Monday, April 13, 2015

Special Session on Obamacare Medicaid Expansion. Why?

by David Ferguson, Conduit for Action: Governor Asa Hutchinson said he is considering a special session to determine the future of Arkansas’ Obamacare Medicaid Expansion, currently called the “Private Option.” Ending Obamacare Medicaid Expansion does not appear to be on the governor’s agenda.

“A special session will likely be needed to take up the future of Arkansas’ compromise Medicaid expansion, Gov. Asa Hutchinson said Thursday, warning that he doesn’t want the new program to mimic what’s already in place.”[i] (emphasis added)Why a special session instead of dealing with the issue in the Fiscal Session early next year? The governor said:“I think the public expects a special session that will be devoted to this issue because it’s a very large challenge for us and we’ve got to build the consensus for it,” Hutchinson said in his office.[ii]Do you care whether the issue is decided in a special session or in the Fiscal Session? Do you know anyone who has said, “I hope the legislature handles this in a special session”?

Actually, I do not doubt there are people who have urged the governor to call a special session, but they are Obamacare supporters. Politically, the reason for a special session is to increase the chances that Arkansas will pass another form of Obamacare Medicaid Expansion and keep Arkansas an Obamacare state.

If you wanted to stop a new version of Obamacare Medicaid Expansion, the best place for the fight would be the Fiscal Session. Why? Because in the Fiscal Session you must get approval from 2/3rds of the membership of each house in order to even file a non-appropriation bill. If you fail to get permission from 2/3rds of each house, it only gets worse, because your only remaining option is to amend your language into an appropriation bill, but appropriation bills must be approved by a 3/4ths vote of each house.

If you want to keep Arkansas as an Obamacare Medicaid Expansion state then you would want the governor to call a special session where you only need to get a majority vote from each house to pass your law.

The discussion of a special session makes it clear that more Obamacare is planned.

From the governor’s comments it appears the current structure called “Private Option” will be gone.
“I don’t think anybody who expects that this was the end to the private option wants it to be tweaked in minor ways and relabeled,” Hutchinson said. “That’s not going to fly with the Arkansas voters, and that’s not my expectation. I think this is going to be a total refiguring of it in an Arkansas way with compassion, fiscal prudence and then also one that’s innovative.”[iii]The problem is while the Governor is trying to focus the discussion on the narrow topic of the “Private Option”, opponents have never sought to merely change the structure of Obamacare Medicaid Expansion in Arkansas. The fight has been about ending Obamacare Medicaid Expansion, no matter what the structure.NOTE: For those who may not be familiar with Obamacare Medicaid Expansion, the program provides health care coverage based on income. This is different from the rest of Medicaid which seeks to help the most vulnerable. The target population of Obamacare Medicaid Expansion is primarily able bodied working age adults with no dependents, and nearly half of the target population do not work at all.Soon Arkansas will have to pay part of the costs of Obamacare Medicaid Expansion, which means Arkansas will have to devote hundreds of millions of dollars each year to continue Medicaid Expansion. This puts Medicaid Expansion in direct competition for dollars with other state programs and with the state’s need for tax relief to attract business, and with taxpayers who need for a real reduction in their tax burden.

When the legislature meets it will not just be deciding whether to continue coverage for the Obamacare Medicaid Expansion population, it will also be setting up winners and losers in the competition for state dollars.

I recommend Arkansas follow the example of the Tennessee legislature were their popular Republican governor called a special session to pass Medicaid Expansion, and the legislature stopped the bill. Those legislators held the promises they made to the voters — no Obamacare Medicaid Expansion for Tennessee.
[i] Hutchinson: Special session likely on Medicaid plan, Arkansas Democrat-Gazette, 04/09/15
[ii] Ibid.
[iii] Ibid.

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