After surviving a defunding attempt during the legislative session that wrapped up last week, the "private option" plan to use federal Medicaid funds to purchase private insurance for the poor is taking center stage in Republican primaries up and down the ballot on May 20. Conceived as an alternative to expanding Medicaid under the federal health law, the program won unanimous backing from Democrats but has sharply divided Republicans in the state Legislature.
That divide could play a factor in races for offices that have nothing to do with the private option, such as state treasurer and state auditor. Primaries for both offices pit lawmakers who supported the program that's extending health coverage to nearly 98,000 people against rivals who have been outspoken in calling for the private option's dismantling.
Though he acknowledges the state treasurer's office has little to do with the private option, Saline County Clerk Dennis Milligan calls the program the "defining issue" in his bid against state Rep. Duncan Baird for the GOP nomination. On his campaign website and in an interview, he criticizes Baird for supporting the program last year and its reauthorization this year.
"It has to do with the leadership, the decision making process of my opponent with respect to our party and the leadership that he demonstrated being a floor leader for Obamacare," he said, referring to Baird presenting the private option funding bill to the House
Baird, who co-chairs the Joint Budget Committee, said he's instead focused on who's more qualified for running the office that handles the state investments and said voters are more interested in talking about how he'll reform the office. But Baird said he'll defend his record on opposing the president's health overhaul.
Baird said Milligan's criticism of him as the "floor leader" for the private option is misleading, and notes that he presents all of the budget bills in his position as the panel's co-chairman.
"If you call me the floor leader for one appropriation, you'd have to call me the floor leader for the balanced budget and tax cuts and public schools as well," Baird said.
The race for state auditor is similarly injecting the private option into an office whose primary duties focus on writing checks for the state, not crafting health care policy. Ken Yang cites rival state Rep. Andrea Lea's votes for the program in questioning her conservative credentials.
"You're hard pressed to call yourself a conservative when you support Obamacare," Yang said.
Lea said that when campaigning she explains that she backed the measure both this year and last because of what she saw as conservative reforms attached to it. Those reforms include the establishment of a Medicaid inspector general last year and a proposal this year to bar any public funds be used to promote the private option or other parts of the health law.
"I think it's just easier to say Obamacare and that seems to be something people don't like than to explain specifics about a bill," Lea said.
Even lawmakers who opposed reauthorizing the private option aren't immune from criticism. Republican Sen. Missy Irvin had voted for the program last year, but announced before this year's session that she could not support continuing it another year.
Phil Grace, who hopes to unseat her in the primary, said he doesn't believe that reversal is good enough.
"The problem is when we really needed her, she wasn't there for us," Grace said.
Irvin defended her position, saying she backed the private option measure last year only after it included changes she had pushed for such as health savings accounts that she said improved the program. She said she could no longer support the program after seeing how it was being implemented.
"People change their minds in business every single day and I felt necessary that we should press pause and let's address these problems," Irvin said.
The program is expected to play a role in several other legislative races. Rep. John Burris, one of the chief architects of the private option, is seeking a state Senate seat in northern Arkansas. Scott Flippo, one of the two rivals in that primary, has cited the private option as a top issue in the race. Republican Sen. Bruce Holland faces a re-election challenge in the primary from Rep. Terry Rice, an outspoken opponent of the compromise Medicaid expansion.
In the fight for the GOP gubernatorial nomination, Little Rock businessman Curtis Coleman is counting on the private option to help overcome a fundraising and organizational gap with former U.S. Rep. Asa Hutchinson. Coleman criticized Hutchinson for not weighing in during the session on whether the private option should continue — a criticism that Hutchinson has also faced from Democrats.
"I think it is going to be a significant issue and I frankly think my opponent's failure to take a definitive position is going to be a liability for him," Coleman said. "I think people view it as a lack of transparency and some view it as a lack of leadership."
Hutchinson said he believes he did the right thing by not saying whether the private option should continue, saying the Legislature didn't need his interference. Hutchinson said he'll continue to monitor the program and would push for the private option's end if it didn't meet the promises.
"We know that Obamacare's not working. It's fatally flawed and the Legislature dealt with this the best they could," Hutchinson said. "My goal would be to continue to put reforms into place, to measure the cost and if it doesn't bring the results we expect, I'll join with others to end it."