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story.lead_photo.caption Gov. Asa Hutchinson describes the mechanics of the line-item veto as he holds the Medicaid funding bill Thursday afternoon at the state Capitol shortly after he vetoed a part of it. The bill now goes to the Senate, where opponents promise to attempt an override. - Photo by Stephen B. Thornton

The Arkansas House of Representatives on Thursday narrowly approved and sent to the governor a measure that, through political and procedural maneuvers, is aimed at preserving funding for the state's Medicaid expansion. Gov. Asa Hutchinson promptly vetoed a part of the bill that would have stopped the funding.

Photo by Stephen B. Thornton
House members stand to applaud adoption of a resolution honoring the late Ray Thornton on the floor of the House at the state Capitol on Thursday. Thornton, who died April 13, served the state in many roles, including as a congressman, university president, attorney general and Supreme Court justice.
Photo by Stephen B. Thornton
Rep. Kim Hendren, R-Gravette, speaks against Senate Bill 121 on the floor of the House on Thursday at the state Capitol in Little Rock. Hendren said he supported the Medicaid expansion but opposed the tactics needed to pass the bill to fund it.

By a vote of 76-13, the House approved Senate Bill 121, the appropriation for the Medical Services Division, which includes authorization to use federal dollars to pay for private health insurance for poor Arkansans. The bill was amended Wednesday in the Senate to "sunset" -- or end -- that Medicaid expansion spending on Dec. 31 of this calendar year.

The House tally -- which had one more vote than the 75 needed to pass an appropriations measure -- was taken with the full knowledge that Hutchinson planned to use a line-item veto to remove the sunset provision and allow funding for the Medicaid expansion, now called Arkansas Works, to continue.

Hutchinson advocated the line-item strategy so the expansion's opponents could vote for a bill that ended the funding. Later that afternoon, Hutchinson made good on his promise and vetoed that portion of the bill, which will now go back to the Senate, where only a simple majority is needed to uphold or overturn a veto.

In a special session earlier this month, the 100-member House voted 70-30 for the changes in the Medicaid expansion that create the Arkansas Works program.

But on Thursday, eight Republicans who voted against the enabling legislation for the Arkansas Works program voted for SB121. One Republican, Rep. Karilyn Brown of Sherwood, voted "present" but later filed a letter with House officials stating she meant to vote "yes." Of two Republicans who voted for the enabling legislation, one voted no and the other voted present Thursday.

Shortly after marking his line-item veto, which effectively preserves funding for the state's Medicaid expansion, Hutchinson said he was pleased by the bipartisan support for the funding bill.

"My goals have been to have some stability in [the] Arkansas health care system. I believe we accomplished that objective," Hutchinson said. "My goal is to accomplish it without dragging this out at length. That has happened, it seems, in times past. We wanted to minimize the debate, minimize the controversy." Thursday was the ninth day of the fiscal session.

In the Senate, opponents said they plan to attempt to override the veto on the Legislature's return Tuesday -- a possibility that many, including the governor, felt was unlikely.

"We are confident that there is a majority vote to sustain the veto," Hutchinson said.

SB121 would give the state an $8.4 billion spending authority through its Department of Human Services' Medical Services Division, reserving about $1.7 billion for the state's Medicaid expansion next fiscal year. The bill also includes spending authority for a range of Medicaid programs.

It was first defeated in the Senate last week when it failed to reach the three-fourths majority needed for passage. Then an amendment was adopted that stated funding of the Medicaid expansion would cease by the end of the year -- an amendment that allowed opponents of the program to vote for its eventual demise -- and the bill squeaked through the Senate on Wednesday by a 27-2 vote, the bare minimum needed.

Just like Wednesday in the Senate, the bill was debated on the House floor Thursday.

Rep. Robin Lundstrum, R-Springdale, voted against SB121, arguing it put too much of an onus on the taxpayer.

