Expand-o-meter: Arkansas Blog, Arkansas Times

Expand-o-meter: Signed, sealed, delivered

David Ramsey — Thu, 02 May 2013 16:37:00 -0500

Chances of expansion passing, final reading: 100 percent
See here for previous entries on the Expand-o-Meter.

All good things (and beaten-to-death gimmicks) must come to an end, and so after 14 long weeks, the Expand-o-meter retires. Last week, the governor signed healthcare expansion bills into law. After our temperature fluctuated wildly up and down, the heat was on in the homestretch, and against all odds, expansion is coming to Arkansas. That’s something worth dancing about.

Lowest reading: Feb. 8, 35 percent

Highest reading: Mar. 29, 85 percent

The final days: The Expand-o-meter viewed expansion as a 50/50 shot the weekend before the big votes, and then veered down to 25 percent and all the up to 90 as things changed rapidly. You can look back at the crazy swings in the House vote here and on the Senate side here.

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Expand-o-meter rumor mill: down to the wire

David Ramsey — Tue, 16 Apr 2013 09:50:26 -0500

Monday, 9:50 a.m. (90%):
The bill passes 77-23. It's on to the Senate, where it's thought they have the votes. Looks very likely that the "private option" will be enacted in Arkansas.

Monday, 9:25 a.m. :

Debate has started. Rep. Bell, speaking against, says the opponents of the bill have been in tears because of "threats and intimidation."

"When you look deep in your heart, do you want to be on the side of threats and intimidation or do you want to vote what's in your heart," he said. "You know what's the right thing to do."

Rep. Collins says he agrees that lawmakers should vote what's in their heart. He says that voting NO is a vote for D.C. Obamacare, voting YES is a vote for the Arkansas private option.

Rep. Payton says he lost friends and neighbors guarding the nation "against threats on foreign shores...Now there's a threat right here in these halls." He says that GIF money is being used to coerce votes.

Rep. Burris objected to the notion that YES votes are having their arms twisted, saying he had fought against GIF shenanigans. He said neither side should attack the others' motives.

Rep. Alexander says he decided two weeks ago that the private option was the best path forward but was voting NO because he said constituents hadn't had enough time to hear about the policy.

Rep. Kim Hammer, undecided as of last night, spoke against the bill. He said 60 percent of the town hall last night was in favor of the bill but he had to think of 100 percent. He said, "While it is a good bill, it could be greater with a few more stopgaps and trigger points."

Rep. Bruce Westerman accuses some unnamed legislators of voting against their conscience. He also said he'd stand up to big bad bloggers. This practice round of his stump speech for Congress is well written but the delivery needs work.

Woah! And Westerman just accused colleagues of being Judas Iscariot. Nice.

Also speaking for the bill: Rep. John Edwards, a rare voice from the Democratic side of the aisle; Rep. Sue Scott, previously a NO (with the best line of the debate: "when I look at the numbers, I see faces with those numbers"); Rep. Biviano; and Rep. Andy Davis.

Monday, 9:00 a.m. (50%)::

Hearing that they have the votes. We'll see.

Max notes that Rep. Jonathan Barnett's bill on diverting general revenue to highways is on the Transportation committee agenda today. Horse trade? (Lobbyist Robert Coon tweets that this is in fact routine: "You get two chances to run a bill. It stays on the agenda until that has happened or you pull it."

***Previous entries after the jump. House debating now.

Monday, 8:45 a.m. (49%):

Proponents are acting awfully confident, but I can't bring myself to go even odds still six votes short. The most likely scenario is that the vote will be short this morning (seems like magic number is locked at 72) and then they'll adjourn and try again either later this morning or this afternoon.

Monday, 8:20 a.m. (40%):

Hearing from vote-counters that they think they have 75. Also hearing from both sides that there are a few that will likely move to whichever side appears to have the votes, so the final count might be less close (on either end) than we're expecting.

Monday, 11:30 p.m. (33%) :

Yet another town hall tonight, this one in Benton and hosted by Rep. Kim Hammer and Rep. Ann Clemmer. Lots of speakers: on the pro side, Rep. John Burris and Sen. David Sanders, along with Medicaid Director Andy Allison; speaking against were conservative advocate Dan Greenberg and former Romney healthcare advisor Avik Roy (an AFP guest). Not sure why they didn't toss a current lawmaker like Westerman, who was in attendance, on the anti- team.

