House approves Medicaid budget on second try 

click to enlarge YES TO MEDICAID: The Arkansas House of Representatives after Tuesday's vote. - BENJAMIN HARDY
  • Benjamin Hardy
  • YES TO MEDICAID: The Arkansas House of Representatives after Tuesday's vote.

The Arkansas House of Representatives narrowly approved a bill to fund the state's Medicaid program on Tuesday, completing legislative action on the appropriation and handing a victory to Governor Hutchinson.

The passage of Senate Bill 99 suggests state lawmakers no longer have the appetite to seriously pursue a rollback of Medicaid expansion, which provides health insurance to some 235,000 low-income adult Arkansans. The Medicaid expansion was created by the Affordable Care Act, or Obamacare. Hutchinson has rebranded the program "Arkansas Works."

In previous legislative sessions, a group of Republican legislators defied the governor and repeatedly held up the annual Medicaid budget in an attempt to end the expansion program. Last week, it appeared as if the House might renew those efforts. When the bill first came up for a vote on Friday, the chamber rejected it by a wide margin, 52-28. Twenty members voted "present" or did not vote. In Arkansas, budget bills require a three-fourths supermajority in both the House and the Senate.

On Tuesday, SB 99 achieved the minimum threshold necessary for passage, 75-18, with 7 members not voting or voting "present." It has already passed the Senate.

The failed vote on Friday was largely a response to a federal judge's order, handed down the previous day, that ended Arkansas's work requirement for certain Medicaid expansion beneficiaries. The first-in-the-nation mandate, which required beneficiaries to report "work activities" to the state each month or lose coverage, was Hutchinson's signature effort to push the Medicaid program in a more conservative direction. Over 18,000 people were stripped of health coverage in 2018 for not reporting work hours. Of those, only about 2,000 have re-enrolled in Medicaid.

U.S. District Judge James E. Boasberg ruled last week that the Trump administration overstepped its authority in approving a waiver allowing Arkansas to create the work requirement. The governor has asked federal officials to appeal Boasberg's decision — but he also wants to keep Medicaid expansion as a whole, which provides a net benefit to the state budget due to the program's generous federal spending.

Last week, Hutchinson framed the adverse court ruling on the work requirement as a reason for the legislature to pass the Medicaid budget: The state can't pursue an appeal of Boasberg's ruling if it ends the expansion program entirely.

"This is a key part of my budget and provides essential funding for health care needs of those Arkansans who are struggling financially," Hutchinson said in a statement after the successful House vote on Tuesday. "This appropriation also allows us to continue the fight for reform, such as the work requirement."

State Rep. Stephen Meeks (R-Greenbrier), who voted "no" on Friday but "yes" on Tuesday, reiterated the governor's argument when asked why he changed his vote.

"If we pull the work requirement out of our budget, we’ll be admitting defeat, and it could derail the effort to include work requirements across the nation. We have to pass a budget with the work requirement in order to encourage [the Trump administration] to appeal," Meeks wrote in an email.

Other Republican legislators who switched from a "no" to a "yes" said they simply had wanted more time to process Boasberg's ruling.

"The Governor and [the state Department of Human Services] met with our caucus on Monday. My concerns were addressed," Rep. Julie Mayberry (R-Hensley) wrote in an email. "I had wished it was in a more public setting so that the public could also hear the response but I now have information that makes me feel more comfortable moving forward."

J.R. Davis, a spokesman for Hutchinson, confirmed the governor met with legislators yesterday to allay their concerns and emphasize that "we have the chance to lead" on the work requirement policy. Davis said federal officials have not yet indicated to the governor's office whether the ruling will be appealed.

"They're still looking at strategic options ... . We're staying in touch with them," he said.

Not all Republicans were persuaded by the governor. Rep. Mary Bentley (R-Perryville) spoke against the Medicaid appropriation before Tuesday's vote, noting that a recent increase to the state's minimum wage could increase spending on low-wage health workers.

"We’re going to see tens of millions of dollars increased in Medicaid. We’re in trouble, and I’m going to vote against this bill today because ... we need a plan for the future and I just don’t see one," Bentley said.

Democrats were united in their support for the Medicaid appropriation. Rep. Vivian Flowers (D-Pine Bluff) spoke in favor of the bill.

"I, like many of you, have concerns. ... But no matter what, we still have a responsibility to our constituents. We still have children. We still have seniors in nursing homes. We still have people who work every day who are relying on us to make sure we take care of them and they are not left out in the cold," she said.

In addition to the Medicaid expansion — which covers low-income adults — the budget bill also included funding for "traditional" Medicaid programs, including insurance for children, the elderly and disabled people. The bulk of the $8.1 billion appropriation comes from the federal government. The bill's sponsor said last week that the state's share of the cost was $1.3 billion in general revenue. Most of that amount will go toward traditional Medicaid groups. The expansion group is expected to cost Arkansas $135 million in state general revenue for the current fiscal year.

Democrats introduced a bill Monday that would automatically reinstate insurance to former Medicaid beneficiaries who lost coverage last year as a result of noncompliance with the work requirement. House Bill 1966, sponsored by Rep. Reginald Murdock (Marianna) and Rep. Andrew Collins (Little Rock), would require the state to notify those individuals their coverage was reinstated. The governor opposes the measure.

This reporting is published courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.

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