"Are we choosing to take a path to becoming a welfare state? Today is not a day for high-fives or slaps on the back. Today we are choosing failure over success," Lundstrum said. "We should always measure success in government not by how many citizens we help but by how many citizens don't need our help. Growing government is never a good or healthy goal for our state. ... We are taking a step towards the march of federal control and government expansion."

Rep. Laurie Rushing, R-Hot Springs, was one of the eight House Republicans who voted against the Arkansas Works enabling legislation in the special session but who voted yes for SB121.

"While I personally disagree and believe we can do better than Arkansas Works. ... I will not vote to cut or defund [the Department of Human Services] because I personally disagree with one program," Rushing said. "The beauty is ... those of us who voted no and were opposed ... we have accomplished what we asked for. ... We all know [Hutchinson] is willing to use the line item veto, but he's willing to put that burden [of continuing the Medicaid expansion] upon himself."

The Medicaid expansion now covers about 267,000 Arkansans, most of whom are now covered by the private option, which takes federal money to buy private insurance coverage. The program extended medical coverage to those with incomes at 138 percent of the poverty level: $16,394 for an individual or $33,534 for a family of four.

With Arkansas Works, Hutchinson made changes to the plan that encourages work and personal responsibility for enrollees.

The state's Medicaid expansion, up until now, has been wholly paid for by the federal government. On Jan. 1, the state will start paying 5 percent of the cost and by 2020, will shoulder 10 percent of the cost. State officials said that Arkansas will pay $43 million in fiscal 2017 to match the federal funds.

Hutchinson said that failing to continue the Medicaid expansion program would create a "hole" of more than $100 million in the state budget, a gap he said would lead to cuts in key state services and one that would stop him from calling a special session for his plan to increase state spending on highways as a way to secure more matching federal highway dollars.

The Medicaid expansion has been divisive among Republicans since a trio of Republican senators worked with then-Gov. Mike Beebe, a Democrat, to create and pass the private option in 2013. It took several House votes in 2013 and 2014.

In the first Senate action on SB121 last week, 10 Republican senators voted against the bill.

The plan to overcome the opposition from the 10 senators via line-item veto was difficult to accept, at least initially, for lawmakers on both sides.

The first effort in committee to add a funding ban to SB121 left many Democrats, who support the Medicaid expansion, conflicted about voting against something they championed, as well as ceding their work to the governor.

During the floor debate Thursday, Rep. Kim Hendren, R-Gravette, the father of the amendment's sponsor, Sen. Jim Hendren, R-Sulphur Springs, said he supported Arkansas Works and the governor but that he did not like process -- being asked to vote for ending something he stood behind and wait for Hutchinson's veto to restore it.

"My no does not mean no and my yes does not mean yes because of this bill, the way it's written," Hendren said. "That's how we start doing the right thing in the wrong way, ladies and gentlemen. It just confuses me and everybody. ... [By voting yes, lawmakers are] accepting a precedent for your kids, and my kids ... that we should not be doing."

Kim Hendren voted no but said he would have voted yes if it appeared that his vote would have been the difference between passage and failure.

After the vote, Hutchinson said he enjoyed Kim Hendren's floor speech, in which the legislator read a back-and-forth email exchange between him and his son. Kim Hendren's wife is Hutchinson's sister.

"Rep. Hendren said what he needed to say on the floor," Hutchinson said. "In terms of this effort, the key thing was transparency. There hasn't been any hiding the ball. Everybody today knew exactly what they were voting on, why they were voting on it, what they were trying to accomplish with it."

House Speaker Jeremy Gillam, R-Judsonia, said the line-item veto, though unusual, wouldn't leave any ill feelings among lawmakers about the legislative process.

"I think this shows the state just how business can be done between the legislative branch and the executive branch. ... That's exactly what they want us to do, is to work together to solve problems," Gillam said. "This [strategy] wasn't something ... you'll see often, probably in my legislative career, I think it will be the one and only time it will ever happen. I don't foresee it as ceding authority to the governor because we can override the governor."