At one point, in what almost seemed like a plant to give me material, an angry man asked how the "private option" wasn't just Obamacare and then stormed out of the room before hearing the response. I took some notes on a variety of things said that I thought were wrong, or right, or somewhere in between. But honestly the big impression I got is that at this point in the discussion, it's all so much noise. Town halls are great, don't get me wrong. But when you have hyper-informed lawmakers throwing numbers back and forth, it's time to vote. As Hammer said, this has been "discussed, fussed, and cussed to death."

Two very general reactions: Opponents of the "private option" have a strong status-quo bias to their arguments, imagining dozens of law changes the feds could possibly enact some day that would impact state legislation, all horrible — so best to do nothing at all. Of course anticipating possible changes is important, but this frame reaches a point of absurdity; given the Supremacy Clause any state law could maybe some day be ruined! Lots of talk like "if you trust the federal government you should love this law." Heh. The other thing that stuck out is that the pundits' complaints about the bill were really at the margins, with lots of praise for aspects they liked. Roy several times said he agreed with 75 or 80 percent of this or that feature or argument. The difference seemed to be between conservative lawmakers pushing the bounds of the possible as far as they possibly could to create an experiment in Arkansas, and the pundits insisting that the experiment wasn't enough to their liking to be worth trying.

What's that all mean? Not much. Ultimately whether the "private option" happens or not is in the hands of legislators pretty unlikely to be swayed by one more argument (on either side) among the hundreds they've heard. Rep. Kim Hammer, Rep. Ann Clemmer and Sen. Jeremy Hutchinson all said they were undecided. Clemmer and Hutchinson both seemed to be leaning YES but hard to know. Hutchinson told the audience that tax cuts were unlikely to happen without the "private option."

For whatever reason, legislators in favor of the "private option" seemed very optimistic about tomorrow. Still seems like a hard road to 75, but we'll see.

Monday, 7:00 p.m. (25%):

The "private option" is certainly on life support but it's not dead yet. The House will convene tomorrow morning at 9:00 a.m. and try again on the appropriation. Three didn't vote yesterday — Rep. Anne Clemmer and Rep. Stephanie Malone were out of the room; Rep. Mary Lou Slinkard voted present but apparently intended to (or intends to) vote "aye." The general thinking is that those three are being counted in the YES group, which would put the vote total at 72, which was what most vote counters were saying in the final hours.

There was some doom and gloom at the Capitol among some expansion proponents, though many insiders are holding out hope. It's thought that there are around 10 legislators that could plausibly switch their vote. Some are saying they want more time with constituents (Rep. Randy Alexander is on record supporting the bill but still voted NO because of a desire for a few more weeks of chatting with the folks). Some support the policy but have political fears. And rumors continue that some legislators — including Rep. Terry Rice, Rep. Jonathan Barnett, and Rep. Les Carnine, all pro-business Republicans who have been happy to accept federal money in the past — have been voting NO due to a personal dispute with House Speaker Davy Carter.

We'll see. I've heard a very wide range of opinions about where we stand this evening; we could put the Expand-o-meter number anyone where from 0 to 60%. One thing we can report with certainty is that journalists are by nature pessimistic and politicians by nature optimistic!

Monday, 1:30 p.m. (45%):

Sounds more and more like they won't have the votes today although very hard to predict last-minute whipping. That doesn't mean it's over. If they don't make it today, they would likely run it again tomorrow. The potential connection to tax cuts would then likely loom large, with time running out in the session.

Monday, 1:10 p.m. (45%) :

Obviously we're at the point where rumors are mostly bluster, but am hearing that two votes were picked up over lunch, putting the count at 74. Sounds like if they fall short today, they'll try again tomorrow.

Monday, 1:00 p.m. (41%):

Questions have started to float about whether they are running the appropriation today given the uncertainty about whether they have the votes. All indications are that they will.

Monday, 12:30 p.m. (41%):

Still hard to believe that Rep. Alexander is going to vote NO on a huge bill that he is on record as supporting. But that is apparently his plan (he wants two weeks to make the pitch to constituents). Have to think there will be some public shaming of him for voting against his conscience during the floor debate if he's a deciding vote.

Monday, 11:20 a.m. (48%):

Rep. Nate Bell will vote NO. He has a long explanation of why on his Facebook page. Bell acknowledges that turning down the private option will hurt the state, but he cannot abide any federal deficit spending. In this case, the "private option" will have no meaningful impact on the debt but it does of course amount to accepting spending from the feds, and that's a principled line in the sand for Bell. With margins this tight, this is a big blow for expansion proponents.

