On Tuesday, the Arkansas House of Representatives voted not to fund a continuation of the state’s alternative to the Affordable Care Act’s optional Medicaid expansion, effectively stripping as many as 96,000 of the state’s poorest residents of their current health coverage. The state Senate is expected to take up the measure on Wednesday and the House will likely re-visit the issue later this week, when supporters expect it to gain final passage.
Arkansas Gov. Mike Beebe (D) worked out a compromise with the Republican-controlled legislature last year to pass an alternative to Medicaid expansion that uses federal money to help people earning up to 138 percent of the Federal Poverty Level (FPL) buy private insurance through the state’s Obamacare marketplace. Nearly 100,000 people have signed up for the popular program so far, and about a quarter million are eligible for coverage, according to official estimates.
But the so-called “private option” has come under fire in recent months as several Republican legislators who originally voted for the deal began reneging their support. Funding for the private option must be renewed every legislative session with a three-fourths supermajority vote in both houses, and current law only funds the expansion through the end of June 2014. If lawmakers fail to appropriate new funds this week, almost 100,000 poor residents will lose their health coverage beginning on July 1.
The private option was voted down in the House even after Obamacare supporters offered steep concessions to the health law’s critics. Beebe and Democratic lawmakers knew that even a single defection in either house would sink the program’s chances of retaining a supermajority. So in an effort to attract GOP votes, Democrats accepted a series of GOP demands.
The state House adopted several amendments aimed at scaling back ACA outreach efforts and passing costs onto consumers. For instance, Arkansas will no longer be able to use federal money to promote Obamacare in any form, including advertising, direct mail campaigns, or through so-called “navigators” tasked with helping people sign up for new plans under the law. The ban on using outreach money applies to the entire Obamacare marketplace, and as the Arkansas Times’ David Ramsey notes, direct mail outreach efforts in particular have been critical to the private option’s success.
If the appropriations deal is eventually passed, Arkansas will also have to give private option beneficiaries the option of creating Health Savings Accounts (HSAs); the state must be granted a federal waiver by 2015 allowing private option enrollees who make less than the poverty level to be charged co-pays and deductibles (which is currently illegal); and the state will no longer be mandated to provide non-emergency medical transportation.
In the state senate, where the bill is expected to come up on Wednesday, lawmakers are wooing Sen. Jane English’s (R) vote by promising her nearly $40 million for job training and workforce education programs.
Various iterations of Arkansas’ private option have been proposed by several other GOP-led states reticent to embrace Obamacare’s Medicaid expansion, including Iowa, Pennsylvania, and Utah. A Virginia senate panel recommended the private option as an alternative to regular expansion on Sunday.