Private Option Supporters Walk Fine Line (AP Analysis)

by Andrew DeMillo, The Associated Press  on Sunday, Jan. 26, 2014 8:54 am  

Arkansas Sen. Missy Irvin, R-Mountain Home, says she won't vote to renew to the private option.

LITTLE ROCK — Supporters of Arkansas' "private option" Medicaid expansion are walking a fine line as they assess the future of the program before this year's legislative session. They don't want to understate the danger it faces of being defunded, but they don't want to declare it dead just yet.

It's becoming a tougher balancing act as the session focused on the state's budget approaches. What had already been a bleak picture for the program became more bleak last week after losing another one-time supporter. Sen. Missy Irvin, who had been a deciding vote for the expansion last year, said she couldn't support renewal.

"While opposed to further public dependence on government programs, I had been convinced that the private option might be a first step in the right direction," Irvin, R-Mountain View, said last week. "I now see it is leading us in the wrong direction."

Irvin's announcement and Republican John Cooper's victory in a special state Senate election a week earlier prompted Democratic Sen. Linda Chesterfield to declare the private option as "at best on life support" when state Medicaid officials discussed their budget. Cooper ran primarily on a vow to defund the private option.

"If Senator Cooper does not vote for it and Senator Irvin doesn't, it's dead on arrival," Chesterfield told reporters.

Chesterfield's comments crystallized the view of private option supporters increasingly worried about the future of the program that had been touted as a model for conservative states that had otherwise rejected the federal health care law.

More than 76,000 people have enrolled in the program, which uses federal money to purchase private insurance for thousands of low-income residents who were newly eligible for Medicaid under the federal health law. It was approved as an alternative to expanding Medicaid's enrollment under the overhaul.

State officials and advocates of the private option had already stepped up warnings about what would happen if lawmakers didn't reauthorize the private option, with $89 million in the state's budget dependent on the savings they expect from the program.

Democratic Gov. Mike Beebe warned that blocking the expansion could have widespread consequences in his proposed budget, possibly threatening funding increases he's proposed to alleviate prison and local jail overcrowding because of parole overhauls.

"The ramifications are huge, and the Legislature will have to figure that out," Beebe told reporters last week.

But Beebe at the same time is warning Chesterfield and others that there's plenty of time between now and the Feb. 10 start of the session.

"Don't get ahead of yourself. ... Right now, there's a lot of reaction that's got a lot of politics to it," Beebe said. "By the time it comes to a vote, there will be real factual issues to be determined and real ramifications."



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