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Friday, February 22, 2013

Playing catch up: Can Beebe stop the Expand-o-meter's plummet?

Posted By on Fri, Feb 22, 2013 at 4:49 PM

Today’s chances of passing expansion: 37%
Last week’s chances: 35%

See here for previous entries on the Expand-o-Meter

Republican governors in Florida and Arizona are for it. Can Arkansas catch up and get Medicaid expansion across the finish line?
  • Republican governors in Florida and Arizona are for it. Can Arkansas catch up and get Medicaid expansion across the finish line?

Despite some giving up all hope that Republicans will ever really consider Medicaid expansion, the Expand-o-meter soldiers on!

Not a whole lot has happened down at the Capitol on the expansion debate over the last two weeks, as topics more near and dear to the Republican majority's heart took up most of the oxygen. At this point in the session, no news is bad news for expansion proponents.

The biggest development came not here at home but in Florida, where Gov. Rick Scott became the seventh GOP governor to endorse expansion. This one is a big deal. Scott has been an anti-Obamcare poster boy who campaigned against the law and had strongly opposed expansion in his state. Florida was the state that originally brought the lawsuit against the Affordable Care Act. His about-face articulated familiar themes: He still doesn't like the ACA, but like it or not, it's the law. Saying no just sends money to other states. And "while the federal government is committed to pay 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care." In short, it's just too good of a deal. Scott's announcement was also significant coming from the South, the first glimmer of hope that expansion might come to the region. Finally, he included an idea that looks like it would be a winner here in Arkansas: a sunset provision that would go forward with expansion for the first three years with the 100 percent federal match rates, then force legislators to re-approve expansion once the match rates were set to start decreasing to 90. This would guard against long-term cost concerns and allow lawmakers to re-examine the issue once we have hard data. At least one local Republican likes the notion.

Back in Arkansas, meanwhile, House Speaker Davy Carter seemed to signal that maybe, possibly, once he has all the information...we might hear a similar tune from him that we heard from Scott. In an interview with Roby Brock, as well as press conferences at the House this week, Carter acknowledged that expansion might make "economic sense" for Arkansas in the short term. He's still a long way from coming out and endorsing expansion and has the usual litany of concerns but his comments this week have been the most open to expansion we've heard yet from a Republican lawmaker in Arkansas. And his focus on what makes sense for the state in a vacuum, given the law as it is, may provide an avenue for other anti-Obamacare Republicans to feel more comfortable with expansion.

Carter's position will remain in flux until we hear back from Gov. Mike Beebe, who met today with Sec. Kathleen Sebelius to discuss possibilities for flexibility in an expansion deal, including partial expansion, which has thus far been taken off the table by the feds. Early reports from Beebe indicate that he is cautiously optimistic about what he heard from Sebelius.

While the results of Beebe's meeting should firm up the terms of an expansion deal, Republicans continue to grumble that they don't have enough information on the projected impact of expansion. DHS has already done an intensive study projecting that the state would save money under expansion. Republicans want a second opinion, and Rep. Bruce Westerman announced earlier this week plans to hire a consultant on the taxpayer dime.

Given Westerman's firm opposition to expansion (and all things DHS), not to mention the recent shenanigans with respect to politicizing Medicaid analysis, there is reason to cast a skeptical eye on the outside consultant. Still, more information is a good thing, and since many Republican lawmakers will simply shut their eyes if info comes from DHS, a new study will at least add numbers to the debate and (hopefully) put an end to complaints that they don't have sufficient information. A pessimist might note that Westerman has the one been leading the charge for The Waste Wing's effort to change the subject from expansion to stories of Medicaid recipients driving nice cars. Waste! Fraud! Abuse! The Waste Wing came up empty with a Medicaid audit that was much ado about nothing but has some legislation coming soon.

A poll released this week suggests that the public in Arkansas supports Medicaid expansion, although the wording of the poll may have been biased in favor of expansion. And of course, it doesn't matter what the public thinks unless three-fourths of the Republican controlled House and Senate agree. Unless...rumors are circulating about a semi-secret alternative route that would require only a simple majority. We're skeptical, but worth keeping an eye on.

All in all, the Expand-o-meter still forecasts rough-going, but the news from Florida and the open language from Carter, who says he'll take an active leadership role in pushing expansion through if he's convinced it's a good deal, moves us up a tick to 37 percent.

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