'Private option' Medicaid expansion bill passes Arkansas Senate, on to governor | Arkansas Blog

Wednesday, April 17, 2013

'Private option' Medicaid expansion bill passes Arkansas Senate, on to governor

Posted By on Wed, Apr 17, 2013 at 6:29 PM

David Sanders Missy Irvin
  • Sen. Sanders and Sen. Irvin explain the amendment.

bruce westerman cecile bledsoe image
  • BACKROOM: Westerman with Bledsoe in the Members only room outside of Public Health

UPDATE:The Senate approves the appropriation 28-7. The "private option" will be headed to the governor's desk.

***Sen. Hendren and Sen. King raise objections to the lack of amendments in the appropriation bill given the amendments to the enabling legislation.

***Sen. Hester says the amendment "fundamentally changes nothing that made me oppose this bill" and gives anti-government boilerplate. Sen. Hendren follows up with more of the same. The senators look very sleepy. Hendren said opposition didn't mean that he didn't care about those in need — "it is about how we express the care we all share for how we take care of those people." He mentions his granddaughter and the national debt. "That's the future I'm leaving to Haley Ray," he says.

***Sen. Hutchinson says "until recently I was not planning to vote for this bill." He says "unfortunately we will not see any debt reduction if we say no to this." Quotes Barry Goldwater. He says that this is an opportunity to reform "entitlement programs." He called the private option "a down payment" on future reform.

***Sen. Clark takes out a little time to slam Mike Ross, the Chamber of Commerce, and hospitals. He complains about free cell phones. Kind of a hodge-podge approach to arguing against the private option. He also says the federal debt will blow "like Mount Vesuvius."

***Sen. Irvin, the key swing vote, says she has "done everything in my power that I know how to do in order to make a thoughtful choice...What changed for me overnight was listening to everyone in the state, listening to town hall meetings, listening to my colleagues, to my constituents."

After the jump, previous updates.

UPDATE 36:There is going to be some procedural back-and-forth with the enabling legislation but the key vote is the Senate appropriation. They're taking it up on the Senate floor shortly.

UPDATE 35: Senate Public Health approves the amendments. All of the questioning was from Democrats. Sen. Flowers called the amendment a "regurgitation" of the bill, made more explicit. Flowers asked, regarding the amendments' goals, "Would you say it was generally addressed in the original bill?" Finally, baffling everyone, Flowers asked for a roll call on the emergency clause. The bill will now head to the Senate floor, where they will re-vote on the enabling legislation and vote on the appropriation. If they get 27 votes, this goose is cooked.

*UPDATE 34: House Public Health approves the amendments. You can read them here. The amendments basically cover the information articulated in UPDATE 32. These are relatively minor changes. They are now discussing the amendments in Senate Public Health. Lot more talking, grandstanding, and so forth to come tonight — but barring some catastrophe, the "private option" is going to be enacted in Arkansas.

westerman stubblefield image
  • NEW BEST FRIENDS: Westerman never left Stubblefield's side

*UPDATE 33: Sen. Irvin and Sen. Sanders are explaining the amendment to the House Public Health committee. Irvin called them "transformative," which appears to be a stretch. In questioning, Meeks and Harris advocated for a block grant with a hard cap, which would be a MUCH worse deal for the state. Still focused on that 0.0008 percent impact on the national debt.

*UPDATE 32: Just now, Gov. Mike Beebe told reporters that the amendments make the use of the 1115 waiver explicit as opposed to implicit; make explicit that businesses won't have to pay the employer mandate penalty for folks covered under the private option exchange; and the request for Health Savings Accounts will be for a larger program than the pilot program currently envisioned.

UPDATE 31: Roby Brock tweets what I've been hearing: that the amendment "will put in ALL CAPS what's in the fine print." Brock also tweets that he wouldn't be surprised if there were more than 27 votes on the appropriation. I agree.