With the fate of the program settled, for now at least, some legislative leaders hope that this is the last time a fiscal session grinds to a halt over its funding.

Gillam said he has no issue with legislators debating the merits of the policy of Hutchinson's plan in the future, but he is hopeful that future fiscal sessions won't be used as a chance to debate policies set in previous sessions.

"It is my hope that we're going to be able to pivot from these kinds of discussions on appropriations and debates ... [to discussions on] actual, substantive reforms," Gillam said. "My hope is we ... move away from this kind of brinkmanship ... with DHS' budget. ... It's imperative to us that we give [the Human Services Department] some stability and consistency."

House Minority Leader Michael John Gray, D-Augusta, said he thinks both parties are fatigued by impasses over appropriations for the state's Medicaid expansion and that this may be the last such fight.

"I think everyone hopes so. ... I think Arkansans hope so," Gray said. "Seems like this national rhetoric [used by opponents of Arkansas Works] is getting old. As our districts get educated on all the ramifications of these budget issues surrounding these appropriations, I hope this puppy is put to bed."

Rep. Bob Ballinger, R-Hindsville, an opponent of Arkansas Works and the private option before it, said he thinks such fights will persist.

"Of course [it will continue]. We're supposed to provide oversight and scrutiny," Ballinger said. "I'm disappointed by how the process kind of broke down and switched to the veto thing because it thwarted that debate. I think it's possible that if people are reasonable and if it causes people to have to compromise, I think that makes for better government."

The House will reconvene Tuesday at 1:30 p.m. The Senate will reconvene on Tuesday 1 p.m.

Information for this article was contributed by Brian Fanney of the Arkansas Democrat-Gazette.

A Section on 04/22/2016

House vote on Senate Bill 121

Here’s how the House voted Thursday on an amended SB121 to grant $8.4 billion in spending authority for state and federal funds, including $1.7 billion for the Medicaid expansion, to the Department of Human Services’ Medical Services Division in fiscal 2017.

Seventy-five votes were required for approval in the 100-member House.

YEA (76)

