Thursday, April 7, 2016

Medicaid expansion legislation passes in House and Senate

Posted By on Thu, Apr 7, 2016 at 11:17 AM

click to enlarge COLLINS: Health reform task force vice-chairman makes case for re-authorization of Medicaid expansion on House floor. - BRIAN CHILSON
  • BRIAN CHILSON
  • COLLINS: Health reform task force vice-chairman makes case for re-authorization of Medicaid expansion on House floor.

The House passed legislation this morning for "Arkansas Works," the governor's plan to continue the state's private option Medicaid expansion, which provides health insurance for more than a quarter million low-income Arkansans. The legislation passed 70-30. Here's the roll call

Also this morning, the Senate passed their own version of the same legislation, 25-10.

Senate Bill 1
 and House Bill 1001 are identical bills. The twin bills exist as a procedural mechanism to quickly run the legislation through. Tomorrow, the House will vote on the Senate bill and the Senate will vote on the House bill. Once that's done, the "Arkansas Works" legislation will head to the governor's desk. 

That's the easy part. Next week, the fiscal session will begin and that's when the governor will face a tough slog in re-authorizing Medicaid expansion. Even though the law passed with a healthy majority, a small minority of Tea Party Republicans say that they will shut down the government rather than let the policy continue. The Medicaid appropriation — which includes funding not just for the private option, but also for children covered by ARKids, the elderly in nursing homes, and the severely disabled — is generally understood to require 75-percent approval in both houses of the legislature. The Tea Party Republicans say that they will block all of this funding unless the state refuses the federal Medicaid expansion money and kicks 275,000 Arkansans off of their health insurance. 

The fact that the majorities today are less than 75 percent doesn't mean Medicaid expansion is doomed. Some legislators may vote for the Medicaid appropriation in the end even though they voted against the enabling legislation this week (in fact, this is common practice on other appropriations — Democrats voted for the Secretary of State appropriation in 2013, for example, even though they bitterly opposed the Voter ID law that appropriation funded). That said, most Capitol observers believe that both chambers are currently short of 75 percent. In the House, vote counts are fluid and there are lots of members to target. In the Senate, however, there are 10 senators who are currently firm No votes. It only takes nine to shut down the entire Medicaid program.  

Here are the 10 senators who voted No today: Clark, Collins-Smith, Bledsoe, Flippo, Hester, Irvin, Blake Johnson, King, Rice, Stubblefield. 

I was on the Senate floor. A few notes:

Sen. Jim Hendren argued for the bill based on the numbers: If the legislature kills Medicaid expansion, it will pull billions of federal dollars out of the state's economy and health care system, leave a hole in the state budget of hundreds of millions of dollars, and slap hospitals with billions of dollars in uncompensated care costs. Hendren pointed out that when Arkansans file their federal taxes in a week's time, they'll pay the same amount regardless of what Arkansas decides to do on Medicaid expansion. The question is whether the legislature wants to block $9 billion from coming in to the state over the next five years. 

Speaking against the bill, Sen. Alan Clark said we're on a slippery slope toward single-payer. So there you go. 

Also speaking against the bill, Sen. Blake Johnson said it was "our time to stand for the individual rights and freedoms of the people we serve." Amazingly, he read almost the entirety of Ronald Reagan's 1964 speech on behalf of Barry Goldwater at the Republican convention, on encroaching socialism. This is quite something. Reagan's speech was in part about how Medicare would lead the country to ruin. Indeed, it's a good example of how conservatives oppose safety net spending on the poor by making wildly false doomsday predictions. Reagan was wrong about Medicare in 1964, as I suspect Johnson would agree. Yet Johnson whipped out a soporific recitation of that same old speech to oppose Medicaid expansion today. (Confusingly, Johnson focused more on Reagan's Cold War hawkishness, which seems of, um, marginal relevance to the debate at hand.)

Hendren closed for the bill by saying that he texted his wife, "I just want you to know that I'm not a socialist."

Rep. Charlie Collins presented the bill in the House. I'll give thoughts on the House debate once I've watched the video stream. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.

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