Special session's focus health law; Arkansas Works eligibility, U.S. waivers issues at hand

Arkansas Works eligibility, U.S. waivers issues at hand

Gov Asa Hutchinson
Gov Asa Hutchinson

State lawmakers will consider Gov. Asa Hutchinson's latest proposals to change Arkansas' version of Medicaid expansion during a special session that starts Monday, against the backdrop of uncertainty over the federal law that authorizes funding for the program.

photo

Senate President Pro Tempore Jonathan Dismang, R-Searcy

photo

Sen. Bryan King, R-Green Forest

photo

Arkansas Democrat-Gazette

Sen. Jeremy Hutchinson, R-Little Rock

photo

Rep. Kim Hammer, R-Benton, is shown in this file photo.

On Friday, Hutchinson issued a proclamation calling for the special session to start at 2 p.m. Monday to consider legislation for clearing the way for the state to seek Medicaid expansion waivers from Republican President Donald Trump's administration.

The waivers would reduce the income eligibility limits in the Medicaid expansion program now called Arkansas Works from up to 138 percent of the federal poverty level to up to 100 percent of the poverty level. The changes also would impose work requirements on people enrolled in the program, with certain exceptions. Arkansas now refers recipients to the state Department of Workforce Services and there is no requirement to follow up.

The Republican governor also wants the Republican-dominated state Legislature to consider a handful of other measures, ranging from shifting about $105 million in the Arkansas Healthy Century Trust Fund from tobacco settlement proceeds to the state's Long-Term Reserve Fund, to shifting legislative oversight of the Arkansas Health Insurance Marketplace to the Legislative Council and to authorizing a study of the Arkansas Health Insurance Marketplace's future.

Lawmakers also will consider what Hutchinson called "technical corrections" in ethics and medical marijuana laws enacted during the regular legislative session to integrate them into the Arkansas Constitution. Legislative leaders said the state's Code Revision Commission would normally consider making these "technical corrections" in the state code, but the commission can't do so because the laws amend Arkansas' constitutional provisions enacted by voters.

The House and Senate are each scheduled to reconvene at 1 p.m. Monday, then formally adjourn the regular session. The special session is scheduled to start at 2 p.m. The General Assembly recessed its regular session on April 3. The special session is expected to last three days.

Lawmakers may have at least one matter to consider before ending the regular session. Sen. Scott Flippo, R-Mountain Home, said Friday that he plans to ask the Senate, before the regular session ends, to override Hutchinson's veto of his legislation that would bar the enforcement division of Alcoholic Beverage Control from enforcing laws related to gaming or gambling devices.

Senate President Pro Tempore Jonathan Dismang, R-Searcy, said he's not sure whether the Senate would override the governor's veto of the bill, but "I'm optimistic that there will be able to be a reconciliation on whatever his issues are before it comes to that point."

Overriding a governor's veto takes a majority vote in the 35-member Senate and 100-member House of Representatives. Senate Bill 496 by Flippo cleared the Senate in a 24-5 vote March 15 and in the House in a 53-22 vote March 28.

Medicaid expansion

More than 320,000 Arkansans were covered under Arkansas' version of Medicaid expansion called Arkansas Works as of March 31.

Hutchinson's proposed waiver would shift about 60,000 Arkansans off Arkansas Works and most of them will be eligible for similar coverage and federal subsidies to help pay the premiums through the state's health insurance exchange, state officials said. The plan would save the state between $66 million and $93 million over the next four years, they estimate.

The current Arkansas Works income cutoff of 138 percent of the federal poverty level is $16,643 for an individual and $33,948 for a family of four. The poverty level this year is $12,600 for an individual or $24,600 for a family of four.

The state is paying 5 percent of the cost of the program this year and is to pay 7 percent of the program cost in 2018. The state's share gradually increases to 10 percent by 2020.

In fiscal 2018, that starts July 1, the spending authority for the Arkansas Works program totals $1.81 billion, with the federal government share at $1.71 billion and the state's share at $109.1 million under Act 1045 of 2017.

The Medicaid expansion program was authorized by the Republican-controlled Legislature and then-Democratic Gov. Mike Beebe in 2013. It was formerly known as the private option under which low-income Arkansans get private health insurance.

The program has deeply divided Republicans because it's financed under the federal Patient Protection and Affordable Care Act signed into law by then-President Barack Obama in 2010. That administration approved waivers for the program.

During the past five years, supporters of the program in Arkansas have struggled to get the required three-fourths support in the House and Senate to authorize the use of state and federal funds for the program each fiscal year. Getting such votes has been easier over the past two years under Hutchinson.

Legislative leaders said Friday that lawmakers so far are favorably viewing Hutchinson's proposed changes.

But Sen. Bryan King, R-Green Forest, said he doesn't plan to vote for the legislation to clear the way for seeking Trump administration waivers.

"These people are big-government, Medicaid-spending Republicans," King said of the Medicaid expansion's proponents. "All these people are Medicaid spendaholics."

Rep. Bob Ballinger, R-Hindsville, who is considering running for the Senate seat held by King in 2018, said that for years he's advocated for reducing the number of people on the Medicaid expansion and for adding a work requirement to the program.

"I don't know why I wouldn't support it," he said of Hutchinson's legislation.

Hutchinson's nephew, Sen. Jeremy Hutchinson, R-Little Rock, said he'll support the legislation.

"I think we have to have those waivers to maintain the viability of the program," Sen. Hutchinson said.

"In one sense you can say it has been more successful than we thought. That obviously puts a pinch on our budget," he said. "If we want to succeed and remain viable, I think we need to make those reforms."

Rep. Kim Hammer, R-Benton, who is running for the seat held by Sen. Hutchinson in 2018, said he's probably leaning toward voting for the proposed changes.

He said he wonders whether by shifting Arkansans from the Medicaid expansion to the state health insurance exchange, "are we becoming more dependent on the federal government, and is this robbing Peter to pay Paul?

"I want to hear their explanations when they sit at the table to talk about it," Hammer said regarding state officials.

Rep. Michael John Gray, D-Augusta, said the Arkansas Works legislation "may be a little premature.

"We don't know what the landscape is going to look like," he said, referring to changes that may be made by Congress in the federal health care law.

"I don't know why we would be taking that on when Washington and the Republican majority [in Congress] is so indecisive on health care when our system in Arkansas seems to be working right now," said Gray, who also is the chairman of the state Democratic Party.

Dismang said transitioning Arkansans who have incomes between 100 percent and 138 percent of the federal poverty line from Arkansas Works to the state's insurance exchange starting in 2018 makes sense because program participants have "exchange-style policies."

"It has been contemplated for a long time and, if this administration is going to give us the latitude to do that, those individuals -- at least in the short term, depending on what happens on the federal level -- are still going to be covered and have subsidies to help support that coverage," he said. "Right now, we are dealt a specific hand from the federal government, and until Congress makes changes, I think you have to act within the boundaries they've given us and also the latitude the new administration may give you."

As for the future of the state's Medicaid expansion, he said, "I think as a state we'll continue to do what we have done in the past, and that is react to federal mandates in regards to health care and I think that's all we can do.

"I have no idea what that new structure is going to look like coming out of the feds, and so I don't know how you could possibly handicap it at this point," said Dismang, who is one of the three key legislative architects of the Medicaid expansion. The others are Sen. David Sanders, R-Little Rock, and former state Rep. John Burris, R-Harrison, who is now a lobbyist.

SundayMonday on 04/30/2017

Upcoming Events