Private Option Plan A Tough Sell for GOP Voters (AP Analysis)

LITTLE ROCK - For Arkansas Republicans elected on a vow to defeat the federal health care overhaul, a proposal to expand subsidized insurance relying on a key part of that law has been far from an easy pitch.

Here comes the toughest sell yet: voters and activists who helped give the GOP control of the Legislature.

That hurdle is what's keeping Arkansas from enacting something that seemed impossible just a few months ago - a compromise proposal to offer coverage to thousands of uninsured residents in a way that allows Republican supporters to cast themselves as still opposing "Obamacare."

The House's decision to delay a vote on the private option - a proposal to use federal Medicaid money to purchase private insurance for 250,000 low-income residents - shows that lawmakers haven't succeeded in closing the deal. The House and Senate have approved bills laying out the framework for the program, but they're still short of the votes needed to OK an attached budget bill.

It's a plan that many GOP lawmakers who railed against the law throughout the 2010 and 2012 campaigns are now embracing. The problem is, they're not sure the voters feel the same way.

"I believe, based upon what's been presented to us, the private option is the best probably that could be done in this scenario," said Sen. Jason Rapert, the Republican chairman of the Senate Insurance and Commerce Committee. "But I do not believe it has been completely sold to the people in a way they believe that. Fair or not, it's got to be presented in a way that people understand it."

Rapert, R-Conway, has derided the federal health care overhaul as Socialism and a job-killer, but he's not rejecting the private option proposal outright.

In fact, the Republicans behind the proposal have also been some of the most outspoken critics in the state against President Barack Obama's signature policy accomplishment. They include Rep. John Burris, the chairman of the House Public Health Committee who two years ago helped lead a GOP effort to block implementing a state-run insurance exchange under the federal health care law.

For two hours last week, Burris outlined to the same chamber why he believed the private option was Arkansas' best option in dealing with a federal law that the U.S. Supreme Court has upheld. Name-dropping conservative figures like Wisconsin Gov. Scott Walker, Burris presented the plan as a way to tackle the costs of Medicaid in a way that Washington's been unable to and actually trim the program's rolls over time.

"We're in a really unique opportunity to really prove to the country what can be done with entitlement reform and how real action, not just taking the money and running, not just taking the money and doing everything exactly the same, but taking the money and making real long term decisions and changes to our entitlement system," Burris said.

Not everyone is sold on the argument, including key legislative leaders who see little difference between what the Legislature is considering and the Medicaid expansion generally rejected by Republicans. They're also hearing from conservative figures and groups like Americans for Prosperity, urging them to oppose the plan.

"This is not free money," said Republican Sen. Cecile Bledsoe, chairwoman of the Senate Public Health Committee and an opponent of the private option. "I just feel like we need to remember that we just need to cut the spending and I believe my constituents agree with that."

But others who have voted against the private option's enabling legislation say they support the idea. They just need some time to give the same closing argument to voters that they've heard in the Capitol.

"I don't know that people fully understand what it is, what it does, the safeguards that are in place," said Rep. Andy Mayberry, R-Hensley. "I don't think people understand the potential ramifications of doing nothing or saying no."

By pushing the vote back a few days, legislative leaders are hoping a similar argument will sway skeptical voters in their districts. They're also hoping to highlight a series of measures aimed at cutting Medicaid costs that lawmakers are considering in conjunction with the proposal.

"If people refuse to sit down and go through this analysis of looking at the bill and looking at what the real effects of our two choices are and get to the realistic and factual point that we cannot stop the implementation of the Affordable Care Act in Arkansas and go through all of this and look at their members of the General Assembly and say 'but it's Obamacare, don't do it,'" House Speaker Davy Carter said. "If that's where we're going, then I think the Republican Party is going to have to regroup."

It's a gamble that will test whether Republicans who have benefited from an anti-Obama atmosphere will be punished by that same sentiment.

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