The Arkansas private option could be in trouble 

A minority of state legislators may put health coverage for 100,000 Arkansans in jeopardy.

Here we go again.

Last year, the news in Arkansas was dominated by months of tense debate over health care reform and a major decision for the state. With key provisions of the federal Affordable Care Act set to go into effect in 2014, should the state accept billions of dollars of federal money in order to expand eligibility for the Medicaid program for low-income Arkansans?

Given the strong anti-Obamacare tenor of a campaign that swept in a new Republican majority in the Arkansas General Assembly, the prospects for expansion seemed dicey, if not impossible.

The drama took an unexpected turn in late February when the feds gave the state permission to pursue a unique approach, which became known as the "private option." Arkansas would use Medicaid funds to purchase private health-insurance plans for low-income residents. Republicans took ownership of the new plan, and after a protracted battle at the Capitol, it eventually passed with a bipartisan supermajority in both houses, with Gov. Mike Beebe signing it into law in April.

For Republican backers of the plan like Sen. David Sanders (R-Little Rock), the private option is "innovative, pioneering and transformative." The idea of a conservative version of Medicaid expansion received national attention as well; in recent testimony before the legislature, former Bush administration Health Secretary Michael Leavitt applauded the effort underway: "You couldn't get the federal government to do this countrywide. But you can do it in Arkansas. And when you do, others will follow." But for some conservatives, the plan was a betrayal, relying on an increase in government spending granted by the hated Obamacare. The split within the Republican Party in Arkansas (what Rep. Joe Farrer [R-Austin] calls "the conservatives and the real conservatives") remains raw.

Coverage under the private option just started on Jan. 1, and — even as enrollment in the new marketplaces created by the federal ACA has faced massive hiccups — the implementation of the private option in Arkansas has been going as well as proponents could have hoped, with around 100,000 gaining coverage thus far.

Just as the private option is getting off the ground, its future appears to be in serious jeopardy in the fiscal session of the General Assembly, which begins Feb. 10. In order to continue the policy past the end of the fiscal year this summer, three-fourths of both houses of the legislature must once again approve the appropriation to accept the federal money that funds it. The rump group of Republicans who opposed the policy are gearing up for another fight, and the path to another supermajority is uncertain at best. Rep. Nate Bell (R-Mena), who opposes the private option, said that there was "no question" that as of now, there are enough votes to block the funding. "I think anybody in the Capitol building would agree with that," he said.             

The private option passed last year with one vote to spare in the Senate, but one of the yes votes, Sen. Paul Bookout (D-Jonesboro), resigned in August after a scandal over misuse of campaign funds. In the special election held in mid-January to take his place, Republican John Cooper — who campaigned explicitly on fervent opposition to the private option — easily won the seat by more than a thousand votes. All of a sudden, the margin for error was reduced to zero.

That same week, in an interview with the Times, Sen. Missy Irvin (R-Mountain View) said she was unhappy with the private option and "right now I cannot support it." A few days later, she released a statement with even stronger language: "I am opposed to moving forward and will not vote to fund the appropriation for the private option." 

Speaking of Private Option, Missy Irvin

  • Governmental Accountability Office: feds failed to ensure private option was budget neutral

    September 9, 2014
    A new report from the federal Governmental Accountability Office (GAO) argues that the feds failed to ensure that Arkansas private option would be "budget neutral" and implies that the private option could cost around 24 percent more over the next three years than regular old fee-for-service Medicaid would have. Here's what you need to know... /more/
  • More than 200,000 have gained coverage via the Medicaid expansion private option

    September 8, 2014
    The Department of Human Services today released the latest enrollment figures on the private option, the state's unique plan using Medicaid dollars available via the Affordable Care Act to purchase private health insurance for low-income Arkansans. Through August 31, 205,097 Arkansans have gained coverage. /more/
  • GOP nightmare comes true: Obamacare is working

    September 8, 2014
    Talking Points Memo notes why Republicans have fought so long and hard against advances toward universal health care coverage — it's popular and it helps millions of people. When the message sinks in, voters are more likely to thank those (Democrats) who delivered it than those who opposed it (Republicans.) /more/
  • The Obamacare open line

    August 23, 2014
    Tonight's open line includes news that Arkansas Democrats are rallying around bread-and-butter populist themes — an increase in the minimum wage and support for expansion of health care coverage. (Pssst: That last thing? Just don't call it Obamacare.) /more/
  • Obamacare and the Mark Pryor-Tom Cotton Senate race

    August 21, 2014
    Yesterday, Sen. Mark Pryor did something that got national attention: he released an ad that actually took credit for the benefits of Obamacare. Cotton's response was surprisingly muted. Could this be the latest sign that the Obamacare attack doesn't pack the punch it once did? One key question of the Arkansas Senate race will be what is more politically potent, the name "Obamacare" (which Cotton will repeat while dodging policy specifics) or the law's more popular component parts (which Pryor is beginning to highlight while avoiding actually naming the law). /more/
  • What is it with Arkansas Republicans and the homestead tax exemption?

    August 21, 2014
    Plus, few Arkansas bartenders, confident private option predictions from Gov. Mike Beebe, Arkansas Democrats weak stance on curbing carbon emissions and Bonnie Montgomery and Martin O'Malley. /more/
  • Tom Cotton and the Republicans get desperate

    August 19, 2014
    Tom Cotton and Karl Rove and Co. are growing increasingly desperate and incoherent in attacks on Sen. Mark Pryor, who's proving not so easy to defeat as Republicans once believed. /more/
  • Southern Governors Association talks private option

    August 16, 2014
    Gov. Mike Beebe, as well as governors from Maryland and Kentucky, discussed health care reform and the private option – the unique Arkansas version of Medicaid expansion – at a panel this morning at the Southern Governors Association meeting. Here are a few highlights, including the unique status of Arkansas and Kentucky, the possibility that the private option helped cut disability applications, and why Beebe thinks Arkansas got it right and Louisiana got it wrong. /more/
  • Beebe: minority of legislature won't run over majority to block private option in 2015

    August 16, 2014
    Gov. Mike Beebe hosted a panel this morning on the private option — the state's plan using Medicaid funds to purchase private health insurance for low-income Arkansans — at the Southern Governors Association meeting in downtown Little Rock. Beebe used the occasion to make a prediction — more bold, aggressive and blunt than we're accustomed to from Beebe, nearing the end of his term. The private option isn't going anywhere, Beebe said, because ultimately the overwhelming majority of the legislature supports it. /more/
  • Bill Clinton on private option and Sunni tribal leaders and genomics and Mike Beebe

    August 15, 2014
    Bill Clinton delivered the keynote address at the Southern Governors' Association this afternoon at the Little Rock Marriott. The theme of this year's conference is "Accelerating the American South's R&D Network", which of course Clinton interpreted as free license to riff on everything from welfare reform to the crisis in Ukraine. /more/
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