Politics & Healthcare
6:36 pm
Mon February 10, 2014

On First Day Of Fiscal Session, Where Do Arkansas Legislators Stand On Private Option?

Arkansas state Senators convened Monday for the beginning of the 3rd Legislative Fiscal Session held since 2008.
Credit Chris Hickey / KUAR

Before lawmakers  milled about in the two legislative chambers,  state police color guards posted their flags and roll was called Monday, preparations for the month-long fiscal session had long been underway with months of hearings and reviews of budget proposals. The session will deal with those budget proposals for various state entities as put forward by Governor Mike Beebe. Members of the House and Senate must reach three-fourths majorities to approve them, amending certain sections along the way.

While the process may sound dull and uneventful, this year’s session may be especially critical as it will largely determine the fate of the state’s "private option" version of Medicaid expansion. And while the legislature’s Democrats are expected to fully renew their support, there’s more of a divide on the Republican side.

“It’s really still sort of up in the air. I don’t know what kind of private conversations are going on and what kind of proposals are there. They haven’t been discussed yet,” said Republican State Senator Bruce Holland.

“It’s a bit of a mystery right now,” said Democratic State Senator David Johnson of Little Rock. “I think that things will turn out with the private option like they did last year, but I think at this point I’m like Senator [Michael] Lameroux who said recently that he’s not exactly sure how it happens...But I think in the end it will happen.”

Republican Senator Bart Hester took an opposing view.  

“I think on a straight up-or-down, yes-no vote there’s not the votes to fund the private option. It will be defunded,” said Hester. “So I think what’s going to have to happen here is there’s going to have to be some sort of a compromise. Maybe a delayed defund, maybe a slow unwind...There will have to be some sort of compromise.”  

Hester was one of a handful of lawmakers who voted against the private option in the last session. Though Johnson and Hester maintain opposing outlooks, many legislators don’t know what will happen.

Senator Holland pointed to a prevailing uncertainty about the fate of the program, which allows low-income Arkansans to buy private insurance using an influx of federal money earmarked for Medicaid expansion under the Affordable Care Act.

“I think there’s a lot of very vocal folks opposing the private option but I think a lot of the rank and file see it as the conservative way to deal with Obamacare in Arkansas,” Holland said.

Holland says he supports reauthorizing the program. Others like Republican Representative Charlene Fite, don’t. She voted against it last session and plans to again this time around. But she says many legislators are giving the many aspects of the private option a close study.

“Everybody is looking at things real closely. I know I’m trying to read everything I can. My eyes are kind of starting to burn and I’ve ordered some new glasses,” she said.

On the table are numerous aspects of the program that many of the state’s conservatives say need to be tweaked. Issues involving physician specialist reimbursements and the status of possible Health Savings Accounts for participants caused Republican State Senator Missy Irvin of Mountain View to publicly reverse her stance, after voting to approve the program last year.

Her vote was seen as critical to narrowly approving the program last year, and her reversal now makes the odds of 75 percent approval in the Senate very slim. Besides Irvin,  recently elected Senator John Cooper of Jonesboro campaigned as a staunch opponent to the plan before winning a special election in January to replace former Democratic State Senator Paul Bookout, who resigned over ethics violations.

The grounds for Irvin's reversal does not appear to have gone unnoticed by other legislators. Republican State Representative John Hutchinson, who also voted for it last time, is also uneasy about casting a 'yea' vote this time.

“I want it to come back. I want it to be rethought...I think we’re going to make a bad mistake if we pass it as it currently is,” said Hutchinson.

Hutchinson says he wants more authority over the Health Insurance Marketplace--where private option insurance plans are purchased--to be put in the hands of Arkansas Insurance Department.

More than 102,000 people in the state now have health insurance under the private option, according to the Arkansas Department of Human Services. As that list grows, legislators have a month to figure out what to do with the program.