Bell's wife has worked for Americans for Prosperity, a vocal opponent of the private option.

Hearing from the House floor and multiple sources that the count is at 72.

Monday, 11:15 a.m. (53%):

Rep. Bruce Westerman had a press conference just now at the Capitol, ostensibly to present HB 1965 — as we've noted below, it's just a poison pill to provide cover for the "do nothing" option — though Westerman spent most of his time re-hashing his case against the "private option." In fact, he said that he would vote against his own bill if it were up today. His main argument was that solutions to the expansion question needed to be "properly vetted." Asked what this vetting would entail, Westerman noted that the "private option" bill would need federal approval (of course, this is in the bill itself, which is structured as a take-it-or-leave it offer to the feds) and said that the "private option" idea was only a few months old. Delay delay delay. And of course, as Westerman knows, waiting a year would mean that the state leaves hundreds of millions of dollars on the table.

Westerman brought up a talking point that he peddled over the weekend — that somehow Congress was going to take away the insurance premium tax that would yield hundreds of millions in additional revenue under the "private option" because of additional plans in the exchange. Asked how Congress could legislate against a state tax on private companies operating on the exchange — a tax that is the standard mechanism for funding the exchanges, and will also be in place on the rest of the exchange in Arkansas and in states throughout the country — Westerman did not have an answer. Also worth noting that this issue was specifically brought up by state officials to CMS, which gave clear approval to the premium tax.

I noted to Westerman that his bill systematically violated the CMS rules and federal law, making it dead on arrival for the feds. He responded that this was a matter of opinion. Not so, but spinners gotta spin. (Westerman's move is even more blatant than Tennessee Governor Bill Haslam, rumored to have intentionally sought a no from HHS. Haslam was at least sly enough to do so before the CMS memo that articulated that his ask was a no-go.)

Westerman said that he believes "the numbers are there to block the appropriation" and said he was actively speaking to other members to try to defeat the private option. He said that a number of legislators are interested in signing on as co-sponsors to HB 1965, so the "cover" angle may have some sway. I asked Westerman whether he was planning to run for Congress. He gave the standard "I'm thinking about getting through this legislative session" answer.

Monday, 9:45 a.m. (53%):

Per John Brummett on Twitter, Rep. Randy Alexander is for it but saying he needs two weeks to speak to constituents. The folks at his town hall were apparently evenly split after hearing a discussion of the issue, which some thought would be enough to persuade Alexander to vote for a bill he believes to be the right thing to do. Would he actually be the deciding NO vote on the biggest issue facing the legislature in decades, simply because the Ledge ran out of time? Lots of lawmakers chatting with Alexander on the House floor.

Meanwhile, I'm told that one of the legislators in the 75 count this morning is now leaning NO, so along with Alexander, the count may be down to 73.

Bell has made his decision and will post an announcement on his Facebook page around noon today. He called it "the toughest decision [he has} ever had to make."

Monday, 9:00 a.m. (58%):

Hearing from multiple sources this morning that there are 75 votes to get the "private option" passed right now, but things can change quickly. There remains no wiggle room, so wobbly votes will probably be getting an earful today.

Monday, 12:00 a.m. (53%):

On the eve of the vote, the general mood among observers the Expand-o-meter has heard from seems to lean toward passage. Still going to be very close.

One place that vote-counters will be watching closely is Rep. Nate Bell's Facebook page. Bell was leaning fairly strongly toward YES at the end of last week, but seems to have gone to bed a MAYBE tonight. He wrote on Facebook, "I am generally blacking out electronics and am spending this evening in study, prayer and thought as I make my final decision on tomorrow's vote."

Later, he added:

The #PO question can be boiled down to one moral dilemma. Do we choose what is best for the state and the state budget/economy or what is best for nation/fed budget/debt/deficit but damaging to the state. VERY difficult choice. Lots of short term pain and fallout without #PO.

Reasonable frame for a conservative like Bell worried about the debt. Of course the impact of the "private option" on the debt over the next ten years is less than a rounding error. Will legislators like Bell be willing to harm the interests of the state for an abstract principle about federal spending with no meaningful impact on the debt? We'll find out.

Here's a video of Bell's town hall meeting Saturday.

