Senate hits 27 votes, passes SB121

The Arkansas Senate on Wednesday narrowly approved a bill to reauthorize the use of federal Medicaid funds to purchase private health insurance for low-income Arkansans in the next fiscal year.

The bill fell short of approval last week. To reduce opposition to it, it was amended to "sunset," or end, funding of the so-called Arkansas Works program on Dec. 31. Republican Gov. Asa Hutchinson has promised to issue a line-item veto of that funding sunset, thus allowing Arkansas' version of the Medicaid expansion to continue for the rest of fiscal 2017.

The sunset amendment also includes a severability provision so that if any provisions or applications of the bill are ruled invalid by a judge, such a ruling won't affect the rest of it.

Senate Bill 121 is an appropriation bill that would grant the state Department of Human Services' Medical Services Division $8.4 billion in spending authority, including $1.7 billion for the Medicaid expansion, for fiscal 2017, which starts July 1. The bill also grants spending authority to other Medicaid programs.

After Wednesday's debate of a little more than 20 minutes, the Senate voted 27-2 to send the amended bill to the House. Twenty-seven votes are required in the 35-member Senate for approval of appropriation measures. In the 100-member House of Representatives, 75 votes are required.

Hutchinson said he was pleased with Wednesday's vote.

"This, of course, is just one step in the overall process, but I am confident that the bipartisan approach that achieved success in the Senate will provide momentum for this strategy for funding Arkansas Works as it heads to the House floor [today]," he said in a written statement.

Sens. Bart Hester of Cave Springs and Blake Johnson of Corning, who were among 10 Senate Republicans who voted against SB121 last Thursday when it lacked the amendment, voted for the bill Wednesday. Of the rest of the 10, two voted against the amended bill, five voted present and one was absent.

After Wednesday's vote, Hester said he supported the bill knowing that Hutchinson plans to veto the defunding provision. "I fought as hard as you could possibly fight this," he said of his opposition to funding the Medicaid expansion.

"When you are outnumbered and outmanned, and you don't have the governor's office and you ain't got the rules in your favor, at some point you understand that I am down to the choices of shutting down [the entire] Medicaid [program] or finding a different solution," he said. "And shutting down Medicaid wasn't an option for me. We wanted to find a different solution for Arkansas, so we could move forward.

"Voting 'no' to end Medicaid is not being a statesman and representing the people of Arkansas. That was the message that was delivered to me from anybody of any significance that came to see me," Hester said, declining to name anyone in particular from Northwest Arkansas, where he lives.

Johnson said he voted for the bill Wednesday because it would defund the Arkansas Medicaid expansion. "My inaction will not change [the governor's line-item veto]," he said. "That's not me. That's his action, and that's up to the governor. That's executive privilege. That's just how I see 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 fall within what is known as the private option, which uses Medicaid funds to buy private insurance coverage.

The Arkansas Works legislation, approved during a special legislative session earlier this month, makes changes that Hutchinson has said will encourage enrollees to stay employed and take responsibility for their health care.

The Medicaid expansion has been fully funded by the federal government since it started in 2014. The state will begin paying 5 percent of the cost starting Jan. 1, and its share will gradually increase to 10 percent by 2020. The state will pay $43 million in fiscal 2017 to match the federal funds, a state spokesman has said.

Hutchinson has warned that failing to reauthorize the Medicaid expansion would create a "hole" of more than $100 million in the state budget and would end his plan to call a special session to increase state highway funding as a way to secure additional U.S. highway funds for which Arkansas is eligible.

He has proposed a $5.33 billion general revenue budget for fiscal 2017, which would be a $142.7 million increase over fiscal 2016. The 2017 budget factors in a nearly $101 million cut in individual income-tax rates that was enacted by the Legislature in 2015.

Senate President Pro Tempore Jonathan Dismang, R-Searcy; Sen. David Sanders, R-Little Rock; and former Rep. John Burris, R-Harrison, who is now a lobbyist, were the legislative architects of the state's 2013 Medicaid expansion that has divided Republicans in the Legislature for the past four sessions. Gov. Mike Beebe, a Democrat, worked with the three to enact the private option in 2013.

