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Thursday, April 11, 2013

UPDATE: House approves Medicaid expansion

Posted By on Thu, Apr 11, 2013 at 3:04 PM

UPDATE UPDATE UPDATE

After more than an hour of earnest debate, the House approved enabling legislation to expand the state Medicaid program through increasing the number covered by federally paid private health insurance.

The vote was 62-37 and one present.

Only a majority was required for passage of the bill, which has already passed the Senate. The appropriation bill to spend the money will require 75 votes, of which today's vote fell well short. But the debate included some hints that at least some voters were candidates for a positive vote in the future. The battle will continue, what's uncertain if whether it will be decided tomorrow or following the weekend, when some legislators say they want to meet with constituents first.

The Senate also fell short of the 75 percent level, by three votes, in its approval of enabling legislation. And there were some indications today of some wobbling on the part of senators who'd been counted on for support.

The fight continues.

Here's the roll call. though it lists Altes and Holcomb as not voting, they were voted manually as paired ballots because of Holcomb's absence — Holcomb for and Altes against. Republican Karen Hopper voted present.

Here are the other no votes, all Republicans:

Alexander Ballinger Barnett Bell Branscum Carnine
Clemmer Cozart Dale Deffenbaugh Dotson D. Douglas
C. Douglas Eubanks Farrer Fite Gossage Hammer
Harris Hickerson Hobbs Hutchison Jean Kerr
Linck S. Malone Mayberry D. Meeks S. Meeks Miller
Payton Rice Scott Slinkard Westerman Womack

The House later approved the Senate version of the same bill 63-35 and one present, a pickup of one aye — Branscum. Kerr also moved into the not voting column. That left twelve needed for passage of the appropriation. Current conventional wisdom is that supporters count 71 to 73 votes for the appropriation and no one seemed terribly concerned by falling 12 short today.

John Burris said, "I think there were people that for whatever reason were going to vote for the appropriation and not the bill itself. I'm not quite sure why. But that was always understood. I think it'll be a higher vote total than it was today." He said he understood a desire by some to go home to talk further to constituents, but added, "We're under a timeline here that really can't change. I hope that doesn't cost a vote for such a long program." He said voters sent legislators to Little Rock to make a decision " ... and if you feel like you made the correct one, I just feel like people are understanding and if you can go home and explain it intelligently, I don't know that it matters if it happens before a vote or after."

HERE'S WHAT I WROTE EARLIER

The House shortly before 2 p.m. began discussions of the bill, HB 1143, to allow Arkansas to expand its Medicaid budget under President Obama's health care initiative through a "private option" approach.

The lead sponsor, Republican Rep. John Burris of Harrison, opened by running through now familiar talking points: Arkansas is better served by taking the shape of the program into its own hands. Not acting will bring instability in the economy and state budget. The existing system isn't working.

Nutty as fringe Republican gubernatorial candidate Curtis Coleman is, I think his news release issued at the start of debate cuts through the fog of technical questions to the core issue for the holdouts among the Republican delegation to providing the needed 75 votes in the House:

A plan to use more federal Medicaid money to subsidize the purchase of private health insurance, nicknamed the ‘private option,’ is still fundamentally an expansion of Medicaid and therefore an expansion of the size and cost of government.

Good for Arkansas people. Good for Arkansas business. A bonanza in federal money that can be channeled to other parts of the state budget. But yes, an expansion in the cost of government.

By the way, to cover his defection as a sponsor, Westerman filed an amendment today to rewrite the bill more to his liking. Far too complicated to be meaningful at this late hour, seems to me, and a bit ludicrous to talk about medical savings account for people in deep poverty. But here it is, for the record.

Rep. Charlies Collins in speaking FOR the bill said he hated Obamacare. He said the situation was "nasty, horrible, sickening." But he said the clock couldn't be turned back. Elections didn't provide the means to overturn the law and now was the time to strike the best bargain possible with Obamacare. He said Arkansas's proposal provided a "stunning" level of waiver from federal rules. Democrats John Edwards and Stephen Magie and George McGill and Mark McElroy also spoke for the bill. Also Republican Doug House.

Speaking against, all Republicans: David Meeks. His concerns include wanting guarantees that poor people will have to pay meaningful co-pays and that doctors get sufficient reimbursements. Republican Majority Leader Bruce Westerman had a prepared speech, which he read from. He said he supported a permanent plan for improvement of Medicaid, but the pending legislation wasn't a palatable solution. He said there hasn't been sufficient independent analysis of the proposal and the state remained unprotected against congressional whims. Andy Mayberry said he was for the bill but would vote against it. He said people need more time to fully understand the alternative that is being offered. Josh Miller said he feared the bill just "kicked the can down the road" and that it might be "putting Old Spice on a skunk." Kim Hammer said he had lost a feeling of trust in the last few hours because of a need to pass a law to require a health care provider to do the right thing and by defeat of a health bill he favored. He said he'd vote no to get some trust back. Justin Harris, who makes a living off federal subsidies of his church daycare, spoke against the health care subsidies. Another no, Stephen Meeks. He said establishment of the program will create the expectation that it will always be there.

Nate Bell said he'd vote against today's bill because he wants to have a meeting with constituents this weekend. But he said he might vote for the appropriation bill, where the 75 votes are needed, if his feedback is good and there's a vote next week. The plan has been to vote on appropriation Friday.

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