Sunday, 6:00 p.m. (50%):

Still looking like a toss-up this evening. Bruce "Do Nothing" Westerman announced just now that he will release details tomorrow morning on HB 1965, which is not an alternative to the private option as he will suggest, but a stunt to try to provide some phony political cover for the "do nothing" approach that Westerman is lobbying for. Westerman was careful to make sure the bill intentionally violated the key requirements of the CMS memo regarding "private option" plans, making it dead on arrival for the feds. Everyone knows this, but presumably the gimmick is to give cover for possible NO votes worried about the consequences coming if the state turns down the private option. Westerman (has he announced his run for Congress yet?) can pretend he offered an alternative, even though his bill would have the practical impact of a NO vote. The amusing part is that HB 1965 has many of the same features that Westerman has railed against all week in the "private option." He's in full whatever-works mode.

Meanwhile, rumors continue to float that there is a subset of legislators reluctant to vote for the "private option" because of personal opposition to Carter. Jason Tolbert tweeted tonight, "Hearing that the Deacons are working against the private option based on spite for Speaker Carter — sad if that is true." Remarkable to think that this policy impacting hundreds of thousands of lives and billions of dollars in the state — not to mention potentially impacting the national health policy debate for years to come — could come down to personal animus. Max suggested on the podcast that given the stakes, some of that may fade if they are very close to 75.

Sunday, 1:45 p.m. (50%):

At the Capitol last week, “what’s your count?” was the greeting instead of hello. There have been a lot of numbers thrown around in the last several months in the debate over healthcare coverage expansion, but now it comes down to two: 75 and 27. That's what it will take in the House and the Senate, respectively, to accept the federal funds to enact the "private option."

The House — generally considered the tougher climb — will vote in about 24 hours. What does the Expand-o-meter think? From Thursday afternoon on we've been stuck at 50 percent odds of reaching the super-majority. Everyone agrees that it will be extremely close, and most admit that no one really knows what will happen. The count was generally thought to be in the low 70s on Friday with the possibility of pushing it over the top, but a number of likely YES votes wanted the weekend to talk to constituents. According to numerous insiders, there are well over 75 who are convinced that the "private option" is the right policy, but a good portion are shaky because of political pressure or other factors. The presence of five to ten wobbly, unpredictable votes has made predictions change by the hour — one vote-counter described it as "trying to nail Jell-O to a wall." So while House Speaker Davy Carter sounds confident, it's looking like a down-to-the-wire tossup.

One promising piece of news for "private option" proponents did come in last night: Sen. Jason Rapert (thought to be a MAYBE) and Rep. Stephen Meeks (thought to be a NO) both announced that they would support the bill. Based on the Meeks announcement and various Twitter activity, it looks likely that the House could get to 75 at this moment, so the Expand-o-meter may be ticking up ... but again, we're at the stage where things change by the hour.

On that note, we'll be updating as rumors and announcements come in. Feel free to throw us news or tips in the comments.

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Expand-o-meter: Can Republican leaders get expansion over the line?

David Ramsey — Tue, 09 Apr 2013 15:02:00 -0500

Today’s chances of passing expansion: 70%
Last week’s chances: 85%
See here for previous entries on the Expand-o-Meter

We're definitely closer to passing expansion than we've ever been, with legislation moving through the General Assembly and a significant group of Republicans actively pushing for the "private option." So why is the Expand-o-meter down a tick? Well, when it gets closer, it also gets clearer just how difficult it is to get to a super-majority. Just as some big names like Sen. David Sanders have come out in full support, some big names like Americans for Prosperity Regional Director Teresa Oelke have come out against. Any little thing — personal disputes, conflicts over other bills, fear of the next election cycle — can swing a wobbly vote. Ultimately, it comes down to the unpredictable idiosyncratic interests of individual legislators.

Encouraging news for expansion proponents:

• We finally got to stop using the "no Republican lawmaker has endorsed the private option" caveat, as first Speaker Davy Carter and Senate President Pro Tem Michael Lamoureux came out for the plan, followed by Sen. Jonathan Dismang, Rep. John Burris, Sanders and other prominent Republicans. And we finally got a bill, co-sponsored by Republican leaders.

• The feds released guidelines for private-option style expansion that confirmed the Arkansas framework and sent a letter directly to the state giving Arkansas a conceptual okay to the state's "private option" plan.

