If you think conflict and high stakes are more interesting than smoothly functioning day-to-day government, and you probably do, then this next month at the State Capitol is for you.
At issue is whether 267,590 Arkansans will remain eligible for government-provided health insurance. That’s the number that had been approved for coverage under the private option as of the end of January.
Here’s the background. The private option was created in 2013 after the U.S. Supreme Court ruled states could choose, rather than be required, to expand Medicaid under Obamacare. (Medicaid is the government health care program that serves the poor, the aged and the disabled.) If states so chose, benefits would go to adults with incomes up to 138 percent of the federal poverty level, which is an $11,880 salary in a household of one and is higher for larger families.
Many Republican-led states then refused the Medicaid money. Arkansas instead used it to purchase private insurance for that population. It’s the reason the state has reduced its uninsured population by one of the highest percentages in the nation, and it’s projected to save Arkansas hospitals a billion dollars’ worth of unreimbursed care over the next five years. But opponents say it’s an unaffordable expansion of Obamacare that creates more government dependency and increases the national debt.
Last week, legislators were called into special session by Gov. Asa Hutchinson to vote on his version of the private option, which he is calling Arkansas Works. He’s pushing it hard. It passed in the House, 70-30, and in the Senate, 25-10. Majorities of Republicans and Democrats in both chambers supported it.
But even those comfortable margins were not big enough to assure the program will continue. The Legislature now moves into a fiscal session, where funding for state agencies requires a three-fourths majority in both Houses – 75 in the House and 27 in the Senate.
Traditionally, legislators have not used the funding process to overturn what was decided in the lawmaking process. If they lose the battle over the policy, they don’t try to block funding.
But opponents are promising to fight this thing to the death in the fiscal session, even if it means, as a tactic, voting against funding the entire Department of Human Services’ Medical Services Division. That division administers not only the private option, but many other medical services, such as nursing home care and health services for foster kids.
The House of Representatives seems more likely to avoid such a fight. Rep. Laurie Rushing, R-Hot Springs, who was one of the 30 who voted no, the next day voted only “present” in a largely procedural vote and then attended the bill signing. She told the Arkansas Democrat-Gazette she and six other House members won’t fight the funding. That’s enough to assure passage.
But the Senate – that’s where it’s going to be interesting. It takes only nine senators out of 35 to block funding, and nine of the 10 opponents have made it clear they will not budge. The 10th, Sen. Missy Irvin, R-Mountain View, is declining to comment about the issue at the moment.
Meanwhile, many Arkansas Works supporters in the Senate are also resolute. If nine opponents can block any DHS funding bill with Arkansas Works, then nine supporters can block any funding bill without it.
All 11 Senate Democrats voted for Arkansas Works. They typically don’t play hardball, but this time? Here’s what Sen. Bruce Maloch, D-Magnolia, said Tuesday: “I don’t think we’re going to pick out a specific agency or entity or college in any of the 10 districts of the senators that voted against it and try to kill their appropriation. … But we will not vote for a DHS Medical Services appropriation without Arkansas Works.”
Sen. Bart Hester, R-Cave Springs, one of the most outspoken opponents, was quoted by the Arkansas Democrat-Gazette observing that both sides are playing chicken, both have a foot on the accelerator, and a “crash” appears inevitable.
In signing the unfunded bill into law, Hutchinson said he hopes that’s not the case. He said he won’t horse trade but that he has “a lot of tools in my pocket.”
Hopefully, one of those tools won’t have to be the jaws of life.