Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
April 20, 2016 01:00 AM

Blog: In Arkansas, saving Medicaid expansion requires killing it first

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    Arkansas' Republican-controlled Senate voted Wednesday to kill the state's successful Medicaid expansion. The GOP-led House is set to do the same Thursday. Republican Gov. Asa Hutchinson has promised Democratic lawmakers that he will publicly defend them for their vote in favor of repeal.

    But don't be alarmed. The governor and legislative leaders aren't actually planning to roll back the expansion. Hutchinson has announced he will issue a line-item veto stripping out the language in the budget bill that would terminate the program at the end of this year.

    Yes, you read that right. A number of states with Republican governors or GOP-controlled legislatures, including Alaska, New Hampshire, Ohio and Pennsylvania, have gone through tortuous political processes to expand Medicaid to low-income adults under the Affordable Care Act. But Arkansas, which originally implemented a customized expansion under a Democratic governor in 2014, arguably wins the prize for the most byzantine maneuvering to keep that expansion.

    Hutchinson, who previously opposed expansion, came around to accepting it after his 2014 election, though he proposed conservative-friendly, personal-responsibility revisions to the program. He needed a three-quarters vote in both legislative chambers to authorize his so-called Arkansas Works plan. He warned that the loss of federal Medicaid expansion funds would leave a $100 million hole in the state budget that begins July 1.

    But last week, 10 tea party-affiliated Republican senators, prodded by a Koch brothers-funded conservative advocacy group, voted against Arkansas Works. In the 35-seat Senate, that was enough to doom the expansion, leaving nearly 270,000 newly insured Arkansans without coverage.

    So Hutchinson came up with the creative idea of passing an amendment to the budget bill stripping out funding for the Medicaid expansion, then vetoing that amendment. Democrats initially balked. They refused to vote in favor of taking away coverage from thousands of constituents, expressing skepticism about the legality of the maneuver and anger over the machinations needed to get around GOP opposition to expansion.

    After some arm-twisting over the weekend and changes in the legislative language that made it more bullet-proof against legal challenges, the Democrats agreed to support the governor's approach. Meanwhile, of the Republican senators opposed to preserving the Medicaid expansion in any form, dubbed the Tea Party 10, two or three senators indicated they would vote for the amendment even knowing Hutchinson would veto it. If they didn't, they knew they would be blocking funding for the entire Medicaid program, including coverage for old people in nursing homes.

    “This is strictly a way to get it done and allow hard-core tea party legislators to say they passed a budget bill that would have stopped spending on the Medicaid expansion if the governor had signed it as is,” said Rich Huddleston, executive director of the Arkansas Advocates for Children & Families, who favors keeping the expansion despite reservations about Hutchinson's proposed changes.

    In one of the stranger twists, Hutchinson vowed to defend Democrats if they are accused of not supporting Medicaid expansion. “Truth is important, and if that is ever misrepresented, I'm happy to make sure that I'm a voice for an accurate record on your intentions,” he said earlier this week.

    So far, Hutchinson's convoluted strategy is working. On Wednesday, all Senate Democrats and two of the Tea Party 10 Republicans voted for the appropriations bill with the amendment ending Medicaid expansion funding. A House vote is expected Thursday. Then, the governor has said, he will sign the bill while vetoing the amendment.

    Hutchinson's Arkansas Works waiver plan still would need approval from the CMS. In an April 5 letter to the governor, HHS Secretary Sylvia Mathews Burwell offered tentative support for the plan, which contains elements similar to waiver proposals in Kentucky, Michigan, New Hampshire and Ohio. She said HHS looked forward to continuing its discussions about the proposal.

    But the administration is widely expected to reach agreement with Arkansas, because failure to renew the state's expansion would be a serious political setback to the administration's efforts to convince more states to accept the coverage expansion.

    During the legislative debate Wednesday, Republican Sen. Jim Hendren, Hutchinson's nephew, said he was upset at the charge that the legislative maneuver to save the Medicaid expansion through the amendment and line-item veto—which he helped engineer—was deceptive. It wasn't a “trick” because the governor had been transparent about his plan to use the line-item veto. "I don't know how much more clear it can be," he said.

    Hmm, they sure have interesting ways of doing things in Arkansas.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Ezike 800.jpg
    Former Illinois health chief Ezike under scrutiny by state's top ethics investigator
    AHRQ Director Robert Valdez in front of American flag
    Q&A: AHRQ chief aims to help communities improve their health systems
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing