Dynamics of Health Debate Change in Arkansas (AP Analysis)

by Andrew DeMillo, The Associated Press  on Monday, May. 13, 2013 8:20 am  

LITTLE ROCK - For the past three years, they've been the three dirtiest words in Arkansas politics. But the Affordable Care Act may get an image rehabilitation in time for next year's election.

The 2010 law and opposition to it helped Republicans topple a two-term U.S. senator, sweep the state's four congressional districts and win control of the state Legislature for the first time since Reconstruction. But, emerging from a session where lawmakers expanded health insurance relying on a key part of the overhaul, Democrats are now embracing a law that many blamed for their losses in recent years.

Republicans, meanwhile, are trying to figure out how to reconcile their dislike of the law with the reality that it's not going away anytime soon.

The "private option" that the Legislature approved to use federal Medicaid dollars to purchase private insurance for 250,000 low-income residents changes the dynamics of the health care debate for both parties. The plan, which still needs federal approval, is being touted by supporters as an alternative to the Medicaid expansion called for under the federal health care law.

For Democrats, the plan's approval removes a key line of attack that Republicans have used over the past two election cycles. If the health overhaul was so bad, they argue, why did a Republican-controlled legislature approve an insurance expansion that relies on that same law?

The private option also changes the dynamic within the Democratic Party. Speaking to a group of leaders from the Delta, former Lt. Gov. Bill Halter blasted Democratic rival Mike Ross and the Republicans running for governor for opposing the federal health overhaul.

Without the law that Ross opposed in Congress, Halter said, Arkansas would be unable to expand health insurance coverage the way it did.

"A lot of people are telling you they're for it now or they're ok with it now, but they weren't leading to get it done," Halter said. "In fact, in some cases they were voting against."

Ross, who voted against the health care law and later supported efforts to repeal it, has said he backs the private option. He said the stance isn't that different from Democratic Gov. Mike Beebe, who has said he would have voted against the health care law if he had been in Congress.

"I've always said there were good parts and bad parts of the health care reform. I've always said the Medicaid expansion was a good part," Ross told reporters.

The bigger fight could come within the Republican Party as supporters of the private option face backlash from conservative activists who see the plan as no different from Medicaid expansion.

It's a division that Democrats hope to exploit.

"I think there's an important political lesson that there's significant political division on the other side and that's beneficial to Arkansas Democrats going forward," state Democratic Party Chairman Will Bond said.

Republicans, however, say they remain united against the health overhaul even if there were disagreements over the private option plan, and say they believe the law remains toxic in the eyes of voters.

"At the end of the day, (Democrats are) still going to have to own Obamacare and be responsible for the votes they cast for it," said David Ray, a spokesman for the state GOP.

House Speaker Davy Carter, who is mulling a run for governor, may be the greatest test of whether opponents of the health care law can live with a plan to implement part of it. Carter and other supporters of the private option advocated it as the best, most conservative way to mitigate what they called the harmful effects of the federal health overhaul.

Implementing the private option and accompanying efforts to curb Medicaid costs are going to be a key part of the governor's race, Carter has said.

"I don't think there's any doubt that over the next four years the most pressing issue is going to be how we implement the private option and make sure we're managing that correctly and make sure we realize the cost savings on these other waste fraud and abuse bills," Carter said last month.

It's unclear how much Carter would be on the defense over the private option in the GOP primary. Former U.S. Rep. Asa Hutchinson, who is seeking the Republican nomination, has said he would have signed the plan into law but would have wanted a special session to address the issue. Little Rock businessman Curtis Coleman has opposed the private option.

The issue may still loom, though, with a group hoping to put the private option on the ballot next year as a referendum. Glenn Gallas, chairman of the Arkansans Against Big Government group, said the effort is aimed primarily at letting voters decide on the issue but acknowledges it will also have a role in next year's election.

"I think it's actually going to define not necessarily the election but more the primaries," Gallas said. "I think the health care debate as framed is going to change. "

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