On Wednesday Arkansas Lawmakers were presented with the first concrete proposals seeking to alter the "private option," the state's unique approach to expanding health coverage for thousands of low-income people using federal Medicaid money.
More than 100 observers packed into a room where the Joint Budget subcommittee on special language heard separate proposals on altering the private option. At the start, state senator Jim Hendren’s amendment to completely end the program by defunding it failed. But Republican State Representative Nate Bell, a self-described deficit hawk, pitched what he called a compromise measure.
Bell said his plan was “primarily...aimed at eliminating marketing and promotion and other attempts to increase enrollment in the Arkansas private option.”
Bell said it would be morally wrong to suddenly deny people the premium assistance they’ve started receiving under the private option, while going further to say that those who want to defund the program—a minority of legislators—could potentially cause an impasse in state government.
“Do we want to become DC?” he asked.
“We have the context of a fiscal session here. That means that we have a very limited ability to substantially modify policy.”
The private option plan continues to be modified, however. State Representative John Burris also introduced amendments to the program’s appropriations language, imposing a deadline for seeking federal approval to establish Health Savings Accounts and new cost sharing criteria for enrollees. Currently, those living at 100 to 138 percent of the Federal Poverty Level pay for some of their coverage. Under the change, those living at 50 percent of the poverty level and up would have to start sharing the cost. In addition, the proposed amendment would remove coverage for non-emergency transportation for most participants.
Burris said the particulars of the non-emergency transport waiver are yet to be determined.
“Nobody has all the answers but we know we...want to develop a state specific plan to address it...Why it's significant is because one of the often debated points of the private option was the wraparound coverage. This, for all intensive purposes, is only the wrap-around coverage that is required...and we're getting a waiver to do it the way we want to do it,” Burris said.
The special language that Burris presented says that if the feds don’t sign off on the proposed changes by January 1st of next year, the private option ends.
After the meeting, state Medicaid Director Andy Allison said even if Representative Bell’s proposal to bar advertising goes through, people will continue to learn about coverage options through healthcare providers.
“We're seeing really a steady enrollment in the program really without any marketing or outreach specifically targeted to the private option. So I think we'll continue to seeenrollment go up and certainly the...special language would not close the door.”
While the new proposals may convince some more Republican lawmakers to vote to reauthorize the private option, some of the Legislature’s Democrats are showing signs of unease. The amendments are to be reviewed by the full Joint Budget Committee Thursday.