LITTLE ROCK — The Legislature’s fiscal session officially begins Monday, but behind-the-scenes negotiations have been underway for some time over the so-called private option, a program that has already provided health insurance to more than 80,000 Arkansans but whose future is uncertain.
The big question as lawmakers prepare to convene at the state Capitol is whether they will appropriate a second round of federal funding for the program, which requires a three-fourths vote in each chamber.
House Speaker Davy Carter, R-Cabot, said last week he believes there is enough support in the 100-member House to approve the appropriation. Senate President Pro Tem Michael Lamoureux, R-Russellville, said the support is not there now in the 35-member Senate, but "by the time the session is over, I think the facts are compelling enough that we’ll figure out a way to get the votes."
The private option, officially known as the Arkansas Health Care Independence Program, is Arkansas’ alternative to expanding the state Medicaid rolls as proposed under the federal Affordable Care Act. Under the program, the state uses federal Medicaid money to provide private health insurance to people earning up to 138 percent of the federal poverty level.
The federal government will pay all costs for the first three years, after which the state’s share of the cost will increase gradually to 10 percent.
By last Monday, 83,032 Arkansans had completed the process of enrolling in health insurance under the private option and an additional 9,525 who applied for the private option had been determined to be better served under traditional Medicaid, according to the state Department of Human Services. A total of 102,173 have been determined eligible for the program.
Gov. Mike Beebe has said his office is talking to legislators who have raised concerns about the program and is working to address those concerns. Legislative supporters of the program have been talking with their colleagues as well.
"There are a lot of conversations happening," said Sen. David Sanders, R-Little Rock, one of the principal architects of the private option. "There are a lot of members who are really digging in, asking questions — many of whom voted ‘no’ last time, who in fact are looking at this with a fresh set of eyes."
Sanders and others who worked to develop the program said they expect it to undergo some tweaks. During the fiscal session the Legislature can consider only appropriations bills unless two-thirds of each chamber votes to consider a non-budget matter, but the private option could be modified in various ways, said Rep. John Burris, R-Harrison.
"I think it will not just be a clean process of no changes or no agreements," he said. "Whether that’s a handshake, a memo, something on the appropriation bill, somebody may file a resolution for a bill — I think there’s several avenues people could choose to take."
Sen. Jonathan Dismang, R-Beebe, said he believes there will be "some accommodations made."
Built into the governor’s proposed balanced budget for the next fiscal year is $89 million in expected savings from the private option, based on moving some people from traditional Medicaid to the private option and reducing the state aid that hospitals receive to help with uncompensated care costs. Beebe has said that if the private option is defunded, the budget will have to be cut, some hospitals may have to close their doors and many Arkansans will lose health care coverage.
The recent election of a conservative Republican senator to a seat previously held by a Democratic supporter of the private option, combined with another senator’s announcement that she plans to vote against the private option after supporting it last year, puts the chances of Senate passage in doubt. The original appropriation for the program passed in the Senate with one vote to spare.
Sen. John Cooper, R-Jonesboro, who won a special election to replace former Sen. Paul Bookout of Jonesboro after Bookout’s resignation amid an ethics scandal, has said he does not think the state can afford its eventual 10 percent share of the cost of the private option.
Sen. Missy Irvin, R-Mountain View, has said that although she voted for the private option last year, she now now believes it is "leading us in the wrong direction."
Beebe has said he expects some legislators who voted against the private option last year to vote for it this year. One legislator who previously voted against the program, Rep. Nate Bell, R-Mena, told the Arkansas News Bureau on Friday that he hopes to see a compromise negotiated that he can support.
"There are … people who were previously insured who, were we to defund this, would be uninsured and uninsurable, and that’s just simply not the right thing for us to be doing," Bell said.
According to DHS, about 113,000 Arkansans were served in 2013 by the ARHealthNetworks program and the state Medicaid tuberculosis, breast and cervical cancer and family planning programs, all of which have been discontinued.
DHS spokeswoman Kate Luck said that ARHealthNetworks, a program for workers who could not afford insurance, likely could not be re-established because it would not meet the standards of the Affordable Care Act. Bell also said some who were privately insured have allowed their plans to expire in the belief that they would be covered under the private option.
"Defunding doesn’t reset us to where we were," he said. "That’s the key point that I think everybody in the state needs to understand."
The House and Senate are scheduled to convene at noon Monday.