By JOHN HOFHEIMER
Leader senior staff writer
As the fate of affordable health insurance for the working poor — without lifetime benefit limits or exclusion for pre-existing conditions — hangs in the balance, more local lawmakers weighed in on the likelihood of the state’s private-option plan being funded when the biennial fiscal session of the General Assembly convenes Monday.
Most legislators seem to favor it, but most is not sufficient. Funding must be approved by a supermajority — 75 percent of both houses — or private-option health care will fail. That means potentially 200,000 working poor Arkansans won’t be insured and there will be an $89 million hole in the state’s budget, according to Gov. Mike Beebe.
BIPARTISAN EFFORT
If ever there was a measure in the General Assembly that depended upon bipartisan support, this is it. Beebe is wielding the big stick for Democrats and a handful of Republican legislators — including state Sen. Jonathan Dismang (R-Beebe) and House Speaker Davy Carter (R-Cabot) — mustering vote support and pushing the envelope.
Carter sets the calendar in the House and, as an advocate of the private option he helped craft, is in a position to bring the issue to the floor when he thinks the needed votes are there.
It was Dismang and Carter, along with state senators David Sanders (R-Little Rock), Michael Lamoureux (R-Russellville) and state Rep. John Burris (R-Harrison), who pushed for the federally funded private option instead of the simple Medicaid expansion called for in President Obama’s Affordable Care Act.
They visited Health and Human Services Secretary Kathleen Sebelius to ask for the wavier that the state ultimately received.
CHECKING CONSTITUENTS
State Rep. Jeremy Gillam (R-Judsonia) voted for the private option in 2013 because he said that’s what his constituents wanted.
He said Thursday that he believes a version of the private option will be funded when the legislature convenes next week. But whether he votes for it will depend upon the people he represents.
“I’m not necessarily advocating for it,” Gillam said. “I’m still visiting with my constituents. I don’t want to make assumptions. I want to talk to them to see if anything has changed.”
Gillam said any funding that involves both the state and federal government is complicated. But the private option is even more so because it is the first of its kind, he noted.
“With this one, you’re in uncharted territory,” he said.
But Gillam said he believes a few of last year’s “no” votes will change with the tweaking that is being discussed and that will be enough to get funding for another year.
But, he added, “The way this thing was set up, we’ll have to have this discussion every year.”
Joe Farrer, a first-term Republican from Austin, is opposed to continuing the private option — just as he was opposed to creating it during the 2013 legislative session.
WOULD DE-FUND
“I’m pushing to de-fund the private option, and I want us to work on a plan that will save Arkansas money. But you can’t just shut it off,” Farrer said. “We’re going to work it down to where it will end at the end of 2014.
“I want people to have health care. I’m in health care. I just don’t want it to cost Arkansas billions of dollars,” he said.
“In an effort to mask the real cost of the private option, the Legislature and governor tried new math by moving the sick and frail to original Medicaid. Arkansas currently spends $6 billion a year on Medicaid. The mathematicians in the Legislature say this increase in cost is paid 100 percent by the federal government. This is true, but only for a short time.
“What they don’t tell you is that Arkansas picks up 30 percent of the $6 billion Medicaid budget, which is $1.9 billion dollars. With the private option, Arkansas is adding 25,000-30,000 more people to traditional Medicaid.
“So this new population will add another half a billion dollars to the state’s budget,” Farrer said in an article he wrote for Talk Business Arkansas. “Whether it is federal tax dollars or Arkansas tax dollars, the private option is a huge increase in spending without any way to pay for it either in the state or federal budget.”
Furthermore, Arkansas has no control over insurance premiums and will be at the mercy of the insurance carriers, he said.
“To keep costs down, insurance carriers will have to decrease reimbursement for services from providers. With very few providers accepting Medicaid and Medicare now, and with Arkansas currently having a significant physician shortage, where will people go for care? Arkansans will experience very long waits and rationed care,” he warned in the Talk Business article.
Will the General Assembly fund the private option?
Dist. 38 Rep. Patti Julian (D-North Little Rock) said, “It’s anybody’s guess. I wouldn’t want to bet on it.” Julian called the vote a toss-up because it was close last year, and it takes a supermajority.
“Unless something stunning happens, I’m going to vote to reauthorize it,” she said. “I think we crafted, with the Republicans, the best option for Arkansas. We have 100,000 who have signed up, who are going to have health-care insurance for the first time.”
COULD HURT UAMS
Julian said she’s worried about how de-funding private option could affect UAMS as well as small and rural hospitals, such as North Metro in Jacksonville.
“We’ll lose them. We’ll throw people out of work, and we’re going to make health care that much less accessible for people in those communities,” Julian said.
She also said the Legislature might have to reinstitute the taxes cut last session to make up the $80 million-$90 million budget deficit that would result from reneging on the private-option promise it made to the working poor last session.
“Education could be hit hard,” Julian concluded.
“This is a federal law. As a state Legislature, our job is to do the best we can as the law exists.”
State Rep. Mark Perry (D-Jacksonville) said, “I’m thinking it will pass. It is a sensible solution for providing health care for people who need it, instead of expanding the Medicaid roles.
“I’m just feeling optimistic.,” he said. “When you start looking at options, it’s the best available. Other states are wanting to copy what we’ve done. We’re in the forefront of expanding health care instead of Medicaid.”
State Rep. Walls McCrary (D-Lonoke) couldn’t be reached for comment Friday. On Thursday, he said he supported the private option and intended to vote for it.
