After a four-day break, the Republican-dominated Legislature on Tuesday will resume tackling whether to proceed with Gov. Asa Hutchinson's line-item veto strategy as a means to allow the use of federal Medicaid funds to purchase private health insurance for low-income Arkansans in the next fiscal year.
The state's fourth-ever fiscal session started Wednesday and took a break after Thursday.
Because the Senate on Thursday failed to pass the state Department of Human Services' Medical Services Division appropriation as is, with the private-option funding intact, the Republican governor came up with another plan. If the Legislature sends him an amended bill that would bar spending on Arkansas' version of Medicaid expansion, he's promised to issue a line-item veto of that ban.
Senate President Pro Tempore Jonathan Dismang, R-Searcy, said Friday that "we'll have a good idea" when the Joint Budget Committee meets at 9 a.m. Tuesday "which direction we are going to go, whether it be this line-item veto direction or just the plain and simple bill" without a ban on Medicaid expansion funding.
Asked whether the line-item veto strategy is the ticket to resolving the impasse in the Senate, Dismang said, "It is a possible avenue. I am not sure again that everybody jumps on and we move forward with. But it is a possibility at this point."
Senate Bill 121 would grant the Medical Services Division $8.4 billion in spending authority, including $1.7 billion for the Medicaid expansion, during fiscal 2017, which starts July 1. Ten Republican senators voted no, and the bill fell two votes short of the 27 votes required for appropriations bills in the 35-member Senate.
The bill went back to the Joint Budget Committee, which declined to amend SB121 to bar spending on the private option, the program legislation enacted in a special session earlier this month calls Arkansas Works. The 22-22 vote on the amendment, proposed by Senate Republican leader Jim Hendren of Sulphur Springs, fell seven votes short of the 29 required for approval. Most Republicans voted for it, while Democrats largely opposed it.
The Medicaid expansion, enacted by the Legislature in 2013, extended coverage to adults with incomes of up to 138 percent of the poverty level: $16,394 for an individual, for instance, or $33,534 for a family of four. Most of the 267,000 people covered receive the coverage through the private option, which uses Medicaid funds to buy private insurance coverage.
Legislation enacted in the special session earlier this month would make changes in the program that Hutchinson has said would encourage enrollees to stay employed and take responsibility for their health care.
Those changes include charging premiums of about $19 a month to participants whose incomes are above the poverty level, subsidizing some enrollees' coverage through employer plans and referring some beneficiaries to job-training programs.
Through this fiscal year, the program was fully funded by the federal government. The state will begin paying 5 percent of the cost of the Medicaid expansion, starting Jan. 1, and its share will gradually increase to 10 percent by 2020. The state funds to match the federal funds will be $43 million in fiscal 2017, said Amy Webb, a spokesman for the Human Services Department.
Sen. Jason Rapert, R-Bigelow, who suggested Thursday that he might withdraw his support for Arkansas Works, said Friday that he learned the federal government requires the Medicaid expansion's private insurance plans to include access to certain health benefits, including contraceptives like the so-called morning-after pill.
"Since we don't have a choice, it's a moot point," he said, and his support for Arkansas Works is firm.
Asked if there is any way that two of the 10 Republican senators who voted against SB121 will change their minds and vote for the bill without the ban, Dismang said, "There is reality to the situation and that's what these members need to achieve their goal, which is not to fund Arkansas Works in special language inside the appropriation bill.
"I think it was trying to bring awareness to the fact that that special language is subject to a line-item veto," Dismang said. "It was fast-forwarding that conversation, so we could either have that conversation [Thursday], like we did, or we could wait three months from now when we are at a stalemate to have that conversation."
The fiscal session is limited to 45 days under the Arkansas Constitution. Lawmakers are working on a state budget for the fiscal year starting July 1.
Hutchinson said Friday that there is "a group" -- he declined to say how many -- within the 10 Republicans who voted against SB121 in the Senate "that have indicated that they will ... support the amended appropriations bill" without the Medicaid expansion.
Sen. Bart Hester, R-Cave Springs, a leading opponent of the Medicaid expansion who voted for Hendren's amendment in the Joint Budget Committee, said Friday, "I am going to vote for the bill I've been asking for," to defund the Medicaid expansion.
"If the governor chooses to veto it, that's up to him," he said.
Another of the 10, Missy Irvin of Mountain View, joined Hester in voting for Hendren's amendment in the Joint Budget Committee.
The others in the 10 are Cecile Bledsoe of Rogers, Alan Clark of Lonsdale, Linda Collins-Smith of Pocahontas, Scott Flippo of Mountain Home, Blake Johnson of Corning, Bryan King of Green Forest, Terry Rice of Waldron and Gary Stubblefield of Branch.
In defending his line-item veto strategy, Hutchinson said, "From the Republican side for those who oppose the funding of Arkansas Works, they can say, 'We were consistent in opposing the funding of Arkansas Works.'
"On the Democrat side and the side of the majority of Republicans that supported Arkansas Works, they can say, 'Our objective -- I voted for funding for Arkansas Works -- and my vote in the end was based upon the governor's promise of a line-item veto that assured funding of Arkansas Works,' " he said.