• Enabling legislation has passed the Senate and passed out of House committee. A House committee of the whole featured Rep. Burris making an impressive case for the "private option" and while it's hard to read too much into questioning, it looked like getting to 75 for the appropriation will be difficult but possible. Gov. Mike Beebe told reporters today that he's "cautiously optimistic," a view that seems to be shared among legislators in favor of the private option.

Discouraging news:

• After weeks of being cagey, Americans for Prosperity came out against the private option. Given that they spent more than one million dollars in the last legislative cycle, it's fair to say that they have the attention of lawmakers. They're now giving the hard sell, including an advertisement that mentions nothing about the actual policy but features clips of Nancy Pelosi. Meanwhile, a scattering of townhall meetings have cropped up, tea partying like it's 2009.

• Former Mitt Romney healthcare advisor Avik Roy flip-flopped from warm to cold on the private option after he realized that he had misunderstood the original policy framework. He's been advising Republicans to vote against the bill, though he may not have much sway over local legislators, particularly after getting the policy details of the Arkansas plan wrong on reimbursement rates, provider rules, and other matters.

• The biggest setback came from Rep. Bruce Westerman, who this morning removed his name from the bill as a sponsor and spoke to the House Public Health committee with a few half-baked arguments against the private option. He told reporters afterwards that he would vote no on the enabling legislation and the appropriation. Westerman probably moves at least a few "maybe" votes into the "no" camp.

Will the strong push from Sanders, Burris, Dismang and the Republican leadership be enough? The Expand-o-meter thinks so, but we're a thermometer, not a mind-reader. Things look pretty solid in the Senate, but in the House, there are around a dozen Republicans that remain wildcards. The future of the state is in their hands.

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Expand-o-meter: chances of expansion keep jumping up

David Ramsey — Fri, 29 Mar 2013 16:43:00 -0500

Today’s chances of passing expansion: 85%
Last week’s chances: 82%
See here for previous entries on the Expand-o-Meter

The big story of the week was tax cuts, with Rep. Charlie Collins pushing an income tax cut and House Speaker Davy Carter hoping to slash the capital gains tax. What does that have to do with the Expand-o-meter? Well, expansion is revenue positive for the state, to the tune of hundreds of millions (more on that in a minute). That leaves a lot more room in the budget for tax cuts. Republicans want cuts no matter what, but Collins acknowledged that revenue gained from expansion is an important piece of the puzzle. And Gov. Mike Beebe has explicitly said he'll be on board with tax cuts if and only if the state goes forward with expansion.

Collins said he was "stunningly encouraged" by the emergence of the new "private option" framework. He wasn't the only Republican speaking positively about it, and even arch conservatives sound open...though Republicans are always quick to note that they are also seeking changes to the existing program. Also, an announcement that might attract some more Republicans: the Chamber of Commerce has endorsed the "private option."

Meanwhile more good news from DHS, which released actuarial numbers suggesting that the "private option" not only wouldn't be more expensive than traditional Medicaid expansion, but would save the feds hundreds of millions of dollars. It's a potentially game-changing theory; many remain skeptical, but it should help to alleviate cost concerns. The finding that should really perk legislators' ears up: expansion saves the state almost $700 million over the next ten years.

Will all of this be enough? We'll see. The tricky part remains that lots of individual legislators are wildcards. Sen. Larry Teague, a Democrat, said in the D-G this morning that he opposes the "private option." And there's always the danger that inter-party squabbling could complicate an agreement.

Still, those are the vagaries of any legislative decision. If you're going to make a bet (and the Expand-o-meter is a gambler), the bet is on YES.

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Expand-o-meter: chances of expansion getting higher and higher

David Ramsey — Fri, 22 Mar 2013 14:27:30 -0500

Today’s chances of passing expansion: 82%
Last week’s chances: 75%
See here for previous entries on the Expand-o-Meter

It’s getting down to the wire and the Expand-o-meter remains bullish. The big news this week: a new DHS study suggesting that the additional cost to the feds of the “private option” could be much lower than anticipated. According to DHS, it could represent no additional cost at all compared with traditional Medicaid expansion. Given that the biggest critique of the “private option” was a higher federal price tag, this could help seal the deal — particularly for wobbly Republicans worried about federal spending.

So far DHS has offered assertions without hard numbers and critics from the right, left, and wonky middle have viewed the findings with a bit of skepticism until we see more. But with Republican lawmakers mostly showing (newfound) faith in DHS reports, their conclusions represent very good news for expansion proponents.