UPDATE 30: What are the amendments? Rep. Darrin Williams said on the House floor that it includes assurances that businesses wouldn't have to pay a penalty for people in the exchanges. I've also heard Sen. Irvin wanted language strengthening or specifying the goal of a Health Savings Account pilot program (this is not tied to the severability clause). All of this is in the territory of more strength, clarity, or details for features already in the existing bill. Still sounds like the amendments are tweaks, not a poison pill that would jeopardize federal approval.

UPDATE 29: Procedural mazes abound. The vote on SB 1020 has been expunged and is being sent to the House. The vote on HB 1143 has been expunged and heads to Senate committee for amendment. I am glad I am not a parliamentarian. Still appears that the "private option" is close to being enacted, but it might be a late night.

They're heading back up to the Senate to expunge the vote on the enabling legislation. Then they'll be able to send it to committee. We're going to be here all night.

UPDATE 27: Yikes. Meeks tweets that "Rep @john_burris says he believes one of the amendments is about a Section 1115 global waiver which is complete flexibility." That sounds like a poison pill if it's attached to the severability clause. Burris knows that so seems implausible. We'll see... That global waiver rumor is wrong — the "private option" instead will rely on an 1115 demonstration waiver. It sounds like the amendment may be simply strengthening the language around the demonstration waiver that's already required in the bill.

UPDATE 26: Tweet from Rep. David Meeks: "Rep @john_burris speaking from the well. The amendment would give the state more flexibility. He wasn't specific about what they were." There's a little bit of confusion at this point — procedurally, does the House first need to send it to the Senate floor?

UPDATE 25: Roby Brock has more speculation on what the amendment might be.

UPDATE 24: Hester, Westerman, and others are lingering in Public Health, presumably to give one last set of pleas (dirty looks?) to Irvin when she arrives. That's the last chance for opponents (unless it turns out that the appropriation actually needs to be amended).

The meeting starts at the call of the chair. And the chair is Sen. Cecile Bledsoe, who opposes the "private option." Possibility for shenanigans? Unlikely, as the Senate has a procedural maneuver available to extract the bill from committee if necessary, not to mention the fact that Bledsoe and Irvin are good friends.

*UPDATE 23: Westerman seems to be holding out hope that the appropriation will also need to be amended, which would complicate things to say the least. But Senators on both sides have indicated that's not the case.

*UPDATE 22: What's the amendment that puts the "private option" over the top? Nobody knows. Heard rumors about extra triggers, something related to veterans, provider payments, and state flexibility. Consensus is that whatever it is, it's relatively minor. (The provider payment issue is likely a big one for Irvin, whose husband and father are both doctors.)

*UPDATE 21: Looking more and more like this is a done deal. The Public Health committee meeting will be at 3:30 or 4:00, after Joint Budget lets out.

*UPDATE 20: If the appropriation passes this afternoon, it's a done deal for all intents and purposes. Final steps: House committee and full House need to concur in amendment to the enabling legislation with a simple majority.

*UPDATE 19: Senate adjourned for Joint Budget and Public Health committees. They're going to take up the amendment in Public Health shortly and then apparently it's going back to the Senate floor for a vote on the appropriation.

*UPDATE 18: I have heard that the amendment would be a minor tweak that won't impact federal approval, and not a Westerman-style poison pill. That's the key question at this point.

*UPDATE 17: Senate Public Health will meet around 4 p.m. today to take up the amendments to the enabling legislation. Enabling legislation as amended would then need a simple majority in both the House and Senate. Sounds like they would at that point have the votes to get the appropriation in the Senate but there is A LOT that could go wrong along the way.

*UPDATE 16: Sending the enabling legislation back to committee for tweaks fits with the narrative I've heard and is likely part of closing the deal. But it does add an additional hurdle, making things dicier than if they had the 27 now.

*UPDATE 15: The Senate has come to order. They're referring the enabling legislation to Senate Public Health for purposes of amendment.

