If you thought convincing a Republican-led Legislature to support a key part of the new federal healthcare law
was a tough fight last year, wait until you see Round 2.
On the same day Arkansas Gov. Mike Beebe's administration stressed to lawmakers how much his budget for the coming year depends on the state's "private option" Medicaid
expansion, voters in northeast Arkansas
stressed to him just how tough a fight he'll face next month in keeping it.
Narrowly attaining the three-fourths vote needed when it was approved by the Legislature last year, the private option already faced long odds before lawmakers gather Feb. 10 for a session focused primarily on the state's budget. The takeover of a northeast Arkansas state Senate seat in a special election last week by a Republican who ran primarily on a vow to halt the program throws into doubt what had been heralded as a healthcare model for other states.
"It makes it more difficult to sustain the private option," Beebe acknowledged to reporters.
Republican John Cooper won former Sen. Paul Bookout's seat after vowing to push for the defunding of the private option when it comes up for reauthorization. The private option, which sharply divided Republicans in the Legislature last year, calls for using federal Medicaid money to purchase private insurance for thousands of low-income workers. Arkansas was the first state to win federal approval for the idea, which was touted as an alternative to expanding Medicaid enrollment under the federal healthcare law.
Cooper painted his victory as a referendum on the law.
"That was the primary issue in this campaign. Obviously that being the case, the voters spoke pretty clearly in this election here," Cooper said.
Cooper's win just complicates things for a law that already faced strong headwinds — including fears of primary fights for several Republicans who backed the private option and well-publicized glitches nationally with the health overhaul's startup.
And last week's result leaves private option supporters without a vote to spare. In the Senate, the private option was approved last year with 28 votes — just one more than needed.
It also guarantees that next month's fiscal session — the third under a 2008 constitutional amendment requiring the Legislature to meet and budget annually — won't be the short, drama-free gathering to which they've grown accustomed.
Instead, they'll face a protracted fight over the private option and a $5 billion budget that depends on the savings the state expects to see from the expanded, subsidized health coverage. Without the private option, the state faces a $89 million hole in its budget, Beebe's administration warned lawmakers last week.
"I would say that the foundation of this budget is based on the savings that we are expecting from the Affordable Care Act and the private option," Sharp said. "If the private option weren't done, we would have to do a completely new budget."
In addition to the budget argument, supporters of the private option believe they have policy on their side. They point to figures released by the Department of Human Services last week that showed more than half of the people enrolled in the private option are under the age of 40 — something they argue strengthens the insurance marketplace for the state. They also note the praise heaped on the program by former Utah Gov. Mike Leavitt, a Republican who is assisting DHS on the private option.
Sen. David Sanders, a Republican who was one of the architects of the private option law, said the policy arguments were what won in the debate last year over the private option. And he said he's confident those arguments will win out again.
"I think what the people of Arkansas hope is the policy trumps personality and even can trump politics and perceived political realities," Sanders said.