LITTLE ROCK, Arkansas — There's no question among lawmakers that the compromise Medicaid expansion approved last year will be the focus as they convene this week for the third-ever fiscal session. What's up in the air is whether there's enough support to keep the so-called private option program alive — and what will happen if the state's abandons it.
Less than a year after the Legislature approved the private option to extend health coverage to more than 83,000 people, the program's future tops the agenda as the House and Senate convene Monday for this year's session. After losing two key votes in the Senate and heading into an election season where Republicans are again running against the president's health care law, the expansion authorized under that law is in jeopardy.
Senate President Michael Lamoureux said he faces a tougher climb in reauthorizing the program, as he tries to persuade one of several senators opposed to the private option to reconsider it.
"It's tougher because once somebody has voted no, getting them to change to yes is very difficult," Lamoureux, R-Russellville, said. "That's essentially what we're trying to do here."
The Republican-led Legislature last year approved the plan to use federal Medicaid money to purchase private insurance for thousands of low-income residents. Dubbed the private option, it was pitched by Republican supporters and Democratic Gov. Mike Beebe as an alternative to the Medicaid expansion envisioned under the federal health care law.
Arkansas was the first state to win federal approval for such an idea, but continuing it faces a high vote bar in the Legislature. The federal funding for the plan must be approved by three fourths of both chambers — 27 in the 35-member Senate and 75 in the 100-member House. The funding bill was approved last year by a 28-7 vote in the Senate and 77-23 vote in the House.
Supporters appear to be at least one vote shy in the Senate after Republican John Cooper won a northeast Arkansas seat in a special election last month on a vow to kill the health care expansion. Republican Sen. Missy Irvin, a former supporter of the private option, subsequently announced she would vote against its reauthorization.
The development prompted one Democratic lawmaker to declare the private option on life support.
"If Senator Cooper does not vote for it and Senator Irvin doesn't, it's dead on arrival," Sen. Linda Chesterfield, D-Little Rock, told reporters last month.
One of the chief opponents of the expansion isn't predicting whether there will be enough votes to block the plan, noting that the private option went through several failed votes before winning final approval last year.
"Even if there were votes to block it right now, there's a lot that could happen before the session ends," House Majority Leader Bruce Westerman, R-Hot Springs, said.
But, Westerman added, "I haven't heard many people who voted against it last time talking about voting for it."
One of the keys may be whether supporters of the private option can find a way to modify the program to make it more amenable to opponents. House Speaker Davy Carter sayas he's open to tweaking the private option if that will help build support, but stopped short of saying what changes he'd be open to.
"Do we need to tweak some things here and there? Maybe," Carter said. "I think we'll talk about areas in which we can do better and I'm certainly open to that, but backing up at this point and pulling up on the state, I'm not interested in that. I don't think the General Assembly is interested in that. I still think we're going to pass it."
The timeline of when the private option fight is even up in the air. One of the architects of the private option plan said the session's limited agenda gives lawmakers the "privilege of focus" on the program and its merits.
"Ultimately, the vote will rise and fall on the policy," said Sen. David Sanders, R-Little Rock.
Whether the Legislature reauthorizes the program could reverberate throughout the state's budget. Beebe has said $89 million in his $5 billion budget proposal relies on savings the state is projected to see from the private option cutting down on hospitals' uncompensated care costs.
Beebe has said halting the program could threaten his proposal to boost funding for the state's prison system to ease overcrowding seen as a result of the state's probation and parole rules being tightened.
"It is bigger than just the private option," Beebe said.
Outside lobbying has also stepped up on both sides as the session nears. Arkansas Advocates for Children and Families has been posting videos of people receiving health coverage under the private option, while the state Chamber of Commerce has argued that ending the program will result in millions of dollars in penalties for businesses not providing insurance to employees.
Hoping to undercut that argument, Westerman said he'll introduce legislation that would give those employees a state tax credit for those penalties.
This year's fiscal session will be the third under a constitutional amendment voters approved in 2008 requiring the Legislature to meet and budget annually. Regular sessions are held in odd-numbered years and fiscal sessions focusing primarily on the budget are held in even-numbered years.
The Legislature can only take up non-budget bills if two-thirds of both chambers vote to allow it. The main non-budget proposal lawmakers are expected to consider is a bill giving the governor discretion to keep the lieutenant governor's office vacant following Republican Mark Darr's resignation last month over ethics violations.
State law currently requires Beebe to schedule a special election within 150 days of declaring the post vacant, but the proposal would give him the authority to not call one if it's vacated within 11 months of a general election. Beebe has said he'll sign the legislation if it is approved by lawmakers.
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