*UPDATE 14: Keep hearing that there is a possibility of minor language changes in the enabling legislation.

On the appropriation, if I had to predict: I think they have it, with Irvin voting YES. But that's really more of a guess than a prediction.

*UPDATE 13: Twitter speculation: The D-G's Sarah Wire notes that two of the three "private option" bill sponsors are in Senate Public Health and not out whipping votes. She wonders whether this means a deal has been reached. Our own Max Brantley wonders whether they have 27 and are playing for one or two more so no one can be singled out as THE vote.

*UPDATE 12: I'm told there is likely to be a vote this afternoon. We'll see. Bill proponents are more confident than you'd think. There's a possibility of some very minor tweaking to address concerns. The swing votes remain Irvin, Stubblefield, and Williams. Multiple folks have told me that Williams has made up his mind but won't tell anyone, so the fact that he's not getting hounded doesn't necessarily mean he's still a NO. As noted below, Westerman was constantly in Stubblefield's ear on the floor. I'm now told that Stubblefield is currently at OW Pizza with Sen. King and Sen. Hester, both strong NOs. Oh to be a fly on the wall.

As Max noted below, the House is holding up tax-cut bills — they likely don't happen if the "private option" goes down.

*UPDATE 11: Senate recesses, will come back 1:30 p.m. this afternoon. Sure seems like Williams is no longer a swing vote and the focus is on Irvin.

*UPDATE 10: Seems very likely they'll recess, go to committees, and try again this afternoon.

*UPDATE 9: Multiple members leaving the floor, pouring into the west wing. This is likely to drag on for a while, perhaps with a delay until later today.

*UPDATE 8: House Speaker Davy Carter has apparently left the House. Is he coming to Senate?

*UPDATE 7: Still no sign of Irvin on the floor. No one is talking to Williams, which makes me think he's not much of a swing vote at this point. Medicaid Director Andy Allison just left gallery to speak with lawmakers.

*UPDATE 6: Westerman is attached to Stubblefield at the hip. Westerman's Congressional run is in better shape if this goes down, so he's working over time.

*UPDATE 5: Senator Missy Irvin is not on the floor. She is considered a possible swing vote.

*UPDATE 4: Hearing from several sources that they're not going to take it up this morning but no confirmation on that. Lots of intense whispering on the floor between lawmakers on both sides. Westerman is lobbying hard.

*UPDATE 3: Senate has come to order. They're going through other business and bills.

*UPDATE 2: Late start. Presumably trying to wrangle #27. I'll report the debate if there is one, refresh this page for updates.

*UPDATE 1: Sounds like they're still stuck at 26. Some talk that they'll pass over the appropriation vote this morning and postpone until later today.

APPRECIATE A GOOD VOTE: Gallery packed in Senate for Medicaid expansion bill vote.
  • David Goins/Fox 16
  • APPRECIATE A GOOD VOTE: Gallery packed in Senate for Medicaid expansion bill vote.

The Arkansas Senate is expected to take up the appropriation for the "private option" bill this morning, with a super-majority needed to accept the federal money to enact the plan. Sen. Jason Rapert and Sen. Jeremy Hutchinson are expected to vote for it, putting the count one shy of the needed 27 (24 voted for the enabling legislation last week).

Sen. Eddie Joe Williams is the swing vote, with a couple of other current NO votes thought to possibly be in play if Williams is not. Right now, all indications are that they're stuck on 26. T

There's a pretty good chance they'll vote more than once today.

The Senate doesn't live-stream their proceedings, but I will update from the floor when they convene.

NOTE FROM MAX: If the Senate refuses to vote for Medicaid expansion, some $110 million-plus in tax cuts should be dead. Plus, the revenue stabilization bill, otherwise due to come out of committee this morning, will suddenly be problematic.

jason rapert image
  • LOOKING FOR 27: Sen. Rapert, Rep. Westerman, and Sen. Stubblefield talk on the Senate floor

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