Charlie Armstrong, D-Little Rock

Eddie Armstrong, D-North Little Rock

John Baine, D-El Dorado

Scott Baltz, D-Pocahontas

Rick Beck, R-Center Ridge

Camille Bennett, D-Lonoke

Charles Blake, D-North Little Rock

Justin Boyd, R-Fort Smith

Ken Bragg, R-Sheridan

David Branscum, R-Marshall

Mary Broadaway, D-Paragould

Charlie Collins, R-Fayetteville

Andy Davis, R-Little Rock

Jana Della Rosa, R-Rogers

Dan Douglas, R-Bentonville

Trevor Drown, R-Dover

Lance Eads, R-Springdale

Les Eaves, R-Searcy

Jon Eubanks, R-Paris

Joe Farrer, R-Austin

Deborah Ferguson, D-West Memphis

Ken Ferguson, D-Pine Bluff

David Fielding, D-Magnolia

Charlene Fite, R-Van Buren

Lanny Fite, R-Benton

Vivian Flowers, D-Pine Bluff

Jeremy Gillam, R-Judsonia

Bill Gossage, R-Ozark

Michael John Gray, D-Augusta

Michelle Gray, R-Melbourne

Kim Hammer, R-Benton

Ken Henderson, R-Russellville

Mary “Prissy” Hickerson, R-Texarkana

David Hillman, D-Almyra

Monte Hodges, D-Blytheville

Mike Holcomb, R-Pine Bluff

Doug House, R-North Little Rock

Joe Jett, D-Success

Bob Johnson, D-Jacksonville

Jack Ladyman, R-Jonesboro

Sheilla Lampkin, D-Monticello

Greg Leding, D-Fayetteville

Tim Lemons, R-Cabot

Kelly Linck, R-Flippin

Fred Love, D-Little Rock

Mark Lowery, R-Maumelle

Stephen Magie, D-Conway

Julie Mayberry, R-Hensley

Mark McElroy, D-Tillar

George McGill, D-Fort Smith

Ron McNair, R-Alpena

Reginald Murdock, D-Marianna

Micah Neal, R-Springdale

Milton Nicks, Jr., D-Marion

Betty Overbey, D-Lamar

Rebecca Petty, R-Rogers

Mathew Pitsch, R-Fort Smith

James Ratliff, D-Imboden

Chris Richey, D-West Helena

Laurie Rushing, R-Hot Springs

Warwick Sabin, D-Little Rock

Sue Scott, R-Rogers

Matt Shepherd, R-El Dorado

Brandt Smith, R-Jonesboro

James Sorvillo, R-Little Rock

James Sturch, R-Batesville

Brent Talley, D-Hope

Dwight Tosh, R-Jonesboro

Clarke Tucker, D-Little Rock

DeAnn Vaught, R-Horatio

John Vines, D-Hot Springs

John Walker, D-Little Rock

Dave Wallace, R-Leachville

Jeff Wardlaw, D-Hermitage

David Whitaker, D-Fayetteville

Marshall Wright, D-Forrest City

NAY (13)

Bob Ballinger, R-Hindsville

Donnie Copeland, R-North Little Rock

Gary Deffenbaugh, R-Van Buren

Mickey Gates, R-Hot Springs

Justin Gonzales, R-Okolona

Justin Harris, R-West Fork

Kim Hendren, R-Gravette

Robin Lundstrum, R-Springdale

Josh Miller, R-Heber Springs

John Payton, R-Wilburn

Marcus Richmond, R-Harvey

Nelda Speaks, R-Mountain Home

Dan Sullivan, R-Jonesboro

PRESENT (11)

Nate Bell, R-Mena

Mary Bentley, R-Perryville

Karilyn Brown, R-Sherwood

Bruce Cozart, R-Hot Springs

Jim Dotson, R-Bentonville

Charlotte Douglas, R-Alma

Grant Hodges, R-Rogers

Lane Jean, R-Magnolia

David Meeks, R-Conway

Stephen Meeks, R-Greenbrier

Richard Womack, R-Arkadelphia

Print Headline: Medicaid-bill ploy on track

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Comments

  • hah406
    April 22, 2016 at 8:23 a.m.

    Open question to the hateful, uncaring members of the GOP like Ballinger, Harris, and Bell: If not this, what would you do to ensure that the working poor of Arkansas can receive needed healthcare without forcing doctors and hospitals to provide it for free? You are always against things. Tell me just once what you are for; what plan you have to make sure people don't die from a lack of care.

  • Whippersnapper
    April 22, 2016 at 9:23 a.m.

    How about "let the people pay for it themselves." That's what I did when I was working poor. I feel no pity for folks who prioritize other things in their spending.

  • GoBigRed
    April 22, 2016 at 10:34 a.m.

    WHIP - Have you priced an emergency appendectomy lately? $35,000.00 in Arkansas. How would you propose that a poor person pay for that? Cancer surgery? Baby delivery with complications? maybe they can just work it off. You know, working on a farm or something. Maybe you could provide them with shelter and food while they work off the debt. What's a fair wage for that farm work? Oh, I forgot. You're against minimum wage laws. Where there's a WHIP, there's a way.

  • cliffcarson
    April 22, 2016 at 11:03 a.m.

    The "Arkansas Works" is a lesser plan of coverage than was the Private Option which was a lesser plan than Obamacare.
    The GOP wants to get rid of Medicare, Medicaid, Social Security , anything that will help the average Arkansan. Going to Arkansas Works is a step toward that Goal. Didn't they promise you that they were going to do this? And still you voted for them!
    They don't want to do away with Social Security and Medicare, they just want to Privatize it so their 1 % Elite can rake off "Management" fees, a cost that will be recovered by reducing the benefits to the users and of course they will also gladly increase the cost to the user. They are promising you less for more cost. All you have to do to get this "deal" is keep voting for Republicans.

