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Fights Still Ahead on Arkansas Medicaid Plan (Andrew DeMillo Analysis)

3 min read

LITTLE ROCK – With a byzantine end-it-to-save-it maneuver, Arkansas Gov. Asa Hutchinson put his imprint on the hybrid Medicaid expansion he inherited and effectively saved the subsidized insurance program. But there’s little guarantee that the Republican governor and legislative leaders won’t face the type of budget shutdown fight that’s accompanied the program since its inception.

Hutchinson used his line-item veto to strike a Medicaid budget provision setting a Dec. 31 end to the program, which uses federal funds to purchase private insurance for the poor. It marks a turning point for the governor, who railed against the federal health care law but avoided taking a position on the hybrid expansion when he ran for office two years ago.

“I think I own the Arkansas Works program,” Hutchinson told reporters after issuing the veto, referring to the reworked version of a program formerly known as the “private option.”

His approach required the support of Democrats, who reluctantly agreed to vote for ending a program they’ve fought to save. And it needed the help of handful of the GOP opponents who had vowed to kill the program but wanted to avoid being blamed for shutting down the entire Medicaid system. The plan was so precarious that it even prompted Democrats to publicly question what would happen if the governor died before he had a chance to strike the defunding provision.

Hutchinson’s likely to have well more than the simple majority needed to uphold his decision to preserve the program, should opponents seek an override this week. And the governor has said he’s confident the maneuver will survive a legal challenge, which opponents have said is a near-certainty.

If the plan clears those hurdles, a bigger question looms: What will it take to save the program when lawmakers take up the issue again in several months?

Created as an alternative to expanding Medicaid under the federal health law three years ago, the hybrid program has been marked by legislative fights and a split within the Republican Party. That divide has been complicated further by the state constitution’s requirement that most budget bills need at least three-fourths support from the Legislature.

Expansion opponents warned the tactic sets a new precedent that gives the governor too much power.

“Whether you are a Republican or a Democrat, you will regret it,” Republican Sen. Alan Clark said last week.

Hutchinson and legislative leaders say they’re hopeful it’s not an approach that’ll have to be used again for keeping the hybrid expansion alive.

“I think we resolved a lot of issues in this debate and the support we’ve generated for funding of this program,” Hutchinson said. “I don’t think anybody wants to retrace those steps next year.”

One factor that gives them hope is the November election and Republicans’ hopes of retaking the White House. Hutchinson and legislative leaders say a Republican president would be more amenable to the reforms they’ve been unsuccessful in seeking for Medicaid, including a requirement that participants be employed or not be allowed to have large assets. They also argue it could lead to the type of block grant Republicans have long pushed for in the Medicaid program.

Hutchinson and other Republicans also face the prospect of the line-item veto plan coming back to haunt them. Conservative groups have signaled they’ll make the maneuver an issue in future GOP primaries, with Americans for Prosperity telling lawmakers they viewed the vote for the Medicaid budget bill as a supporting the expansion program. Democrats, meanwhile, may take Hutchinson up on his promise to defend any lawmakers who come under fire for initially voting for the program’s end in order to save it.

Hutchinson says the focus is on moving forward with the restrictions lawmakers approved to the program, including the requirement that some participants pay premiums.

“We are making the best judgment for health care in Arkansas based upon federal policy right now,” Hutchinson said. “That’s all a governor can do. That’s all legislators can do. What’s the best thing right now?”

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

(Copyright 2016 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

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