So is expansion a slam dunk? Not just yet. Getting to 75 percent is still a steep climb given the conservative, Obamacare-phobic makeup of the General Assembly. Thus far, there has been very little public criticism of the “private option” from the right. We got our first real dose this week when the Cato Institute’s Michael Cannon came to town. Cannon was invited to testify against state-run exchanges, which mostly fell on deaf ears (it goes to show how much of a difference the "private option" has made that Sen. Jason Rapert, once a vehement opponent of state-run exchanges, shrugged Cannon off).

However, Americans for Prosperity invited Cannon to be the guest speaker at their Conservative Caucus Luncheon, where much of his talk focused on attacking the “private option” (or “the Beebe proposal” as he called it). Cannon called it crony capitalism that was even worse than Medicaid expansion and represented an effort to trick Republicans into capitulating on Obamacare.

Will we start to hear attacks like that from conservatives in the state? That remains the possible fly in the ointment. One Tea Partier at the Capitol to see Cannon called the “private option” lipstick on a pig. Rapert tweeted yesterday that he was “growing tired of the waiting game…and I have said so internally. Time is up and no one has presented details.” As for AFP — one of the biggest spenders in the state on legislative races and a key gatekeeper on the GOP’s right flank — they have been cagey and noticeably quiet so far. Cannon clearly fired them up, as the AFP Arkansas twitter account sent out a clear rejection of the “private option,” only to have AFP Regional Director Teresa Oelke quickly get online to walk it back. They’re still “waiting on details,” she tweeted. What position (if any) they decide to take looms large.

That said, the overwhelming majority of public comments from Republican lawmakers have been positive. House Speaker Davy Carter has been asking this week for some form of legislation to begin moving through the process. The Expand-o-meter keeps on heating up, shooting north of 80 percent for the first time.

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Expand-o-meter holding steady

David Ramsey — Fri, 15 Mar 2013 13:17:00 -0500

Today’s chances of passing expansion: 75%
Last week’s chances: 75%
See here for previous entries on the Expand-o-Meter

Though the "private option" is likely to cost the feds hundreds of millions more per year, it remains a much more popular idea among Republican lawmakers than traditional Medicaid expansion, which appeared dead in the water just a few weeks ago. The "private option" seems fishy and we still think the political optics of the executive power grab are awful, but all systems appear to be go from a legal perspective. DHS has sent a letter to the feds to make it official and once DHS releases their projections next week, the Ledge should have most of the details they need to proceed.

If there's a risk here, it's probably that The Four Privateers (Sen. David Sanders, Sen. Jonathan Dismang, Rep. John Burris, and Rep. Bruce Westerman) will try to squeeze even more demands out and could possibly walk away if they don't get what they want. They want more "flexibility" than the law currently allows and their urge to chip away at the existing program burns on. Hard to believe that Republicans would back out over details or subsidiary fights now that private insurance companies have a stake too, but you never know with true believers.

Meanwhile, the conservative wing of the General Assembly still has doubts about expansion even with the "private option." Anti-Obamacare lost causers are bringing in a big gun next week to fan the flames.

Still, the Four Privateers have a lot of conservative cred and should be able to sell the deal. They'll even argue that it won't cost more due to the magic of free markets, even though that's not so. Should be all sorts of twisting and turning since many of the arguments for the new deal are awfully similar to those for the old deal. We'll hear from Republicans about "cuts" that aren't really cuts in service. Maybe we'll even hear that the feds can afford to pay a little more because the ACA is revenue positive. Romneycare-style premium assistance, once a conservative idea, then socialism, now arrives full circle into the waiting arms of the Four Privateers.

And for the folks that are desperate for healthcare in this state, that's welcome news. The Expand-o-meter is holding course, remaining at 75 percent.

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Almost there? Expand-o-meter keeps rising...

David Ramsey — Fri, 08 Mar 2013 13:52:00 -0600

Today’s chances of passing expansion: 75%
Last week’s chances: 65%
See here for previous entries on the Expand-o-Meter

After the emergence of the "private option" last week, things continue to look sunny for the prospects of expanding health coverage. No Republican has endorsed it yet, but it sure feels like it's all over but the shoutin'.