  • mrcharles
    April 22, 2016 at 11:05 a.m.

    I saw a child on medicaid chewing gum. I calculated that before the sun turns into a Red Giant engulfs the planet earth [ you know science stuff that causes migraines for the NO and denier ILKS ] and takes us in to Whippersnooples rapture land { with his all infinity pass} , an emergency appendectomy could be paid for. See what a waste that child is doing by chewing gum. Actually it was as man in a wheelchair just wanted some drama since children dont matter either.

    I feel no pity................ what a guy................... remember Mary's son saves . Please ignore that stuff about the son of man coming to judge the goats and sheep, you will be too busy tending your goats. And when it is said, WHEN it will come to you what is meant and you will go where you should. Just sayin.

  • Whippersnapper
    April 22, 2016 at 12:05 p.m.

    GoBigRed (and others),
    Most major hospitals will allow you to go on a payment plan for major procedures. I have a buddy who was telling me that he had his first kid (without insurance - cost of several thousand dollars) and they negotiated a payment plan of something like $50/month (with no interest). Had a second kid while still paying on the first, and they just added that balance to the existing balance and kept the payment the same. Had to have an ER visit and surgery and they just added the balance and kept the payment the same.
    .
    THIS is reality. Hospitals can and do get paid back (slowly, in some cases) and the "price" they quote at first is the "price" they list for insurance because they know it will be negotiated down.
    .
    We had an ER visit in our family (since Obamacare took effect) and our deductible (in the wonderful Obamacare world) was around $4,000. The bill was for $1,500 just to go in, not get any X-Rays, be evaluated by a doctor, and have him pop a dislocated joint back into place. No specialized (or any) equipment used, just sitting on an exam table and getting an arm pulled sharply for a fraction of a second. After I called and discussed everything with the billing folks, they negotiated it down to $700 and offered a 30% discount off of that if I paid cash within 30 days. Yes, the actual cash they were willing to accept for literally five minutes of a doctor's time with no equipment used was $500 instead of $1500.
    .
    I say all this to point out that the situation isn't nearly as dire as you portray it to be. hospitals WILL work with you on payment plans, they WILL give significant discounts if you just ask, and in the worst case scenario, our government has laws in place to permit the discharge of medical and other debts through bankruptcy.

  • mrcharles
    April 22, 2016 at 12:23 p.m.

    I have cousins in 2 states whipper, one here and one in another red state., both lawyers... Yeah I saw a unicorn one day. My attorney cousins, both would be considered moderates if voted on by both sides here, handle consumer bankruptcies. They tell me before the Affordable Care Act came along even people with good insurance were devastated by medical bills. Their cases due to medical bill problems have dropped 30 % or more. Several attorneys in ARkansas who collected on just medical bills made big money, and knowing people who worked there it was often the tactic to just make an offer so high they couldnt pay to just force people into bankruptcy to just get file off desk. So will have to respectfully disagree with your personal story. I have been told that work out plans such as your illustration is more rare than you think, kinda like the reason my step father would not wear seat belts, you might get trapped and burn up-- well we know the odds both ways on this issue.

    And finally there are areas in Arkansas with clear streams and no ticks. How come in fishing across the state I see dirty water and ticks?

    My point is is that is not as easy as you portray to get payment plans and discounts, if you even beg, much less just ask.

  • Delta2
    April 22, 2016 at 12:37 p.m.

    Whippersnapper, I applaud you, and others like you, who take responsibility for your medical expenses. But for every one of you, there are about 5 or 10 others who just ignore bills, and they know if they show up in the ER, they'll have to be treated if it even remotely appears to be an emergent condition (which is a very subjective determination).

    I can tell you my rural hospital has certainly benefited from Arkansas' decision to expand Medicaid, Arkansas Works, whatever you want to call it. It has made a positive difference, and led to expansion of services to the people of the area.

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