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.