Medicaid expansion nears the finish line | Arkansas Blog

Wednesday, April 20, 2016

Medicaid expansion nears the finish line

Posted By on Wed, Apr 20, 2016 at 10:03 AM

click to enlarge HESTER: "When I realized I was not willing to shut down Medicaid, then it was like, what are we going to do now?"
  • HESTER: "When I realized I was not willing to shut down Medicaid, then it was like, what are we going to do now?"

All indications are that the Medicaid expansion will be re-authorized in Arkansas, likely by the end of this week. 

The Senate is expected to take up the Medical Services appropriation this afternoon, which includes the Medicaid budget and funding for "Arkansas Works," Gov. Asa Hutchinson's plan to continue the private option Medicaid expansion. The appropriation also includes an amendment that purports to end "Arkansas Works," but the governor has pledged to line-item-veto this amendment.

The elaborate procedural game was set up to break the impasse in the Senate, where ten senators were threatening to block the entire Medicaid budget in order to try to stop the private option. At least three of the Tea Party Ten are expected to surrender and move forward with the appropriation knowing that the the governor will use his line item veto power to continue the private option. 

The dummy amendment was revised yesterday, at the urging of Democratic lawmakers, to try to ensure that the scheme is on more sound legal footing. Rep. Bob Ballinger, a diehard opponent of the private option, said yesterday that a lawsuit was inevitable. Backers of "Arkansas Works" from both parties expressed confidence that it would withstand a legal challenge. 

Senate President Jonathan Dismang and Senate Minority Leader Keith Ingram both said that they expected that the amended appropriation would pass the Senate this afternoon. 

Nearly all of the "Arkansas Works" backers are expected to vote for the appropriation. The one question mark is Sen. Stephanie Flowers, who has expressed skepticism about the weird procedural process. Both Ingram and Dismang said this morning that they were not sure how she would vote; she was not in attendance at Joint Budget and I have not been able to reach her for comment. 

Even if Flowers doesn't vote for the appropriation, backers of the plan likely have a cushion because at least three of the Tea Party Ten are reportedly voting for the appropriation and "Arkansas Works" backers only needed to flip two to get the supermajority. 

Sen. Bart Hester and Sen. Blake Johnson have said they would back the plan; Sen. Missy Irvin is rumored to be the third but has declined to comment. 

Hester said that he was going to vote for the appropriation because it was in fact the bill he was asking for (even though he is not getting the result he wants in the end). 

"Certainly I understand the governor intends to veto it," Hester said. "I've voted for many bills that I knew Gov. Beebe was going to veto. Sometimes you vote for the bill you think is right and the governor's the governor." 

"I lost the fight," Hester admitted. "But the fight is not over. I don't think the policy is good." Hester said that there could be appropriation battles in the future. 

But the truth is that it's hard to imagine how the Tea Party Ten can win an appropriation fight as long as, well, there's only ten of them. Hester is backing down in large part because he's painted into a corner: the Ten had the votes to block the Medicaid budget but they had nowhere close to the votes to actually pass anything.

The only thing the Ten ever had was a threat, and it was an ugly one: They said that if the majority didn't cave to their demands, they would shut down the Medicaid program (that includes the elderly in nursing homes, children on ARKids, the severely disabled, medical services for foster children, and much more). They only had leverage insofar as they could make a credible threat to unleash a humanitarian catastrophe on the state of Arkansas. 

In the end, despite his talk of "hard chicken," that was not a cliff that Hester was willing to drive off. 

"We're 68 days away from a Medicaid shutdown," he said. "You can get down here and get closed away from the world and just think about X's and O's and numbers, but the reality is there's so many people that affects."

The bottom line, said Hester: "When I realized I was not willing to shut down Medicaid, then it was like, what are we going to do now?" 

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

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