LITTLE ROCK — Gov. Asa Hutchinson encountered no vocal opposition last week when he outlined to a legislative task force his plan for a modified version of Medicaid expansion and his goal of cutting $835 million in costs from the traditional Medicaid program over five years — but that doesn’t mean fights aren’t coming.

LITTLE ROCK — Gov. Asa Hutchinson encountered no vocal opposition last week when he outlined to a legislative task force his plan for a modified version of Medicaid expansion and his goal of cutting $835 million in costs from the traditional Medicaid program over five years — but that doesn’t mean fights aren’t coming.


The Health Reform Legislative Task Force voted Wednesday — in a voice vote with no "no" votes heard — to support Hutchinson’s efforts to obtain federal Medicaid waivers to enable his vision for Medicaid expansion. A co-chairman of the panel said later the show of support should not be taken to mean that the governor’s plan can be achieved without a fight.


"Everybody’s waiting for the cage fight," said Sen. Jim Hendren, R-Gravette. "It’s coming. But we’re not there yet."


Hutchinson wants to impose new restrictions on the Medicaid expansion program known as the private option, which he has proposed renaming Arkansas Works because he says the changes he favors would encourage more of the beneficiaries to become employed.


To get the changes approved, Hutchinson will need to obtain federal waivers and — perhaps a bigger hurdle — win over both supporters and opponents of the current program.


"Some of these things sound great, but administratively the costs to them outweigh any benefit that you get from them," said Sen. Keith Ingram, D-West Memphis, a member of the task force and a supporter of the private option.


Ingram said some of the proposed restrictions may be overly punitive, such as a requirement that people pay premiums if the value of their assets is above a certain level.


"All of us have had situations where (a family member) might have a home that’s worth X amount of dollars, but they have no money and they’re in a nursing home," he said.


Ingram said he did not oppose the governor’s pursuit of waivers for Arkansas Works — he did not vote at all, he said — because there will be time to debate the details of Medicaid expansion next year.


"I think all of us take comfort in that it’s got to come back in front of the Legislature," he said.


Rep. Reginald Murdock, D-Marianna, also a task force member and a supporter of the private option, said that although he is not in total agreement with the governor’s ideas, he voted for the motion to support the governor because that was the appropriate thing to do based on "where we are in the process."


Murdock also said he was pleased that Hutchinson dropped from his wish list a provision to lock out people who fail to pay premiums if required to do so.


"We want to make sure that we’re not crippling the very purpose of the (Affordable Care Act)," Murdock said.


Sen. Cecile Bledsoe, R-Rogers, another task force member, said she abstained because she continues to believe that Arkansas’ Medicaid expansion is not sustainable. But she said she did not vote against supporting the governor at this stage because "we will always have that chance during the special session to vote on the legislation."


Hutchinson has said he expects to call a special session on the future of Medicaid sometime in the spring, after the March 1 primary election.


The private option uses federal Medicaid money to subsidize private health insurance for more than 200,000 low-income Arkansans — an alternative approach to the expansion of Medicaid rolls that was envisioned under the Affordable Care Act. The federal government is paying 100 percent of the cost now, but states that accept Medicaid expansion under the health care law must pay 5 percent in 2017, 6 percent in 2018, 7 percent in 2019 and 10 percent in 2020.


Hutchinson has said he is willing to continue with Medicaid expansion after 2016 only if the federal government allows the state to make changes to the program and the state is able to cut costs in the traditional Medicaid program to pay for the state’s share of the expansion cost. He says that means costs must be cut by $835 million over the next five years, of which between $50 million and $60 million per year must come from state spending on Medicaid.


Hendren said the task force will work through 2016 to find ways to achieve those savings. By the time of the special session it should have a "framework" to recommend, but it likely will have much more work to do at that point, he said.


"Ninety days or so (from now) is what we’re talking about for a special session." he said. "Are we going to have agreement on $835 million in 90 days? Probably not. And that may make it more politically difficult to some who say, ‘I want to see the savings before I’ll vote for an expansion program.’"


But Hendren added, "The good news is, that $835 million, it identifies cuts that would make that 10 percent match sustainable moving forward beyond 2020. So we’re not going to go bankrupt in 2017, ‘18 and ‘19 because the match rate doesn’t jump right up to 10 percent."


Like the coming battle over continuing Medicaid expansion, cutting millions from traditional Medicaid is not expected to be easy.


‘That is the beginning of what we know is going to be a bloody fight," Hendren said.