All eyes— again! — have been on my home state of Arkansas this week as the General Assembly late yesterday passed the “private option,” aka the “Arkansas Plan,” or using Medicaid funds to buy exchange coverage for 250,000 uninsured Arkansans starting next year. This was no small feat, given the structural and political barriers at play. In Arkansas, most appropriation bills must meet the highest bar: a supermajority, or three-fourths vote of each chamber. The measure passed the House on a second attempt with only two votes to spare, and last night the bill squeaked out of the Senate with 28 votes (one to spare).
The votes were close despite the fact that virtually every major interest group in Arkansas backed the bipartisan measure. House and Senate leadership championed the approach as a conservative, private-market solution to cover more Arkansans while taking advantage of available federal funds that will help the state economy, save taxpayer dollars, and protect small businesses and rural hospitals. So why, then, other than the supermajority necessary, was this still such a tough vote for many lawmakers in the General Assembly?
Opponents voted “No” to reinforce their continued opposition to Obamacare, federal spending, and government programs in general. As Say Ahh! readers are well aware, the federal government would pay 100% of the costs for newly covered adults under Medicaid, decreasing to 90% over time. One clear point of contention for conservative members with respect to the private option arises from the potential for increased spending that will help Arkansas coffers but will impact federal spending at the same time (and the issue of whether premium assistance is cost-effective is certainly a live one as my colleague Joan Alker has raised before).
So a major tension for lawmakers on the fence: Do they vote to accept the funds and infuse them into the state economy to cover more people in need of health care, make better use of funds currently spent in ERs, and protect hospitals? Or do they stand firm on ideological grounds about federal spending and stay true to their record opposing Obamacare?
Ultimately, after political deals and amendments to appease nervous lawmakers, a bipartisan, supermajority of Arkansas legislators chose the practical path forward to help the thousands of Arkansans who desperately need health care and can’t get it today. (Arkansas Advocates for Children and Families tells some of their stories here.)
So now what? Several steps remain before this vote becomes a reality, including federal approval by HHS for the necessary waiver proposal and required public input process that will that come next. (Be sure to watch Say Ahhh! for a future post from our resident Medicaid waiver watcher Joan Alker for her take on what this might signal for waivers and premium assistance options moving forward.) Last but certainly not least, many questions remain about the intent of this bill to move children from ARKids First B, or CHIP, into this new private option—a move that we think is ill-advised at the moment. (See my previous rant blog post on the subject.)
But make no mistake—this is progress. Even as we learn more about details and next steps, yesterday’s vote cleared a major hurdle to cover thousands of uninsured adults, many of them parents and others important in the lives of children. And it signaled to the rest of the country that practical, bipartisan progress to get families the health care they need is well within reach.