"Both [are] honest positions and the key to all of this is ... transparency. We haven't hidden the ball from anybody. I told 'em every side, no trickery, how this would play out and what I would do," Hutchinson said.
Brenda Vassaur-Taylor of Fayetteville, a co-founder of the Conduit for Action group that opposes Arkansas' Medicaid expansion, said, "We are not in favor of the governor's scheme, via Senator Hendren's amendment to [Senate Bill] 121, that may give the appearance on its face of one thing but intended to provide a different outcome.
"However, like most Arkansans, we are growing accustomed to this style of governing from this administration and its Senate leadership, whether talking about campaigning or keeping an unpopular and expensive welfare program such as the private option," she said in a written statement.
David Ray, state director for the Americans for Prosperity group that opposes the Medicaid expansion, said, "This is the kind of Washington, D.C.-style politics that makes people so cynical about the political process.
"We don't support any efforts to circumvent the three-fourths majority required to appropriate funding to continue Obamacare's Medicaid expansion," he said in a written statement.
Richard Huddleston, executive director of the Arkansas Advocates for Children and Families that supports the Medicaid expansion, said Hutchinson's line-item veto strategy "is a creative strategy to be sure, one that I can't recall being used in my 20 years of advocating at the Legislature.
"For this or any other strategy to work, there will have to be a high level of trust between the governor and the Legislature, across both sides of the political aisle, and between our leaders and the public. I am hopeful we will get there eventually and get it done. We have to rely on the governor and our legislative leaders to come up with the right strategy to pass a bill with funding for Arkansas Works," he said in a written statement.
"Too many other critical programs for vulnerable children and families depend on passing this bill with funding for Arkansas Works. We have to put partisan politics aside and do what is in the best interests of Arkansans and that means passing a bill that ends up including funding for Arkansas Works," said Huddleston.
Hutchinson has proposed a $5.33 billion general revenue budget for fiscal 2017 that would increase spending by $142.7 million over fiscal 2016 and factors in nearly $101 million in individual income-tax cuts.
He's warned that failing to reauthorize funding for Arkansas Works would create a "hole" of more than $100 million in the state budget and lead him to not call a special session for the Legislature to consider his plan to increase state highway funding to get more federal funds for roads.
Jodiane Tritt, vice president of government relations for the Arkansas Hospital Association, which supports the Medicaid expansion, said, "Appropriating and funding the entire Medicaid program -- including the Arkansas Works program -- is of the utmost importance for our patients, hospitals, healthcare institutions and providers, and healthcare system.
"However the governor and the Legislature legally achieve that goal is up to them," she said in a written statement.
Hutchinson said the stance of Democrats will be important in determining whether his line-item veto strategy is successful.
Sen. David Burnett, D-Osceola -- whose November re-election opponent is state Rep. David Wallace, R-Leachville -- said Friday, "Right now, I don't want to be put in the position of voting against [funding the Medicaid expansion.]
"The 10 people causing the gridlock ought to be the ones giving in, but not me," he said.
"I want to help the governor and I want the Medicaid expansion to pass. I'm running a political race, but the vast majority of folks won't understand the political gymnastics and will think I am voting against Arkansas Works," said Burnett, who voted against Hendren's amendment on Thursday in committee.
Sen. Bobby Pierce, D-Sheridan, who's hoping to survive a challenge from El Dorado Republican Trent Garner in the general election, said he's campaigned "for the last umpteenth months for Arkansas Works [because] it is the right thing to do."
"Now I'm asked to vote against something I have been campaigning for," said Pierce, who voted against Hendren's amendment Thursday. "I am going to do what is right for Arkansas. Arkansas Works is good for Arkansas."
"Why can't some of those [10 Senate Republicans] vote for it?" Pierce said.
Dismang, who is one of three legislative architects of Arkansas' version of Medicaid expansion, said he understands the concerns of Democrats.
"But I think folks are most concerned about the outcome than they are on the process," he said.
Both Senate Democratic leader Keith Ingram of West Memphis and House Democratic leader Michael John Gray of Augusta said last week that Hutchinson should focus more on persuading two of the 10 Senate Republican funding opponents to vote for it.
They left the door open to supporting Hutchinson's veto strategy.
Ingram said Thursday that Hutchinson "has a bully pulpit in his office and certainly he can use a stick or use a carrot, and ... I think that he needs to do that on people that are obstructionist" to get the needed 27 votes in the Senate.
When asked about Ingram's comments, Hutchinson said Friday, "I'll let Sen. Ingram make the comments that he wants to make.
"I have used the strategies that I believe have the best chance of success. There are some that tell me that I should be more aggressive toward the Democrats. But no, I think that giving them time is appropriate, understanding that they are working their way through this, and having confidence ... that they are going to reach the right conclusion," the governor said.
"On the 10 [Senate Republicans], if somebody wants to crash their government, there is not a whole lot you can say beyond that," Hutchinson told reporters. "But no one has been been more forceful this last week, virtually every day, having more news, front pages of the paper, stories that you are writing about, the consequences of a no vote and the lack of funding.
"So I have been about as far out as any governor could possibly be. But I think I've got a good balance of continuing the communication, continuing to work for an outcome that works for everybody, and that's how I am [as] governor and I'll continue to be," he said.
SundayMonday on 04/17/2016