It required multiple votes in the House in 2013 and 2014 -- when Davy Carter, R-Cabot, was House speaker -- to authorize the use of federal funds for the program. The Senate narrowly approved the funding in those years.

During Wednesday's 24-minute debate on SB121, Sen. Terry Rice, R-Waldron, said he has "heard lies, half-truths ... in this debate since the conception of the private option."

He said he gives to the needy and to many causes around the world. "I am not mean. I am not harsh," he told Senate colleagues. "You'll never give ... service to conservatism by embracing socialism." Rice, who opposed SB121 last week, voted present Wednesday.

Sen. Alan Clark, R-Lonsdale -- who also opposed SB121 last week but voted present on it Wednesday -- warned colleagues that in favoring the measure, "the Legislature is giving power to the executive branch," and that "will be a historic mistake."

Sen. Jason Rapert, R-Bigelow, who voted for SB121 last week and this week, said he "has fought aspects of the federal Obamacare legislation since I have been here."

"We are really at a point of where Arkansas simply is trying to survive the best we can until we can get Washington to negotiate," he said. "The vast majority of my district asked me to vote for this bill."

Obamacare is an informal reference to the federal Patient Protection and Affordable Care Act signed by President Barack Obama in 2010. Arkansas received a waiver from the Obama administration for the state's version of Medicaid expansion.

Sen. Linda Collins-Smith, R-Pocahontas, who voted present on SB121 Wednesday after voting against it last week, said the legislation is deceptive.

But Senate Republican leader Jim Hendren of Sulphur Springs, who sponsored the defunding amendment and supported the bill, said senators should be careful about "throwing out words like 'deceive' and 'lie' regarding what is going on."

If Hutchinson's line-item veto strategy for continuing to fund Arkansas Works "is a trick, it's the worst hidden trick I have ever seen," Hendren said. "It has been in the newspaper. It has been very clear what the governor is going do."

The state's governors have had line-item veto authority for decades under the Arkansas Constitution, said Hendren, a nephew of Hutchinson's.

Sen. Bryan King, R-Green Forest, who voted against SB121 last week and this week, ended Wednesday's debate by warning, "We are spending this state and country into financial doom."

In the House on Wednesday, legislators voted 98-0 for House Bill 1002, the general appropriations bill that grants about $1.3 million in spending authority to pay the expenses and mileage of judicial aides and legislators.

Democrats had blocked the measure in two previous votes. The Arkansas Constitution requires that the general appropriations bill be passed before any other appropriation bills can be approved.

House Speaker Jeremy Gillam, R-Judsonia, said Wednesday that SB121 will be the first major item considered today in the chamber and that he was "99 percent" sure there would be enough votes to move it on to the governor.

He said he expects the measure to be supported by the "high 70s" to "low 80s" of the 100-member chamber.

"I feel it will be a fairly uneventful afternoon in our chambers," Gillam said.

House Democratic leader Michael John Gray of Augusta said there are some Democrats who aren't "100 percent sold" on having to vote to defund Arkansas Works after they voted for it in the special session earlier this month.

Relying on the governor's line-item veto, Gray said, has invoked some general "leeriness" among some members, but he thinks lawmakers understand the issue and the tactic.

"I think it's got a lot easier road to go today than it would have had a couple days ago," Gray said Wednesday. "There's the question of, 'Did we do the right thing? Should we have tried more to push a clean bill?' Is this setting the right precedent?' But at the end of the day, everyone's looking at the final outcome."

Rep. Laurie Rushing, R-Hot Springs, said some people have used social media, emails and texts to chide her for voting against Arkansas Works legislation in the special session but pledging to vote for its funding in the fiscal session.

She said most of the comments have come from outside of her district.

"I think my favorite [barb] is one that said, I'm not strong enough of a woman to stand up to the male GOP leaders. ... That one kind of got me, especially coming from another woman," Rushing said. "I think we have a strong voice up here as women leaders. I'm not being bullied by the male GOP. Sometimes, they're being bullied by me."

A Section on 04/21/2016