LITTLE ROCK — The House on Thursday approved legislation for using Medicaid funds to subsidize private insurance for thousands of low-income Arkansans.
By a vote of 62-37 on House Bill 1143, the House joined the Senate in approving enabling legislation for the so-called private option — proposed as Arkansas’ novel alternative to expanding Medicaid under the federal Affordable Care Act. The House later approved the identical Senate version, Senate Bill 1020, by 63-35.
Both bills go to the Senate — the House bill for committee consideration and the Senate bill for concurrence in House amendments.
A more critical vote on health care expansion will come when the House considers HB 1219, an appropriation bill that would clear the way for the state to use federal money for the program. Passage would require a three-fourths majority, or 75 votes in the 100-member House — at least a dozen more votes than either version of the enabling legislation got Thursday.
House Speaker Davy Carter, R-Cabot, who favors the private option, said Thursday his preference was for the House to pass the appropriation on Friday, but he said he was considering requests from some House members to delay a vote until Monday so they could visit with constituents over the weekend.
"These are genuine, reasonable requests to go home and to be able to have that dialogue with the people that put them into office," he said, adding that he would contact individual legislators Thursday night and make a decision Friday morning.
Carter said he remained confident the appropriation would pass, despite the enabling legislation’s garnering of fewer than 75 "yes’ votes. Asked if the bill might come up on Friday and then again on Monday if it failed the first time, Carter said, "It will get through the first time."
Gov. Mike Beebe said Thursday he would like to see the House vote on Friday and would be fine with a second vote on Monday if it did not pass the first time.
The governor also said that several of the House members who voted against the proposal Thursday have said they would support the appropriation bill.
"I think there is a lot more support for the appropriation bill than the 63," he said. "It’s just real close."
Thursday’s House vote came just hours after Sen. Jason Rapert, R-Conway, chairman of the Senate Insurance and Commerce Committee, suggested the Legislature put off deciding the fate of health care expansion for a few weeks to give lawmakers more time to explain the plan to the general public.
"I believe that based on what’s been presented to us the private option is the best probably that can be done in this scenario. But I do not believe it has been completely sold to the people in a way that they believe that," Rapert told reporters.
Rep. Andy Mayberry, R-Hensley, expressed a similar view on the House floor Thursday while speaking against HB 1140.
"I think that it is incumbent upon us to be able to let (constituents) know what we’re doing," he said. "And then come back here, and I’m not talking about coming back here in terms of months down the road. I’m talking weeks, not months."
Beebe said he wants the issue to be resolved and for the Legislature to go home at the end of next week, when regular business of the session is scheduled to end. He said he could understand lawmakers wanting to explain the private option to constituents, "but why do you have to go home for three weeks to explain it to them?"
Carter said a delay of weeks is "not an option."
The proposal would enable people earning up to 138 percent of the federal poverty level — $15,856 for an individual, $32,499 for a family of four — to use federal Medicaid dollars to buy private insurance through the state insurance exchange.
Officials say the measure would extend insurance coverage to up to 250,000 people who currently lack insurance. The federal government would pay the full cost of the expansion for the first three years, after which the state’s share of the cost would increase gradually to 10 percent.
Presenting the enabling legislation on the House floor, Rep. John Burris, R-Harrison, said the private option is better for Arkansas than Medicaid expansion and better than doing nothing. He said the state Medicaid rolls would shrink under the private option but would continue to grow if the state does nothing.
The private option would allow the state to implement reforms that would not be possible otherwise, Burris said. He also said the private option would save money for the both the state and the federal government.
"The state wins, the federal government wins and the consumer wins because they get better care," he said.
Burris also said the bill will not take effect if the federal government does not fulfill every promise and grant every waiver for the private option.
Speaking against the bill, Rep. Stephen Meeks, R-Greenbrier, said the answer to improving health care in Arkansas is empowering local communities to be able to help their citizens.
"The answer is not bigger government," he said.
Speaking for the bill, Rep. George McGill, D-Fort Smith, urged members to think about the estimated 250,000 uninsured Arkansas who would gain insurance under the expansion.
"What would you do if there was 250,000 Arkansans standing on these Capitol steps begging you to give them help?" he said.