Arkansas' first-in-the-nation program using federal funds to buy private health insurance for the poor will survive another year after the Legislature reauthorized the program Thursday, despite an influx of new Republican lawmakers elected on a vow to kill the hybrid Medicaid expansion.
The Arkansas House voted 82-16 to reauthorize funding through June 2016 for the "private option" plan, which was crafted two years ago as an alternative to expanding Medicaid under the federal health law. Arkansas was the first state to win federal approval for such an approach, touted as a compromise for Republican-leaning states.
The reauthorization now heads to Republican Gov. Asa Hutchinson, who had called on lawmakers to continue the program while a proposed task force looks at alternatives for covering the more than 213,000 people currently in the program. The House approved a separate proposal setting up the task force, sending the bill to the Senate for a final vote.
"I think this ends the debate and moves us forward into a new conversation about how do we take care of Arkansas and make a healthier Arkansas," House Public Health Committee Chairman Kelley Linck, R-Flippin, told House members before the vote.
The private option had sharply divided Republicans, who control the Arkansas Legislature and have made major gains primarily by running against President Barack Obama's health care law. The future of the program appeared in jeopardy after the election of several new lawmakers whose campaigns focused almost exclusively on ending the private option.
"We've got Republican legislators down here now in districts that hadn't even thought about voting Republican in the past, and it's based on this issue," said Rep. Josh Miller, R-Heber Springs, who was elected in 2012 and has called for repealing the private option. "I think it would be a shame for us to continue a program that a lot of Republicans thought was bad under the previous administration, and there have been no significant changes to it."
Several opponents of the program, however, cast the plan as a move toward dismantling the program.
"I made a promise to my constituents that I would do everything within my power to end the private option, and this is the only path we have," said freshman Rep. Laurie Rushing, R-Hot Springs.
Twenty-eight states and the District of Columbia have agreed to expand Medicaid under the health care law since the U.S. Supreme Court ruled in 2012 that the decision was up to states and not mandatory.
Hutchinson, who took office last month, remained mum throughout his bid for governor last year on whether he supported continuing the program that started under his Democratic predecessor. Hutchinson praised Thursday's votes as the "right step forward" for reforming Medicaid.
"I am grateful for the confidence that the legislature has placed in the task force and the opportunity it represents to guide the future of health care reform in Arkansas," he said in a prepared statement.
Hospitals have credited the private option with cutting the state's uninsured rate and saving them millions of dollars. But opponents have cited the eventual cost when the state is required to pay for part of the expansion — 5 percent in 2017, and 10 percent by 2020. The estimated cost to the state when it begins paying for 10 percent is nearly $222 million.
Hutchinson's plan could set the stage for another fight over Medicaid expansion next year. The proposed task force would be required to issue recommendations next year, including larger reforms to the Medicaid system. Its recommendations could include calling for another hybrid approach to expanding Medicaid.
The Legislature also faces another vote on funding the program next year, since the Arkansas Constitution requires the state to budget on an annual basis.
Legislative leaders acknowledged that questions still surround those on the program.