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Correction: More than 180,000 Arkansans have been enrolled in private health insurance through the state's private option program, according to the Department of Human Services. An article in Thursday’s editions incorrectly stated the number of enrollees.

One day after a tidal wave of Republican candidates won election in Arkansas, legislative leaders are saying the state's private-option Medicaid expansion program will have to change dramatically if supporters want it to survive.

And Democratic Gov. Mike Beebe said Wednesday that the program faces a serious challenge from the slew of newly elected lawmakers who ran campaigns promising to dismantle it.

Republicans picked up two more seats in the Arkansas Senate, beating Democrats in all four contested elections. And in the House, Republicans gained a net of 13 seats, increasing their majority from 51 to 64 out of 100 seats.

Voters rejected many candidates who supported the private option.

And since it takes a three-fourths legislative supermajority to continue the program, it will be hard for private-option supporters to win when the Legislature convenes early next year.

Sen. Jonathan Dismang, R-Searcy, one of three key legislative architects of the program, said he's not sure what the health insurance program could look like in the future.

"In its current form, I don't believe there is any way it survives," he said.

The private option, which uses federal Medicaid dollars to provide private health insurance for more than 200,000 poor Arkansans, has received unanimous support from Democrats since its creation in 2013. But the issue has divided Republican lawmakers, with some fiercely opposing the program, arguing that it will be financially unsustainable after federal financial support is reduced.

As it stands, the program extends insurance coverage to adults with incomes of up to 138 percent of the poverty level -- $16,105 for an individual or $32,913 for a family of four.

If the program is discontinued, supporters argue that the state will be left with a $100 million hole in the budget, because several tax breaks were approved with the assumption that the extra federal Medicaid dollars would be flowing into the state.

Federal dollars pay 100 percent of the private option until fiscal 2017, when the state will pick up 5 percent of the cost. The state's share ultimately will be 10 percent starting in fiscal 2020.

Supporters also argue that it will be expensive to transition private-option enrollees off of the plans or to provide them with alternative coverage. And once the program's over, they argue that the number of sick and uninsured Arkansans requiring emergency medical assistance will spike, resulting in more uncompensated care at hospitals statewide.

State Department of Human Services officials have warned that without the program, some rural hospitals will face deficits and others may close; federal Medicare reimbursement rates have been cut, so these hospitals are increasingly reliant on the private-option funds. The Legislature is scheduled to hear financial impact reports from those hospitals in coming months.

Rep. Ken Bragg, R-Sheridan, the House majority leader, said early Wednesday that he hadn't polled the newly elected House members, but he knew some had campaigned specifically against the private option.

"I think we're going to have some challenges," he said. "A lot of them were campaigning against the private option, but they didn't have the real benefit of sitting in the session and hearing the information that many of us heard. We always said we're going to evaluate it, and that there might be some adjustments to it. But it's hard to speculate until we really sit down and talk to people."

The Democrats lost seats Tuesday night but are holding on to slim leads of less than 70 votes in two races. Neither race had been officially declared as of late Wednesday.

The House minority leader, Rep. Eddie Armstrong, D-North Little Rock, said Wednesday that he believed the private option played a large role in his party's losses Tuesday night.

"I think the private option is still strong; I know people actively campaigned on this issue up and down the ticket on the Republican side of the aisle," he said. "It was framed in a way by some of our colleagues as the end-all-be-all of wedge issues."

Armstrong called on the newly elected Republicans to work with supporters to try to find a compromise to continue the program.

"I would challenge them to think about the ... Arkansans that now benefit from what the Democrats and Republicans worked toward to make law for our people," he said. "It's something that we should look at as an opportunity to survey what is best for the people of Arkansas ... financially, socially, spiritually, however way you can package it."

Because a supermajority is needed for passage, supporters have always struggled to round up enough votes.

In 2013, the 35-member Senate passed it 28-to-7, one more vote than the minimum needed to secure passage. Earlier this year, it passed with no votes to spare, 27-8.

In 2013, the 100-member House passed it 77-to-23, two votes above the minimum. Earlier this year, supporters had to vote five times before enough House members could be persuaded to fund the program for another year, with a final vote of 76-24. Some of those members, who won re-election Tuesday, said during this year's session that they would re-evaluate whether to support the program next year based on the financial effect of the program.

Beebe said Wednesday that the program has "got a serious problem."

"It is going to have huge effects on hospitals if they don't do it. Some will close," Beebe said.

He said the private option means roughly $28 million for the University of Arkansas for Medical Sciences, and without that funding the hospital could face "major cuts, layoffs."

"It will have an impact on the budget because [the Legislature is] not going to repeal the $100 million tax cut, and the tax cut was created and occasioned and possible because of the private option; that money has got to come from somewhere," Beebe said.

The program will survive only if the newly elected Republican governor fights to save it, Beebe said.

"Based upon what happened, Gov. [Asa] Hutchinson is going to have his work cut out for him trying to salvage the private option," he said.

Many newly elected legislators said Wednesday that they wanted to wait to get more information before deciding whether to continue the program. Several, however, said the program would need to be changed in order to gain their votes.

Michelle Gray, a Republican from Melbourne who unseated Rep. Tommy Wren, D-Melbourne, on Tuesday night, said that 90 percent to 95 percent of the people she talked to during her campaign were worried about how the program was affecting Arkansas.

"It's just not sustainable as it is right now," she said. "My management style is I'm always open to suggestion. I think there is some tweaking that could be done."

Others said they wanted the program eliminated immediately.

Dave Wallace, a Republican business owner in Leachville, said he's worried about the private option and, as it stands, he wouldn't support reauthorizing it.