Rep. John Burris has been out pitching the "private option" even though he is not pitching anything! Burris has also had what look like productive policy talks about the deal with the same administration officials Republicans were sparring with before.

Sen. Jonathan Dismang, another Republican who has had positive things to say about expansion now that it's routed through private companies, spoke at a healthcare rally at the Capitol. That would have been unthinkable just a few weeks ago, and Gov. Mike Beebe made sure to put his arms around him for a bipartisan photo-op.

None of the good vibes changes the fact that this approach is likely going to cost taxpayers more , and will likely lead to higher premiums on the exchange (which the government, not consumers, will be on the hook for). But the deal is still likely to be a great fiscal deal for the state in a vacuum and even features some new revenue streams.

Yeah, the Waste Wing is still making noise but their moans and groans are no longer relevant to the expansion debate.

In short, against all odds, it is looking very likely that the state will offer coverage to people that desperately need it. For all the ideological infighting these are the folks that this is about.

The Expand-o-meter now thinks that there is a 75 percent chance that the General Assembly can make the steep climb to 75 percent.

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Medicaid "private option" has expand-o-meter heating up

David Ramsey — Fri, 01 Mar 2013 14:11:00 -0600

Today’s chances of passing expansion: 65%
Last week’s chances: 37%
See here for previous entries on the Expand-o-Meter

Well! When I was hustling from Gov. Mike Beebe's press conference to Speaker Davy Carter's press conference on Tuesday, I texted Lindsey: "everything is different." Beebe reached a game-changing agreement with Sec. Kathleen Sebelius and the feds last Friday and shared it with lawmakers Tuesday. Employing an obscure provision of the Social Security Act, Arkansas has permission to offer health coverage to the entire expansion population through the exchange. Instead of expanding the Medicaid program, the government will pay for low-income folks to purchase private health insurance.

Local Republicans, who for months have shown no signs of buckling in their anti-Obamacare fervor, seem to be embracing the new "private option" (despite the fact that it likely costs more). Rep. John Burris, previously running a delay game, is now saying that Republicans "have a lot of ownership in this model."

Some other good news for expansion proponents: Democrats are united in favor of it and another poll was released showing public support. And yet another Republican governor came out in favor of expansion, though at this point it's likely to be other red states following our lead.

But the big one is the new "private option," which has the Expand-o-meter feeling positively giddy about the chances of Medicaid expansion (or whatever we're calling it now), leaping from the doldrums of last week to its highest point yet.

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

David Ramsey — Fri, 22 Feb 2013 16:49:31 -0600

Today’s chances of passing expansion: 37%
Last week’s chances: 35%
See here for previous entries on the Expand-o-Meter

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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Delay delay delay: Prospects looking bleaker for expansion

David Ramsey — Fri, 08 Feb 2013 14:05:00 -0600

Today’s chances of passing expansion: 35%
Last week’s chances: 38%
See here for previous entries on the Expand-o-Meter

Though the Washington Post is under the impression that Arkansas has already said yes, things in fact remain dicey for Medicaid expansion. Republicans, led by House Public Health Chairman Rep. John Burris, are now promoting the idea of waiting to make the decision until the fiscal session next year. From a fiscal point of view, this is insane: The 100 percent match rate between 2014 and 2016 is the part of Medicaid expansion that no one denies is a good deal for the state. Waiting until the fiscal session would mean the state couldn’t start expansion until July 2014, leaving six months of money on the table. Burris is no fool, so this instead has the stench of a delay tactic. If Arkansas wants to say yes, they would do so this year.

Meanwhile, Republicans continued trying to change the subject to their preferred topic: Waste! Fraud! Abuse! “We keep hearing stories of…” is their opening line, which we guess means that some people really like gossiping (or fantasizing?) about Cadillac-driving Medicaid recipients, “crazy check” scammers, and housecleaners who don’t work enough days. Rep. Bruce Westerman, captain of The Waste Wing team, filed a bill along with Sen. David Sanders to institute a costly system of biometric smart cards for Medicaid recipients — sort of like the Voter ID of health care. Experience in other states suggests that this will harass some eligible folks out of the program while doing nothing about fraud. Westerman also filed a shell bill that looks like an effort to codify Medicaid-attacking hijinks from Legislative Audit.

As for the much-hyped audit of the Medicaid program, the release was delayed until today to foster cooperation between Leg. Audit and DHS. The results were much ado about nothing. Bummer for the Waste Wing. Meanwhile, the Medicaid program itself shows early signs of curtailing cost growth.

