin a period of Washington-style gridlock and brinkmanship lasting weeks, even months.
“We’re going to keep you entertained, I guess,” a Republican insider said woefully the other day, assuming inaccurately that I find right-wing obstructionism and general political dysfunction entertaining.
The issue is Medicaid expansion, or the private option, or what Gov. Asa Hutchinson now calls “Arkansas Works.”
The special session beginning today will seek to secure a simple majority vote to pass the general authorizing legislation for Hutchinson’s adapted and renamed form of the private option. Hutchinson also had wanted companion authorization to convert the parts of Medicaid for mental health and the developmentally disabled to “managed care.” But the governor’s close allies who lead the House and Senate — House Speaker Jeremy Gillam and Senate President Pro Tem Jonathan Dismang — asked him Monday to give that up because he couldn’t pass it.
Managed care is a system by which for-profit private management companies intervene between providers and the state to coordinate billings and payments and presumably save money.
What Hutchinson wanted was to pass managed care to show the right wing that he was committed to finding savings at the same time he was insistent on renewing Medicaid expansion.
Without managed care, he must fly naked on expansion, so to speak.
The governor was stymied on managed care by resistance led by a firebrand freshman state representative from Mountain View, Republican state Rep. Michelle Gray, who is the business manager for her husband’s medical clinic. She was joined by many in the Democratic caucus who were anxious to flex anti-Hutchinson muscle out of presumed concern that you can’t achieve major savings through managed care without imperiling care for the needy.
Next week the regular off-year budget session will begin. The legislative chambers will need at that time to approve by three-fourths votes the vast appropriation for the state Human Services Department that would include the federal money for Medicaid expansion as presumably authorized, effective July 1, by this week’s special session.
“Nothing about any of that is a foregone conclusion,” a health-industry lobbyist said ominously.
The strongest likelihood is that the simple authorizing legislation for Medicaid expansion, requiring only the majority vote, will pass in the special session this week.
But the prospects for next week’s budget session seem almost dire. There are nine state senators not flinching in their avowed opposition to Medicaid expansion, which they call Obamacare and unaffordable spending. Nine opposing senators would deny a three-fourths majority in the 35-member Senate.
If Medicaid expansion is abandoned now, after three successful years during which the Arkansas model of privatized expansion has been nationally hailed, then the following would happen:
• A quarter-million poor people would lose health insurance and have no option for it, falling as they would between basic Medicaid and the eligibility level for subsidies in the general Obamacare exchanges.
• Those quarter-million mostly healthy people would come out of the state health-insurance pool and force increased premiums for the rest of us.
• Hospitals would return to a system of providing uncompensated care, rather than insured care, that could likely break many of them.
• State government would lose at least a hundred million dollars in its general revenue budget. That’s because the federal government pays all of Medicaid expansion, but, if we abandon Medicaid expansion, the state would revert to basic Medicaid with a 70-30 federal-to-state match.
• Hutchinson’s plan to bail out the state highway system with state general revenue surplus funds would be deep-sixed on account of there not existing any general revenue surplus funds unless we expand Medicaid at federal expense.
Most of the talk I’m hearing suggests the near certainty of an inability to get that three-fourths vote in the budget session beginning next week.
Then, if the Hutchinson administration excised the expansion money to try to salvage a simple Medicaid budget for the deeply needy aging and disabled, Democrats might peel off, leaving the three-fourths threshold even more remote.
The projected scenario I’m hearing, in the event of failure to get the three-fourths, is simply recessing the budget session to reconvene in June on the brink of the new fiscal year July 1 to try to apply pressure to produce the one or two additional votes needed.
Brinkmanship has worked so well in Washington.
That was in jest.
Failing anything else, there is talk of declaring Medicaid spending authorized by a majority vote on an imaginative constitutional argument, or even of going into federal court seeking to have the court order Arkansas to spend the federal Medicaid money for a program it has lawfully enabled by a simple majority vote.
That’s getting ahead of the game, which is hardly a game.
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers’ Hall of Fame in 2014. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.