Backup Medicaid Plan Requires Leap of Faith (Andrew DeMillo Analysis)

Gov. Asa Hutchinson on Tuesday at the state Capitol.

LITTLE ROCK – With a backup plan to save Arkansas’ Medicaid expansion by defunding it, Gov. Asa Hutchinson will need a leap of faith from political foes on both sides of the aisle to prevent thousands of poor people losing their health coverage.

The unusual maneuver the Republican governor and legislative leaders are pursuing underscores the dwindling options left to break a deadlock over the program and a score of other services provided by Medicaid.

The approach creates an uneasy union for the expansion’s supporters and some of its detractors. It depends on a handful of hardcore opponents casting a vote that they can portray as fighting a program they know the governor will reinstate. It also will require Democrats to support defunding a program they’ve fought for, with assurances from a rival party governor that the expansion won’t die.

“I don’t think it was anyone’s desired first choice, but it was a functional option,” House Speaker Jeremy Gillam said. “And I think we need to consider functional options at this point.”

The backup plan calls for adding a provision to the Medicaid budget that defunds the hybrid expansion, which uses federal funds to purchase private insurance for the poor. If approved by the Legislature, Hutchinson has promised to line-item veto the defunding provision. The move would allow the Legislature to effectively fund the program by upholding his veto, which requires a simple majority vote.

Hutchinson said the approach offers the best chance to resolve a budget standoff sparked by the Medicaid expansion debate.

“That allows everyone to vote their conscience and to accomplish a result,” Hutchinson told reporters. “Whenever you can follow our constitution in Arkansas and achieve a result, utilizing the mechanisms of government, that 70 percent of the Legislature and the majority of both parties support, to me that’s a good outcome.”

The plan faces criticism from some Republicans who say it’s an attempt to circumvent the state’s budget rules, but the approach could provide a way out for some of the senators opposed to the expansion. At least two of the 10 GOP senators who have blocked the Medicaid budget said they’d vote for the measure with the expansion defunding, even if it allows Hutchinson to reinstate the program.

“I think the question is ‘Would I vote for a bill that I asked for?’ And the answer to that would be ‘Yes,'” said Republican Sen. Bart Hester, who has been one of the most outspoken opponents of the hybrid expansion.

Republican Sen. Blake Johnson, another expansion opponent, said he’d also back the revised budget bill.

“That would be up to the governor at that point,” Johnson said.

But the harder sell may be for Democrats, who said they’re wary of casting a vote against the Medicaid expansion they’ve unanimously supported despite the governor’s pledges to save the program via a line-item veto. Several are venting frustration at being asked to cast such a vote in a way they say gives cover to Republicans holding up the process.

“If everybody understands, at least (those) that follow the political process at the Capitol, that it’s going to be vetoed, then I’m not sure why a couple of those wouldn’t just vote for the appropriation as it is,” Democratic Sen. Bruce Maloch said. “My problem is everybody in my district doesn’t know the goings on at the Capitol and the fact that it’s an assumed deal it’s going to be vetoed.”

Or as Democratic Sen. Linda Chesterfield said: “The people I represent are not going to understand that voting against it is voting for it.”

Hutchinson says he understands Democrats’ concerns, but says the focus needs to be on the best way to preserve the health coverage for thousands of Arkansans.

“I understand those emotions, but we need to diminish the personal angst about this and keep an eye on the 250,000 Arkansans that are watching very carefully what happens here as to whether they’re going to have health care or not,” Hutchinson said

Andrew DeMillo has covered Arkansas government and politics for The Associated Press since 2005. Follow him on Twitter at Twitter.com/ademillo.