LITTLE ROCK — After a long day of wrangling, the Senate on Wednesday night passed legislation to fund Arkansas’ proposed private-option for health care expansion with federal Medicaid money.
"It’s a victory for Arkansas, for the people of Arkansas, for the businesses in Arkansas, for the hospitals in Arkansas," Gov. Mike Beebe said after the Senate’s 28-7 vote on House Bill 1219. "It’s taking something that most Arkansans would never have approved and making it better."
The House and Senate met into the night to tack amendments onto enabling legislation meant to strengthen the state’s hand in expanding health care under the federal Affordable Care Act, but it was the Senate’s approval of HB 1219 that was critical in providing the revenue stream for what would be a first-in-the-nation plan.
The bill goes to the governor.
"I do not want to spend money increasing the size of government," said Sen. Jeremy Hutchinson, R-Little Rock, who voted for HB 1219. "But, the only way we’re going to reign in the size of government is to have a chance to reform the entitlement programs … I’m afraid we have one window, one opportunity to reform and it’s right now."
Sen. Jim Hendren, R-Gravette, said he opposed the bill because he was concerned about the growing national debt.
"We can’t continue to spend our kids and grand children’s … future," he said.
Senators met in a morning session and convened briefly in the early afternoon without taking a vote on HB 1219, which would grant the Beebe administration permission to use millions of federal Medicaid dollars to subsidize private health insurance for an estimated 250,000 low-income Arkansans through a new health insurance exchange.
Supporters apparently were short of the three-fourths majority needed — 27 votes in the 35-member Senate — to pass the appropriation bill. The Senate approved the measure in its first nighttime meeting of the legislative session.
HB 1219 passed the House with just two votes to spare Tuesday after falling short in the first House vote Monday.
Also Wednesday, the House and Senate referred matching bills — HB 1143 and SB 1020 — containing enabling legislation for health care expansion, which both chambers previously passed, to each chamber’s committee on public, health welfare and labor to add matching amendments, which the committees approved.
The Senate passed the amended version of HB 1143 at 7: 45 p.m.The House later concurred in the amendment and sent the bill to the governor.
The House passed the amended version of SB 1020 after 9 p.m. The bill goes to the Senate for concurrence in the House amendment.
The amendments contain language clarifying or emphasizing that:
—If the federal government fails to grant all requested waivers for the private option, the legislation will not take effect.
—One of the necessary components of the private option is permission from the federal government for the state to develop a pilot program to create health savings accounts known as "Independence Accounts" that give the account holders some control over how their Medicaid dollars are spent.
—Businesses will not have to pay a penalty or tax for their employees earning up to 138 percent of the federal poverty level who obtain insurance through the state insurance exchange instead of through their employer.
—No aspect of the private option can be changed except by the state.
—As required under the Affordable Care Act, 80 percent of the money insurers collect in premiums must be paid out in claims.
The amendments also add Sen. Missy Irvin, R-Mountain View, as a co-sponsor of the enabling legislation. Irvin previously opposed the private option but testified in the House public health committee the amendments would allow her to support it.
Irvin told the committee that what it took to win her support was "to make sure that we stay in control and that we are doing something that is completely transformative for the state of Arkansas, that will go towards job creation, that will protect taxpayers, that will protect patients and make sure the patients have ultimate freedom in their health care, which is for me the most important part of that bill."
Beebe said Wednesday night that he supported the amendments and that his staff discussed the amendments with officials with the U.S. Department of Health and Human Services to make sure they were acceptable. That federal agency must give final approval to the state’s plan before it can take effect.
"If there’s a message about this," Beebe said of the Legislature’s work to craft a new private option health insurance plan, "the message is Washington, Republicans and Democrats can work … without regard to party labels, (they) can figure out what’s best for their people and go solve a problem and do something for the benefit of their constituents."