Friday, January 18, 2013

Taking the temperature of the Medicaid expansion debate

Posted By on Fri, Jan 18, 2013 at 9:57 AM

Today’s chances of passing expansion: 51%

House Speaker Davy Carter, still on the fence
  • House Speaker Davy Carter, still on the fence

Will the legislature approve Medicaid expansion?

Introducing the Expand-o-meter, our guesstimate of the state of the debate, which we’ll update frequently as new developments come along.

When the Republicans took the majority in November, it seemed to spell doom for the prospects of expanding Medicaid. After all, many Republicans had centered their campaign on anti-Obamacare rhetoric. House Majority Leader Bruce Westerman said in a House Republican address, “As the states now have protection from being forced to expand the program, our view is that supporting Medicaid expansion is really embracing President Obama’s law.” Yikes.

But events of the last two months have mostly been good news for proponents of expansion.

• On Nov. 15, unexpectedly, Rep. Davy Carter was elected Speaker with Democratic support and a small group of Republicans who turned to Carter in lieu of expected Speaker Terry Rice. Though Carter is a basically a conventional conservative, he is viewed as a more moderate figure and more open to expansion than Rice would have been. And unsubstantiated rumors floated that expansion proponent Gov. Mike Beebe may have been involved in orchestrating the maneuver (Beebe and Carter are mutual fans). Carter kept up hopes of a bipartisan approach by hiring Democratic staffers.

• In November the Department of Human Services updated its analysis of the fiscal impact of expansion and found that it would save more than $700 million to the state’s bottom line between 2014 and 2025, with projected savings year after year. Republicans have been skeptical of the projected savings, but research indicating that expansion actually saves the state money is a potential game-changer.

• Carter and Senate President Pro Tem Michael Lamoureux have been striking a cautious, relatively open tone, in stark contrast to the campaign rhetoric of their caucus.

• The RAND Corporation released a study this month projecting that the state would add thousands of jobs, save thousands of lives, and add a half-billion dollars annually in economic stimulus to the state GDP.

• On the other hand, the feds announced that states must expand all the way up to 138 percent of the federal poverty level if they want the Affordable Care Act’s generous matching rates — not a surprise but a setback for moderate Republicans who had pushed the partial expansion idea. Carter and Lamoureux both said the all-or-nothing verdict made passing expansion significantly more difficult. The feds did give the OK to co-pays, another idea dear to Republican hearts, and while it’s unlikely the feds will budge on partial expansion, you never know.

So, with the legislative session having just finished its first week, what does the Arkansas Times's highly scientific (okay, totally subjective) measure say about the chances for Medicaid expansion? Given all of the above, the Expand-o-meter thinks the odds are better than even...but just barely. We'll check in again soon.

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