The Arkansas General Assembly will kick off its third fiscal session in a little over a week and there is little doubt what will dominate the debate.
Committee meetings on the budget are already in full swing, but the topic on everyone’s mind is renewing the Arkansas Private Option. Both proponents and opponents seem confident.
The Arkansas Private Option was a plan approved in last year’s legislative session after the Supreme Court threw the states a hot potato. While the court upheld the Affordable Care Act as constitutional, it carved out a narrow bit of flexibility for states to decide whether to expand state Medicaid programs to those with incomes within 100-138 percent of the federal poverty level. In Arkansas, that would apply roughly to a family of four making around $20,000 to those making in the lower $30,000 range in annual income.
Legislators tried to make lemonade out of the lemons and came up with a middle-ground solution. While agreeing to expand health care coverage to the state’s population up the 138 percent line, they created a new innovative program that utilizes the private health insurance market rather than the traditional Medicaid program.
But not everyone likes the taste of the lemonade. Although a bipartisan group of legislators passed the private option in 2013 with over 75 percent of both chambers, opponents have increased in number and are preparing to fight against continuation of the program in the fiscal session.
The potential to end the program is the result of "built in circuit breakers," as one of the Republican architects of the private option, Rep. John Burris, coined during the previous session. Funding for the private option is dependent on the state Legislature annually approving the appropriation by three-fourths of both chambers. Although theoretically true for every state program, the feature was presented as one of the selling points last year to help convince reluctant legislators to vote for the plan.
The biggest hurdle for continuing the plan likely lies in the state Senate, where it appears the votes are short. In 2013, the funding was approved by 28 senators with 27 out of 35 votes needed. But two of the votes 28 votes are no longer there.
— Sen. Paul Bookout of Jonesboro was forced to resign over campaign finance violations and incoming Sen. John Cooper was elected to replace him largely on a platform of opposing the private option.
— Sen. Missy Irvin of Mountain View went from a reluctant vote for the plan in 2013 to — at least right now — opposing refunding the plan in upcoming session. In her lengthy statement explaining her switch, she pointed primarily to concerns over the reimbursement rates paid to doctors under the plan and concerns over the health saving accounts which are slated to be added to the plan in 2015.
The result is that the plan will need to be resold during the fiscal session. Sen. Jonathan Dismang of Beebe, one of the Senate leaders of the plan, framed the debate well when he said that it boils down to the question of "is real conservative reform worth the growth in eligible enrollees."
That’s the debate. Does Arkansas reject expanding completely as some other states have done by refusing the federal funded Medicaid expansion dollars or do we continue to build one of top health care reform programs in the country
I will add that other conservative Republican-led states such as Utah and Iowa are hoping to duplicate the ideas of legislators from Arkansas. Arkansas has become a leader on the subject of state-based health care reform!
In the end, plan supporters will have to keep enough Republicans on board by touting the private market and consumer-oriented reforms. For the plan to continue, the case must be compelling enough to overcome the toxic nature of supporting anything that even hints of Obamacare.
Jason Tolbert is an accountant and conservative political blogger. His blog — The Tolbert Report — is linked at ArkansasNews.com. His e-mail is jason@TolbertReport.com.