There was some other good news for expansion proponents. Two more Republican governors came out for Medicaid expansion; despite hating Obamacare, that's now six that have concluded that expansion is too good of a deal to pass up. (Still no movement from our Dixie neighbors; Tennessee is probably the real bellwether and there's a little hope there.) Here at home, Gov. Beebe has floated another compromise idea and gotten a maybe from the feds.

Still, none of these developments make a lick of difference if the Republican leadership is determined to run a delay game. For the third straight week, the Expand-o-meter is dipping down.

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Taking the temperature of the Medicaid expansion debate: Bryan King wants to rid his system of waste

David Ramsey — Fri, 01 Feb 2013 12:20:00 -0600

Today’s chances of passing expansion: 38%
Last week’s chances: 45%
See here for previous entries on the Expand-o-Meter

Republican lawmakers went back to their old standby this week to fight Medicaid expansion: Waste! Fraud! Abuse! Get ready to hear some harrowing tales of Medicaid Queens riding around Mountain View in convertibles from Sen. Missy Irvin.

Looked like it would be a slow week for the expansion debate with other stories dominating the news but on Wednesday, things got lively in the Legislative Audit committee meeting (there's a phrase we're not used to writing). Republican co-chair Sen. Bryan King announced that he'd requested that Leg. Audit release its findings on the Medicaid program, slated to be released in March as part of the DHS audit, this week instead.

There are reasons to be suspicious about the report, which many believe to be politically motivated, and suggestions that King has tried to influence the audit and use it as a political stunt. DHS released a furious response, complaining of "alarming flaws," which wouldn't surprise us, but also suggests that the audit at least looks bad.

The good news is that once released, we'll actually have something to debate, instead of unspecified anecdotes of waste (a "gut" feeling, as House Speaker Davy Carter described it). But politically, it almost doesn't matter whether the audit findings are as fishy as DHS says. The conversation will shift, and Republican lawmakers hoping to block expansion are giddy about poking holes in the existing system rather than talking about expanding. It certainly feels like this was carefully rolled out this week, as Republicans spread rumors about shocking waste uncovered in the report, then tweeted and re-tweeted reports of those rumors, then Carter went out of his way to offer a preemptive defense of Leg. Audit. (Rumors that Carter may run for governor cast another dark cloud on expansion — can't win a state-wide Republican primary unless you're anti-Obamacare).

On the plus side for expansion proponents, some consensus emerged that a "circuit breaker" would be a potentially powerful tool to avoid sticking the state with bigger costs than advertised down the road if the feds change the match rates (leaving the Republicans only with Sen. Ceclie Bledsoe's bizarre logic: better to never give coverage than possibly some day take it away). And the early returns on the Medicaid program's Payment Improvement Initiative look good, with the shortfall less than half what it was, suggesting that the program may be well on the way to cutting costs to offset fears of the costs of expansion down the road.

Still, the unified Republican front to change the subject to waste leaves the Expand-o-meter very bearish this week, as we dip below 40 percent.

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Taking the temperature of the Medicaid expansion debate

David Ramsey — Fri, 25 Jan 2013 11:13:49 -0600

Today’s chances of passing expansion: 45%
Last week’s chances: 51%
See here for previous entries on the Expand-o-Meter

Key Republicans on both the Senate and House Public Health committees struck strident tones against full expansion at committee meetings earlier this week. Partial expansion continued to be a popular notion for a possible compromise, and Sen. Jonathan Dismang floated a new idea on that front. But the Republicans open to some form of expansion seem to be putting all their eggs in the partial expansion basket. As Dismang put it, “obviously if the federal government digs its heels in and says there’s nothing available but full expansion I think that changes things. I think there’s very little room for full expansion amongst the members. If we work through some of these details and get to some compromise, I don’t think partial expansion is out of the question.” The trouble is, the feds have said it’s all or nothing and given no indication that they’re willing to budge. As House Speaker Davy Carter told reporters on Wednesday, “I’m less optimistic that would be an option …they’ve said they weren’t interested in anything but all or nothing…that makes it extremely difficult.”

All this leaves the expand-o-meter feeling a little sickly, as the odds dip below even.

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Taking the temperature of the Medicaid expansion debate

David Ramsey — Fri, 18 Jan 2013 09:57:00 -0600

Today’s chances of passing expansion: 51%

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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