Wallace beat Democratic incumbent Wes Wagner of Manila, who supported the measure. Wallace said that voters in his district were very critical of the program as well as the Affordable Care Act, which provided the federal funds to pay for it.

"It's kind of one of those programs that you see when you buy a used car; you buy it now and you pay for it later," he said. "I truly believe it will result in one of the highest tax increases -- either directly or indirectly -- in Arkansas if we don't repeal it. I'm convinced of it."

Several of the newly elected senators also committed to voting against the program.

Democratic state Rep. James McLean of Batesville lost Tuesday to former Rep. Linda Collins-Smith of Pocahontas in a race for the Senate seat held by Sen. David Wyatt, D-Batesville.

McLean, who voted to create the private option, said, "I'm not very optimistic about its future. It will be very very difficult to reauthorize it and keep it. But who knows. They might be able to come up with a compromise plan."

Collins-Smith couldn't be reached for comment Wednesday. But during her campaign, Collins-Smith said the private option "is taking people who are able-bodied and putting them on Medicaid," and its "cost is just out of control."

"I would vote to end it. No matter what you call it, it is Obamacare," she said.

A section on 11/06/2014

Print Headline: Private option shaky after GOP blitz

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Archived Comments

  • hah406
    November 6, 2014 at 7:29 a.m.

    It is absolutely insane to think that providing people access to healthcare, reducing the number of uninsured, and keeping rural hospitals open is a bad thing. Will these legislators who want to do away with the private option take the credit / blame / responsibility when uncompensated care costs spike and their home town hospital starts laying off employees, cutting services, or closes altogether? I want Michelle Grey to stand up and say "Yep I did that" when the only hospital in Izard County closes.

  • Garycmillerlawgmailcom
    November 6, 2014 at 7:53 a.m.

    Arkansas is too poor to take care of itself without federal help. Always has been. This Republican fantasy of no government threatens to send us back to the primitive conditions that existed here only about 100 years ago.

  • TomN
    November 6, 2014 at 8:30 a.m.

    The bile in me says let 'em go ahead and do it for most surely many Arkansans will then finally see their shortsightedness, how they have been duped and played by the outsiders, and then the backlash will come.... But then I think of all the people -- patients and employees -- and counties and hospitals that will irreparably suffer.

  • FreeSpiritMan
    November 6, 2014 at 8:34 a.m.

    Maybe sending us back to the primitive conditions that existed here only about 100 years ago is really what Arkansas needs. Example, I know of one person with 2 kids never had health insurance until Obamacare and also has never voted. Another who got Obamacare and really liked it and then votes for Tom and Asa. Go figure.

  • Whippersnapper
    November 6, 2014 at 8:36 a.m.

    The private option is dead. The private option ought to have never been enacted. The simple fact is that the Private Option took a limited supply of money and used it to provide insurance for perfectly healthy adults - this is not about caring for the disabled and/or the children or elderly, this is about giving goodies to perfectly physically capable adults who just don't want to have to provide for themselves. THAT is never a good thing.

  • insultech112241630
    November 6, 2014 at 8:44 a.m.

    Good, get a job and quit sucking everyone else's blood. Move out of the country and into the city, whatever?
    A hospital is a business just like all others, if it's not profitable let it shut down. If the people don't want to support their own healthcare---- Let them eat cake!!!

  • Goad
    November 6, 2014 at 9:21 a.m.

    When the Feds drop from 100% to 90% then AR has to pick up the 10%. Without the Private Option AR picks up 100%. Then the 90% which comes from federal tax dollars we send to Washington, can be diverted to wars or whatever Washington wants. So instead of receiving 90% of healthcare tax dollars back! we pay that and then pick up the 100% of health cost. It doesn't go away the Arkansans just pay thru higher insurance and hospital and doctor charges. Also, not having insurance will cause delays in care will make uninsured even sicker. Cost goes even higher. Other option is to let uncovered die in the parking lot. Once they enter hospital, you pay double.

  • nwar
    November 6, 2014 at 9:23 a.m.

    There are tens of thousands of Arkansans that you say are "able-bodied" that go to work every day and make low wages with little or no health care coverage. That is not to say that they have no health problems. They wait on your tables, mow your grass, take care of your grandmothers, etc. They work hard and they do not get paid enough money to buy health insurance on their own. The private option is 100% federal money that will only rise to a state 10% match in the future. Many lives will be saved because a waitress was able to get a colonoscopy or a diabetic received much needed treatment. It is still hard for me to believe that all the right wing Christians in this state would just turn their backs and say let these people suffer and die.

  • BirdDogsRock
    November 6, 2014 at 9:47 a.m.

    The people of Arkansas are willing to forego ACA and the private option in part because the real societal and taxpayer price of health care is obscured. The medical establishment is legally and ethically obligated to provide at least emergency care, regardless of ability to pay. Thus, taxpayers are still paying to take care of the uninsured, but through a circuitous back-door route that partially (but not fully) reimburses hospitals and doctors for providing uncompensated care. If society adopted a hard-line "no pay, no care" approach to emergency care, and people did start dying in the parking lots, then the societal and human price would be vividly apparent. Maybe then more people--even christians--might finally realize that society needs to establish some type of competent and efficient mechanism to provide a basic level of health insurance for all. Right now, it's too easy to reflexively say "Obamacare bad!", without having to think very deeply about the consequences or alternatives.

  • nlrar009
    November 6, 2014 at 10:05 a.m.

    When the private option ends are the tax cuts that were part of the deal going to be repealed?

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