LITTLE ROCK — Gov. Mike Beebe said Thursday he wants state lawmakers to decide whether to expand Medicaid under the federal Affordable Care Act during the regular legislative session that starts Jan. 14 and not in a special session, as some have suggested.
Also Thursday, the state received conditional approval to establish a health insurance exchange, another key component of the health care law, in partnership with the federal government.
Some Republican legislators have floated the idea of leaving the issue of expanding Medicaid off the table during the regular session and holding a special session later to deal solely with Medicaid expansion. In an interview Thursday with the Arkansas News Bureau, Beebe said he does not favor that approach.
"If you can do stuff in a regular session, you do it in a regular session. It saves taxpayers’ money," he said.
A special session would have to be called by the governor. Beebe has done so only once, calling legislators to the Capitol in 2008 to pass an increase to the state’s severance tax on natural gas. Lawmakers passed the tax hike in three days, the constitutionally mandated minimum amount of time it takes to pass a bill in the state.
"I don’t do special sessions unless they’re three days, which means everything’s done before you get here," Beebe said Thursday.
Expanding the state Medicaid program to include people earning up 138 percent of the federal poverty level would add an estimated 250,000 people to the Medicaid rolls. Originally, the Affordable Care Act required states to expand their Medicaid programs or lose federal Medicaid funding, but the U.S. Supreme Court has said the federal government cannot threaten to take away states’ Medicaid funding for non-compliance, in effect making the expansion optional.
Sen. Michael Lamoureux, Senate president pro tem-elect, said Thursday, "Ideally we’ll get it resolved during the (regular) session. I think I agree with that. But the point is, there’s a chance that we won’t have the facts to do that."
Lamoureux said there are still unanswered questions about the expansion, including "what it’s going to cost the state."
Under the Affordable Care Act, the federal government would pay the entire cost of the expansion for the first three years, after which the state’s share would increase gradually, eventually topping out at 10 percent.
"The 10 percent that we’re supposed to pick up … we don’t know if that number is a stable number yet," Lamoureux said.
He added that he remains hopeful the federal government will relent on its position that states cannot implement partial expansion. The Obama administration’s "take-it-or-leave-it approach" is not conducive to winning the support of Republican legislators, he said.
Legislative support is necessary for the expansion because a three-fourths vote in both chambers is required for most appropriations.
Previously, Republican legislators have argued that action on various components of the Affordable Care Act should be delayed because of uncertainty about whether the law would withstand a court challenge, which it largely did, and whether President Obama would be re-elected, which he was.
Beebe said Thursday that if Republican legislators believe there is uncertainty about the expansion, they can hold hearings during the regular session.
"I don’t know what uncertainty they’re talking about right now, but I’m certainly open to hearing what anyone has to say about their uncertainty," he said. "Right now I would prefer that they hold their hearings and get their questions answered, one way or the other, in the regular session. I’m a fiscal conservative, and I’d rather save the money and not spend extra money if we don’t have to."
On Thursday Beebe received a letter from Health and Human Services Secretary Kathleen Sebelius advising him that Arkansas has received conditional approval for a state partnership exchange. The conditions include a requirement that Arkansas show it can perform certain activities, including providing consumer assistance, outreach and education. Beebe and state insurance officials say they would prefer that the state provide those services rather than the federal government.
Every state is required to have a health insurance exchange — a marketplace where people and small businesses can shop for insurance plans — in place by Jan. 1, 2014. The exchanges can be run by the state, by the federal government or by a partnership between the two.
Beebe has declined to pursue a state-run exchange because of opposition from Republican legislators. Some of those legislators also dislike the idea of a partnership, saying they would prefer that the state not have any role in the exchange.
Beebe said Thursday that position is surprising.
"Most folks that I know that are resistant to it are the very folks that say, ‘We don’t want Washington telling us what to do,’" he said.
Lamoureux said he understands why people would be surprised to see some Republicans favoring a federally run exchange.
"The truth is, it’s not that they want a federal exchange. It’s that they don’t want any exchange at all," he said.