Arkansas House Passes Private Option on 5th Vote

Mar 4, 2014

As ice melted on state Capitol grounds Tuesday, tensions surrounding the 'private option' alternative to Medicaid expansion were also thawing inside. The appropriation bill for the program passed in the House of Representatives on a 76 to 24 vote.
Credit Chris Hickey / KUAR News

After more than a week of delaying a 5th vote on funding the private option, the Arkansas House of Representatives passed the measure Tuesday on a 76 to 24 vote. A minority of lawmakers in the House had prevented the funding bill for the Department of Human Services Division of Medical Services from reaching a three-fourths supermajority to pass out of that chamber, but three lawmakers switched their previous “no” votes to “yes” votes.

State Representatives Kim Hammer of Saline County, Mary Slinkard of Gravette and Les Carnine of Rogers reversed their positions and voted yes on the appropriation bill. On the House floor, Hammer explained his new stance. He said through the private option, those with “honorable needs” and those who are “probably just trying to build their welthfare portfolio” are likely part of the mix of healthcare recipients.

“But for me to point and to say which ones that are and which ones that aren't, I can't do that. But I do know this: there are people that are going to be hurt if I don't vote for this,” he said.

The bill in part allows the state to accept $915 million dollars from the Federal government for Fiscal Year 2015 in order to purchase private health insurance for low-income people. The federal government will pay for 100 percent of the program until 2017, when the state will have to start chipping in, eventually paying a 10 percent share by 2020. It's been estimated that more than 200,000 Arkansans could be eligible for private option health plans. 

Hammer said the private option would either be a “great success” or a “miserable failure” and said he was still concerned about oversight of the program.

“If it doesn't show the measureable results that we had been promised...when we come back here in January, if it's not a great success I will be voting against it,” he said.

Staunch opponents didn’t stop at outlining their positions either. State Representatives Joe Farrer, Randy Alexander, John Hutchinson and John Payton spoke against the bill. Alexander reiterated the claim that the federal government, through the Affordable Care Act, prevents states like Arkansas from asserting their rights to create their own, more effective health policies.

He said Arkansas and other states will be prevented from independently crafting policies by “remaining servants of a central government that allows only poor choices that meet nobody's needs but [the federal government's].”

After the vote, House Speaker Davy Carter made the case that Arkansas is doing all it can under the conditions laid forward by the federal government, which allowed the state to use federal dollars to pay private health insurance premiums for the poor.

“I think we've done our very best with the parameters in which we've had to work,” he said. “I think that's something that Arkansans should be proud of. I think we're leading the country,” he said.

Governor Mike Beebe also responded to opponents concerns, saying there is less uncertainty surrounding the program now, than was the case when the legislature first passed the program in the General Session last year. He said that should reaffirm lawmakers’ resolve in continuing to reapprove the program, which is an alternative to expanding Medicaid under the ACA.

“If anything it was even more compelling to do it this time than it was last time,” Beebe said.

“You have two more reasons: You have the removal of the uncertainty as to whether the feds would let us do it. You also had the tax cuts [that the legislature passed last year] that were predicated on the savings generated by the private option. So if anything, it was even more compelling this time to do it than it was last time. Not to mention that you'd be throwing 100,000 people off of healthcare,” he said.

About 105,000 people have received health coverage under the private option. Most of those have signed up for healthcare plans available on Arkansas's Health Insurance Marketplace. A small number of enrollees who've been deemed “medically frail” have received coverage through traditional Medicaid.

The Arkansas DHS has so far determined that about 127,000 people are eligible for coverage under the private option. The private option applies to individuals living at or below 138 percent of the Federal Poverty Level (with annual incomes of about $16,000 for an individual and $32,000 for a family of four).

The measure passed in the Senate two weeks ago and now awaits the Governor's signature. Beebe told reporters he’d sign the bill.

On the length of time getting the appropriation bill for the private option through the legislature, Beebe said “I think anytime you've got to have a 75 percent vote on a controversial issue it's always going to be protracted and cause a lot of consternation.”

Beebe and Department of Human Services officials say they’re going to introduce new administrative policies to monitor private option’s “high cost” cases and report back to the legislature on a regular basis to keep lawmakers informed on how the program is running. Committed opponents of the private option say they’ll keep fighting the policy in next year's regular legislative session.