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The future of the private option 

It could turn on the results of two state Senate races.

click to enlarge TOO CLOSE TO CALL: Robert Thompson is one of two Democrats in tight Senate races.
  • TOO CLOSE TO CALL: Robert Thompson is one of two Democrats in tight Senate races.

"This election in this Senate district is going to determine the future of the private option," said Rep. James McLean (D-Batesville), vying for an open state Senate seat against Republican Linda Collins-Smith of Pocahontas, a Tea Party stalwart and diehard opponent of the private option.

McLean could be right. Most local politicos are focusing on the tight race for control of the Arkansas House (see our story on p. 19). The Senate won't be changing hands, with just a handful of contested races and Republicans with a healthy 22-13 majority. But Democrats are defending a couple of seats in the northeastern corner of the state that could have a huge impact on the private option, the state's unique policy that uses Medicaid funds to purchase private health insurance for low-income Arkansans.

It takes 75 percent supermajorities in both the House and Senate to appropriate the federal funds that pay for the private option. The policy barely got over the finish line in both 2013 and 2014 after protracted battles; it passed in the Senate this year with no votes to spare. Two Senate seats held by pro-private option Republicans were seized in the GOP primaries by candidates who campaigned explicitly on opposition to the policy. That doesn't mean it's over; most believe that it's at least possible to flip two votes to reauthorize the policy again next year. But if the private option loses another Yea vote? Or two? Yikes.

In the House, regardless of what happens this November, things have a way of working themselves out. Finding 75 votes in a big body, with plenty of places to hide, and lots of fence sitters to aim for, is an easier task than in the Senate, where just nine votes can derail the private option (and where the "Hell No" caucus is anchored by at least half a dozen immoveable opponents).

The private option's survival, then, could depend on whether 1) McLean can win a tossup race against Collins-Smith for the District 19 seat vacated by Democrat David Wyatt, who opted not to run for re-election, and 2) potentially whether District 20 Sen. Robert Thompson (D-Paragould), who won a squeaker in 2012, can fend off a rematch challenge from Republican Blake Johnson, whose position on the private option remains somewhat murky.

"[Collins-Smith] doesn't have anything to run on except Obamacare," McLean told the Times (like the private option's Republican proponents, McLean draws a distinction between the state's policy and the federal law that funds it). "She has said that she is bitterly opposed to the private option, and she's committed to ending it. Which is a vote against the largest employer in this Senate district."

This is a point that McLean hammers home a lot: White River Medical Center and affiliated hospitals and clinics in 10 communities in the area employ more than 1,200 people.

"It has been the engine that's floated our boat for the last 10 years when we've lost industry," McLean said. "I have a hard time understanding someone who is pro-business and claims to want to invest in the economy and grow jobs can immediately, on day one, vote against the largest employer in the Senate district. She has no answer to that. She cannot go and explain to the employees of White River Medical Center and their families why she's going to vote against it except for purely ideological reasons. That's where we're at and that's what this election is going to be about."

The private option has helped to get struggling medical facilities on their feet, McLean said.

"Prior to the private option they were losing millions of dollars each year," he said. "Because of the private option they've been able to build a stand-alone emergency room in Sharp County, which was badly needed, they're continuing to provide service at Stone County with the hospital up there, and they have a multitude of small clinics spread throughout this five-county area. This is a big deal. She is putting the hospitals and small clinics providing people health care in small communities at risk. She is committed to putting politics before people. She is putting a rigid, radical ideology before the people that she professes to want to represent. To me, that's just unconscionable. Linda Collins-Smith has said 'I'm going to vote against the private option and I don't care.' She needs to be held accountable for that. She needs to explain to the business community — is she going to be someone who has your back, or is she somebody who's going to be committed to the Tea Party talking points and cut off your nose to spite your face."

The right-wing Collins-Smith, a former state representative who owns a Days Inn in Pocahontas, was ostensibly a Democrat until flipping to the GOP in a failed bid for Senate District 19 in 2012. She did not respond to numerous requests for an interview.

Meanwhile, another decisive race is playing out next door in Senate District 20, a rural area nestled against the Missouri bootheel. Thompson, one of the Senate's strongest supporters of the private option, is facing a tough challenge from Johnson in a rematch of a 2012 race that Thompson won by a margin of fewer than 500 votes.

Johnson, a soybean farmer, is not a fan of the private option, but he won't say whether or not he'd vote the policy down in 2015 if he should win.

"It is not a good system as it is ... it is not sustainable as it is," he stated. "You don't know if the federal reimbursement is going to stay until the end of the three-year period ... we're over those federal caps, we're almost $20 per person [over], and that is a concern." Johnson also cited the Government Accountability Office report this fall that indicated expansion of traditional Medicaid would have cost less than the private approach. Does that mean he would have pushed for traditional Medicaid instead in 2013, if he'd been in office then? "I probably would have," he said.

When pressed to state whether he'd vote the private option up or down, though, Johnson said, "It's not an action of today," and the answer was "not as simple as yes or no." Still, he indicated that he does not see the private option itself as a necessity, and asked, "Do you put the wants before the needs as a state?"

Given the great pressure that legislators will be under in 2015 to vote yes, it seems like Johnson might not be a solid no; on the other hand, he's been supported by Conduit For Action, the "dark money" conservative group created for the express purpose of opposing the private option. It's hard to know which way Johnson is hedging: Is he placating Conduit and the hardliners, or is he placating the powerful hospitals in his district that want the private option?

Thompson, who practices law in Paragould, said he's met with administrators from all four hospitals about the private option. "To the one, every administrator said not only has it been an unqualified success in terms of providing care through our hospital, but also taking it away would be devastating. So, I'm proud to support it." Thompson also believes perception of the policy in conservative rural Arkansas is slowly but surely changing.

"I do think the importance of the private option is sort of seeping down to people — especially people who work in health care, but also the general public," he said. "I spoke with one woman who is in her early 30s. She's had a back condition her entire life and didn't understand what it was. She never had health insurance. She received insurance through the private option and now she's receiving treatment for a congenital problem with her spinal cord. I've heard a number of anecdotes like that."

So where are things headed in the legislature in 2015, then? "I'll let you know on Nov. 5th," Thompson said.

McLean is adamant about the stakes in this election, saying that if Collins-Smith wins, he believes "the private option is dead. You're going to have too many radicals in the Senate to do anything. It's over with."

The private option has been declared dead before, so even if the aginners gain another vote in the Senate, it remains to be seen whether a rump minority of legislators will succeed in blocking billions in federal money flowing into the state and kicking more than 200,000 Arkansans off of their health insurance. Still, if either McLean or Thompson loses, reauthorization becomes a much steeper climb and the future of the private option would be very much in doubt.

"I'm going to vote for the private option," McLean said. "She is not. The impacts are huge."

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