The decision to go along with the Medicaid expansion will likely loom over the campaign to win control of the Legislature. But no matter who wins control of the Legislature, Beebe indicated he's already prepared for a rough road to win the three-fourths vote to go forward.
"Nobody's going to have a super-majority, and it takes a supermajority to appropriate money for Medicaid," Beebe said. "So it's not going to be any harder or any easier one way or the other, regardless of who has the majority."
The U.S. Supreme Court in June upheld the health care law, but justices said the federal government could not take away states' existing federal Medicaid dollars if states refused to widen eligibility. Under the health care law, the federal government agreed to pay the full tab for the Medicaid expansion when it begins in 2014. After three years, states must pay a gradually increasing share that tops out at 10 percent of the cost.
Beebe's support for the expansion was hardly a surprise, since he had said he was leaning toward it. Beebe and his administration have touted the benefits of the expansion in recent weeks, pointing to a state estimate that Arkansas would save $372 million over the next several years by adding 250,000 people to its Medicaid rolls.
The Department of Human Services, which has been roundly criticized by Republicans opposed to the expansion, says the estimate is based on other savings through the federal health care law.
Beebe said he decided to support the expansion after receiving assurances from federal officials that the state could back out of the expanded eligibility later.
"I wanted to make sure we were the masters of our own fate," Beebe said.
The expansion debate is added to a legislative agenda that was already destined to focus primarily on Medicaid. State Human Services officials have projected the program faces a shortfall of up to $400 million for the fiscal year that begins July 1, 2013. In addition, many Republican lawmakers are skeptical of the state's efforts to curb Medicaid costs by moving away from a fee-for-service model to one that pays for "episodes" of care.
The public already had a brief glimpse of the fights looming over Medicaid earlier this year, as Republican lawmakers called for setting aside part of the state's surplus to help with the shortfall. A legislative panel rejected that idea, and Beebe noted that that the surplus money would be available when the Legislature convenes in January. State officials have said the surplus could grow to as much as $200 million by the time the Legislature convenes.
A closely split Legislature complicates matters, with a three-fourths vote needed in both chambers to appropriate money. The difficulty in getting that kind of support was one of the reasons supporters of a state-run health insurance exchange — another component of the federal health care overhaul — dropped their support for it in the face of Republicans temporarily blocking the state Insurance Department's budget last year.
It's an obstacle Beebe could face with the expansion, even if his party keeps the Legislature.
"If they voted today, I don't think the support is there for it today," House Minority Leader Bruce Westerman, R-Hot Springs, said. "I don't even know if he could muster a simple majority."
The Medicaid expansion seems even more likely to play a role as Democrats try to prevent a Republican takeover of the state Legislature. Beebe has touted the expansion's benefits, but said he didn't plan on an aggressive lobbying effort in the months leading up to the session.
"I'm just going to tell them the whole truth, and they've got to make up their own mind," Beebe said.