The tight margins in the Senate make steep hurdle for continuation of the private option | Arkansas Blog

Monday, February 15, 2016

The tight margins in the Senate make steep hurdle for continuation of the private option

Posted By on Mon, Feb 15, 2016 at 9:03 AM

click to enlarge HUTCHINSON: With margins extremely tight in the Senate, the governor will need to use every trick he's got to nab a supermajority for the private option. - BRIAN CHILSON
  • Brian Chilson
  • HUTCHINSON: With margins extremely tight in the Senate, the governor will need to use every trick he's got to nab a supermajority for the private option.
Gov. Asa Hutchinson has done a masterful job of navigating the treacherous politics of the private option since he was elected in the anti-Obamacare wave of 2014, but he'll face his biggest challenge yet this April, when the General Assembly convenes for a special session to decide the fate of the policy. In particular, vote counters in the Senate worry that the numbers put the future of the PO in real jeopardy. 

Hutchinson wants to continue the private option with conservative tweaks, and he'll present his revised version of the policy to the Health Reform Legislative Task Force on Wednesday. Hutchinson is expected to announce that most of his requested changes have been agreed to by the federal government. The task force, which has been generally receptive to the framework presented by the governor, is expected to recommend approval next month. 

But the future of the private option gets a lot dicier come April, when it will need supermajority approval in both houses of the General Assembly. Technically, the enabling legislation up for vote only needs a simple majority, but the appropriation could be blocked by a rump group of 26 percent in the House or Senate. In other words, a tiny minority of aginners could shut down the entire Medicaid budget if they didn't get their way on the private option. Thus, in practice, the governor's team is pursuing a supermajority threshold in order to enact "Arkansas Works," the governor's name for the private option with his requested conservative bells and whistles added. 

A supermajority threshold is an incredibly steep climb for any contested matter and it can start to seem downright impossible on a controversial issue like Obamacare funding. Of course, the PO managed to get over the finish line in 2013 and 2014 after knock-down, drag-out fights. And Hutchinson easily enacted his plan in 2015 to keep the PO for two years and create a task force to figure out what to do next — with room to spare. The task force, meanwhile — despite having previous diehard PO opponents like Rep. David Meeks, Rep. Joe Farrer, Sen. John Cooper, Sen. Cecile Bledsoe, Sen. Jim Hendren, and others — has been generally open to continuing the PO with the governor's changes. 

But any hope of a smooth ride in the coming special session came to an end when Sen. Terry Rice quit the task force in protest over "Arkansas Works." The fight coming in April might be the toughest one yet, because the legislature is even more dominated by anti-Obamacare zealots who campaigned explicitly against the private option. In 2015, the General Assembly essentially kicked the can down the road and bought the governor some time. That papered over the deep split within the GOP on this issue. This time around, it will no longer be possible to hide between vague promises of "ending the private option" and coming up with something better. The aginners haven't backed down an inch despite the tweaks added by the governor, and they're now gearing up for yet another try to kill the coverage expansion and kick 250,000 Arkansans off of their health insurance. 

With enough cajoling and horsetrading, the governor can probably find a way to 75 percent in the House, where vote counts are fluid and it's easier for members to hide in the 100-member body. But in the Senate, just nine senators can hold up the train. The numbers are extremely tricky. According to sources at the Capitol, seven senators are basically immovable No votes: Rice, Scott Flippo, Linda Collins-Smith, Bart Hester, Gary Stubblefield, Bryan King, and Blake Johnson (Johnson is ideologically more establishment than Tea Party but sources say he feels beholden to Conduit for Action, the anti-PO advocacy group funded by Fayetteville businessman Joe Maynard, which helped work to elect Johnson in 2014).  

The margins, in other words, are incredibly tight. The aginners have a firewall of seven locked-in No votes and they only need to pick off two to threaten to shut down the Medicaid budget. And there are places to pick: Alan Clark, Missy Irvin, and Greg Standridge are all thought to lean No, though vote counters believe they could be persuadable. The governor's team will have to persuade two of those three or the coverage expansion dies. Bledsoe and Hendren are also said to be skeptical of "Arkansas Works", though most believe they'll eventually back the governor (both have personal connections — Bledsoe's son is the governor's surgeon general; Hendren is the governor's nephew). 

On the one hand, you might say we've seen this movie before. The PO has looked like it was in real trouble countless times. I remember when John Cooper was elected and some claimed the private option was dead. Or when Missy Irving flipped to a No in 2014 and the obituaries started again. Or when the last election brought in a wave of aginners. The truth is that for all of the bluster, ending the PO would be a political and policy catastrophe: The state would lose billions in federal money flowing in to the state's economy, the hospitals would be hit with more than a billion dollars in uncompensated care costs, the state budget would be hundreds of millions of dollars in the hole, and of course the state would have to send out 250,000 cancellation letters to its low-income residents. Hutchinson knows all of this, and of course many of the most powerful interests in the state are lined up behind the PO. We'll soon see two budgets — one with and one without the PO — and the potential pain will suddenly become real to a whole new slate of stakeholders. There's also $750 million (and $2 billion in federal matching funds) in highway funding that Hutchinson has been adamant is dependent on keeping the coverage expansion and benefiting from its net revenues.

The problem is that at least seven senators just don't care. No matter what, they're going to vote to shut down the Medicaid budget until the PO, or whatever the governor wants to brand it, goes away. If they can get two more (and they probably have more than enough if the vote was held today), Arkansas could become the first state in the nation to turn back on Medicaid expansion, snatching health insurance from hundreds of thousands of its neediest citizens in the process. 

Governors have plenty of tools at their disposal to try and twist some arms, and of course Hutchinson is actually better equipped to cajole Republicans than Gov. Mike Beebe, a Democrat was. This is setting up to be the biggest political battle of his governorship and he'll need every tool he's got. 

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

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