By JOHN HOFHEIMER
Leader senior staff writer
The posturing, debate, arm twisting and horse trading that will inform the General Assembly’s decision on whether to fund private- option health care for about 200,000 Arkansans gets underway in earnest Monday, when the 2014 fiscal session begins.
A year ago, an alliance of Republican and Democratic legislators, health-care professionals and Gov. Mike Beebe found an innovative way to implement the Affordable Care Act in Arkansas — made all-the-more difficult because both houses of the Assembly had to approve the issue with a 75 percent vote.
Federal approval of Arkansas’ unique private option to Medicaid expansion came after Beebe and legislators traveled to Washington to meet with Health and Human Services Secretary Kathleen Sebelius.
Now, as other states such as Penn-sylvania look to Little Rock for the Arkansas solution, funding for the state’s private option alternative is in doubt. And it’s not even the state’s money that would be spent. It’s federal money.
That same alliance must get another 75 percent approval to fund — to actually accept and spend federal funds — on the health care reform bill they passed in last year’s session.
Beebe said the state budget could implode if lawmakers don’t approve the funding and thus don’t receive the expected funding from the federal government.
House Speaker Davy Carter (R-Cabot) is a banker who knows how to count votes, and he says he’ll depend on those who helped pass this bill last time.
Carter said the private option and the budget are the two biggest items by far that the General Assembly will consider. He thinks debate will begin soon after the session convenes Monday.
CARTER OPTIMISTIC
“I’m very optimistic that we’ll move forward and continue to fund it,” Carter said Monday. “It’s been debated, and it should pass.”
Carter, who sets the House calendar, said he thought it could be passed within a week to 10 days.
He said failure to approve the funding could cost the state $80 million to $100 million and create a shortfall that would have to be made up at the detriment of other needs, including new prison beds to ease overcrowding.
“We’re leading the country on health care,” Carter said. He also said if the state loses private-option funding there would be an $89 million decrease in revenue immediately, small business could face fines up to $38 million and hospitals and clinics may be forced to close.
UNJUST ACTION
Carter said, “If we don’t pass this, it will affect the budget from A to Z. Everything except K-12 education.”
He said people are already lobbying on both sides.
“It’s unjust to pull up before we get started,” Carter said. “A lot of people made decisions based on what we said we’re going to do.”
Carter, who was at ground zero during the last session, said he would rely on some of the same people to pass the funding. In the House, that includes John Burris and, in the Senate, David Sanders, Dismang and Michael Lamoureux.
Carter said there was overwhelming opposition to Obamacare, but that was an issue for representatives in Washington.
The challenge now is to “roll our sleeves up” and make Arkansas’ private option the best health care implemented in all 50 states, he said.
Sen. Jonathan Dismang, (R-Searcy) is reluctant to talk about strategy for getting the votes to fund the program. Getting the facts to the legislators is the key, he said.
“It goes back to making sure members have the information to make an educated vote,” Dismang said.
The $89 million budget shortfall that has been talked about has been verified by the Legislative Audit, he said. “If it is voted down, I can’t predict the action of the other side,” Dismang said, adding, “I’m surprised to be at the point that we are.”
WRECKS BUDGET
But Rep. Jim Nickels (D- Sherwood) said he’d be surprised to see private-option funding come to a vote before the close of a three-week filing period for office seekers at noon March 3.
That could limit challenges to incumbents based upon their private-option vote, he said.
Nickels said, “We have 100,000 covered. I can’t see the state Legislature kicking these folks to the street.”
If it’s not funded, it wrecks the budget, Nickels said. The General Assembly approved tax cuts after approving the private option because of the federal money that would be generated from it.
He said Blue Cross/Blue Shield has maybe 88 percent of the new private-option business in Arkansas. He said some doctors are concerned about the fee structure, which tends to favor general practitioners over specialists, such as OBGYNs.
First of all, Arkansas Blue Cross/Blue Shield is the only company to offer the private-option Medicaid insurance in every county. In many counties, it’s the only company that agreed to offer insurance, according to Max Greenwood, a Blue Cross spokeswoman.
She said primary care physicians and specialists might earn less under the new plan than in traditional private insurance because the company had to keep costs down to keep premiums down.
Specialists are still getting twice as much as they would through the traditional Medicaid. “There is no change in primary care reimbursement,” Greenwood said.
WE’RE LISTENING
“We’re listening to their concerns,” she said. At same time, “we are trying to have them understand that our premium rates were based on these reimbursement schedules,” Greenwood continued. But, “traditional Medicaid allows a little over $1,200 for a normal delivery, while the new fee schedule allows $2,500.
“It’s something that people have talked to us about and we’re listening to their concerns. But it seems like a contract issue between physicians and the private insurer,” she said.
Sen. Eddie Joe Williams (R-Cabot) says he believes a compromise is possible, but he’s not willing to say what it might be.
“I make daily phone calls,” he said. “But it’s still a long way off.”
Williams said he voted for the private option in 2013, but he was not one of its biggest supporters. “I asked what will we do with the people who signed up if this thing collapses,” he said. “A substantial number that have signed up have come out of state programs,” he said.
NECK AND NECK
“Neck and neck” is Rep. Doug House’s view of the upcoming legislative vote on the private option.
House, the North Little Rock Republican, said, when the program passed the Legislature last year, it was a neck and neck vote.
“Even though it will be close, I think it will pass,” House said.
He said, even though legislators represent their constituents, they must also govern. “And that means sometimes make decisions that are unpleasant. That was something I learned in the military,” House said.
He added that 75 percent of the state has spoken and favors the program. “It’s a small minority that is trying to crash it,” House said.
“When we first passed it last year, we made it clear to the federal government that, if it wasn’t working, we would kill it. But it hasn’t even started or been implemented yet. That starts this year,” he explained.
That’s one of the reasons he can’t make sense of the opposition. “I appreciate that some lawmakers are welded to their dogma, and they feel the need to represent the majority view of their district, but sometimes you have to look beyond your local neighborhood,” he said.
House likened it to the church.
The church doesn’t like divorce, but when a spouse comes in beaten, battered and starved, you do what you have to do, he said.
He added, “We didn’t make this mess. We were handed it by the federal government.”
House said his number one concern is to keep the hospitals open.
Meanwhile, the lineup has changed, with private-option supporter Sen. Paul Bookout (D-Jonesboro) resigning for ethics violations and replaced by John Cooper, a Republican who won a special election running against the private option.
The governor warned Arkansas sheriffs last week that the private-option vote could affect them.
“My proposed budget for the coming fiscal year has additional funding to both open more state prison beds and to ensure that county jails continue to get reimbursed for holding state inmates.
“This unique, bipartisan solution has taken federal funds made available under the Affordable Care Act and helped uninsured Arkansans obtain policies from private insurance companies,” Beebe said.
“Already, 140,000 Arkan-sans have applied for this improved care, and 88,000 of our citizens have completed the process and are already fully insured. The influx of federal money also has us projecting $89 million in savings — savings that the Legislature has chosen to return to taxpayers, the best interests of us all.”
Leader staff writers Joan McCoy and Rick Kron contributed to this report.
