Former state Rep. Nate Bell of Mena said Tuesday that he has been hired as the interim director of the state agency responsible for Arkansas' health insurance exchange.
Hours after taking the job, he urged members of a legislative committee to delay its approval of Senate Bill 113, which would fold the agency, the Arkansas Health Insurance Marketplace, into the state Department of Insurance, effective March 15.
"I was very content being on the farm, but I don't believe this move is beneficial for the state and that's why I'm here," said Bell, who raises chickens.
After he spoke, the bill failed to garner the five votes necessary to clear the eight-member Senate Committee on Insurance and Commerce.
[RELATED: Complete Democrat-Gazette coverage of the Arkansas Legislature]
The bill's sponsor, Sen. Jason Rapert, R-Conway, who is chairman of the committee, said he plans to present the bill to the panel again on Thursday.
He accused the marketplace's board of directors of defying the will of a subcommittee of the Legislative Council that made a recommendation in December that became the basis for his bill.
"This is something that should not be some sort of drama," Rapert said.
He added that he's concerned about money in the marketplace's reserves and that he and Rep. Richard Womack, R-Arkadelphia, a fellow chairman of the Legislative Joint Auditing Committee, have asked legislative auditors to "immediately" audit the marketplace.
Bell said he wanted a few days to work with Rapert and the Insurance Department to come up with an alternative that would satisfy lawmakers' concerns while preserving the marketplace's independence.
Rapert said the Legislative Council subcommittee had already spent more than a year studying the issue and that he doubted Bell would present any new arguments.
"I actually told him I hate that they put him on a sinking ship," he said.
The committee's three Democrats voted against advancing the bill. Four of its five Republican members voted for it. The fifth Republican, Sen. Missy Irvin of Mountain View, wasn't at the meeting during the vote.
The Legislature created the marketplace in 2013 to set up state-run exchanges that individual consumers and small businesses would use instead of the federally managed healthcare.gov.
Under the 2010 Patient Protection and Affordable Care Act, such exchanges allow consumers to shop for coverage and apply for subsidies to help pay for it.
Using money from a $99.99 million federal grant, the Arkansas marketplace set up the small-business exchange in 2015.
But at Gov. Asa Hutchinson's request during his first year in office, the agency scrapped its plans to use its remaining grant money to build an exchange for individual consumers. Instead, the marketplace took responsibility for certifying the plans sold through healthcare.gov and for helping consumers sign up for them.
According to the Insurance Department, 62,731 Arkansans were enrolled in such plans as of Jan. 15.
Meanwhile, enrollment in the small-business exchange ended in 2017 because Arkansas Blue Cross and Blue Shield, the only company offering plans, dropped out.
State Insurance Commissioner Allen Kerr has said the Insurance Department already carries out many of the same duties performed by the marketplace and would be able to take it over at an annual cost of no more than $571,500. By contrast, the marketplace's spending totals about $2.6 million a year.
The move would allow the state to reduce a fee paid by insurance companies that supports the marketplace as well as expenses associated with the federal website. Insurance companies pass the fee along to consumers in the form of higher premiums.
This year, the fee is equal to 4.25 percent of the premiums for the plans sold through healthcare.gov. A portion equal to 3 percent of the premiums goes to the federal government, and the marketplace keeps the remaining 1.25 percent.
Kerr has said the Insurance Department would eliminate the marketplace's share of the fee. Insurers would still pay a fee equal to 3 percent of the premiums to the federal government. In the 34 states that don't have their own exchanges, insurance companies that sell plans through healthcare.gov pay a 3.5 percent fee to the federal government.
Bell served three two-year terms in the House, starting in 2011. He was elected as a Republican but switched his affiliation to become an independent in 2015. His wife, Phyllis Bell, is an aide to Hutchinson.
Bell said he was hired by the marketplace's board chairman, Brett Kirkman, about 4 p.m. Monday. That was less than two hours after the marketplace's board authorized Kirkman to hire an interim replacement for Angela Lowther, who on Thursday submitted a letter to Kirkman saying she would resign effective Feb. 21.
That vote by the board was a redo of one it made during a closed session that lasted more than 45 minutes on Friday. Under the Arkansas Freedom of Information Act, such votes must be made during a public session to have legal effect.
Bell and marketplace spokesman Sarah Johnson said the amount Bell will be paid hadn't been finalized. The board limited spending on the position to no more than the $150,000 annual salary Lowther was paid.
Bell said he began getting calls from friends involved in health policy about two weeks ago about the proposal to fold the marketplace into the Insurance Department. He started contacting marketplace board members late last week.
He said keeping the marketplace as an independent entity would allow the state to better respond if the federal government raises the fee it charges to support healthcare.gov as well as to pursue different strategies for providing health coverage.
Bell acknowledged that, as a legislator, he was opposed to the formation of health care exchanges and Arkansas' method of expanding Medicaid through subsidized, private insurance plans. He was among 22 members of the House who didn't vote on the bill in 2013 that became Act 1500 and established the marketplace.
The bill passed in the chamber with the support of 78 members and no one voting against it. Not voting has the same effect as voting "no."
In 2014, he proposed restrictions on promoting enrollment in the exchanges or in the expanded Medicaid program that have been attached to the appropriation bills for the state Medicaid program and the Health and Insurance departments ever since.
The restrictions were pitched as a way of winning support for the Medicaid funding bill and are sometimes called "the Bell amendment."
Addressing the Insurance and Commerce Committee on Tuesday, Bell referred to a 2015 U.S. Supreme Court ruling that upheld tax credit subsidies that help people buy insurance, even states that did not set up their own exchanges.
"It's clear that the ACA at least for the foreseeable future is here to stay, and it's our job to do the best we can with that situation," he said.
Sen. Linda Chesterfield, D-Little Rock, who was on the Legislative Council subcommittee that in December recommended moving the marketplace under the Insurance Department, said she supports SB113 but agreed to Bell's request for a delay in moving the bill to the Senate as a courtesy to a former colleague.
"I realize that the train is rolling, and AHIM is about to get run over by the caboose," she said. But she added, "It does not hurt us to extend that courtesy."
Metro on 01/30/2019