Gov. Asa Hutchinson made his case today for the future of the private option: he is asking the legislature to fund the policy for two more years and he is asking for the creation of a task force which would look into extensive reforms to the entire health care system in the state starting in 2017. Hutchinson said that the changes for 2017 and beyond “will include a compassionate and reasonable cost-effective response for care of those currently on the Private Option.”
This is good news for the immediate future of the healthcare coverage expansion in Arkansas. But Hutchinson’s speech is far from the end of the game. The private option still needs supermajorities from both the Arkansas House and the Senate to continue. That remains a very steep climb — it only takes nine senators or 26 in the House to block the appropriation.
Some observers I spoke with today were skeptical that Hutchinson had picked up votes with today’s speech. There’s certainly still plenty for the Tea Party to hate in his proposal. Others, however, seemed to believe that a significant number of Republican lawmakers would coalesce around Hutchinson’s path forward.
I spoke with a number of legislators. There are still a scattering of hard no votes, but several lawmakers who voted no last year seemed open to the Hutchinson proposal, with at least one definitively declaring support. These are preliminary, same-day reactions of course, and there will be much debate and lobbying to come. But for a political lay of the land on the day of the speech, see below for some legislators’ reactions in their own words. I’ve also included a statement from conservative advocacy group Americans for Prosperity, an elegant exercise in hedging.
Let’s start with the Republicans:
Sen. Bryan King (voted against the private option in 2013 and 2014)
King has been one of the most vocal opponents of the private option in the legislature. No surprise, he was not swayed by Hutchinson’s pitch. King said he would oppose continuing funding for the private option for two years. “That’s just kicking the can down the road until after the next election,” he said.
I’m opposed to keeping the program going. I’ve always been opposed to the private option. We didn’t know what it was going to do when it was passed. It was just a bunch of promises and it’s all failed, except for providing health care to a certain segment of the population.
It’s been over-budget and it’s been a financial boondoggle for big insurance companies. It’s been a financial catastrophe.
King said he wasn’t sure what would happen but at this point believed that Hutchinson’s plan had a good chance of getting the supermajority, noting the power of a newly elected governor to pull in votes.
If you’ve been voting against it, do you think this is going to end it? You say the ‘private option’ is ending, but it’s Medicaid expansion. I’ve been around down there long enough to know that when you look at January 2017, the current makeup of the Assembly that has already voted to expand Obamacare in some form or another – I’ve got a better chance of starting for the Kansas City Chiefs in 2017 than anybody can think that Obamacare expansion’s not going to come back.
Sen. Cecile Bledsoe (voted against the private option in 2013 and 2014)
I loved it. He did a great job articulating his plan. He talked about the cost of the private option. He talked about the good, and he talked about the costs. I think it was just a wonderful speech. I think people are excited.
Rep. Kelley Linck (voted for the private option in 2013 and 2014; part of the delegation that Hutchinson took to meet with the feds in Washington D.C.)
Linck said he was “absolutely” on board with Hutchinson’s approach.
It’s a good way of not cutting off our arm immediately. We know that we can’t sustain this. Those of us that voted for it, we’re not sure how we would sustain it. This gives us time instead of immediately we’ve got to come up with something new and innovative. This gives us time also to measure the private option. Maybe this is — or at least components of the private option are — the best thing for the future. The task force will certainly have that opportunity.
I asked whether the votes would be there in the GOP caucus.
I believe they will be. I don’t think anybody’s going to love this, I don’t think anybody’s going to hate it. If all sides are not happy then we’ll probably have a consensus.
Rep. Joe Farrer (voted against the private option in 2013 and 2014)
Farrer has been one of the most outspoken opponents of the private option in the legislature. So it’s significant that he is now stating that he will support Hutchinson’s plan:
I like it. It’s a compromise that nobody likes 100 percent. To me that means it’s probably actually a pretty good deal if nobody’s really happy with it. I’m going to support it. I think it’s the right thing to do. Again, I would have liked to have ended the private option quicker.
I think it will pass. There’s going to be some that’s going to vote no. But I don’t think you’re going to have the fight over it that we had last time. Because we do have a solid end date. It’s hard for people that ran “we’re going to kill the private option.” Well, we did kill the private option, just probably not as quickly as we wanted. I’ve talked to some of the other representatives, and they don’t have a bad problem with it.
Farrer said he was encouraged by Hutchinson’s plan to enact system-wide changes in 2017.
My whole thing was we had a broken system that we never fixed, that we never addressed. The way the governor’s bill is written, now at least we get to reform the Medicaid system in Arkansas.
Farrer continued to express hope that Arkansas could eventually get a block grant to pursue a reform of the Medicaid system with less federal government interference.
Rep. David Meeks (voted against the private option in 2013 and 2014)
Meeks said he was waiting to see the details on Hutchinson’s proposal before reaching any conclusions but said the broad outline was in range of something he could support.
I appreciate the leadership and the vision that he laid out. I still want to see the details — how the task force is going to be made up. What the end date really means as far as 2016.
Meeks compared it the Hendren-Ballinger amendment during the 2014 debate, which would have killed the private option and cut off the funding for the coverage expansion, but done so a few months later. In practice, however, Hutchinson’s proposal doesn’t set a cutoff date to refuse federal dollars for coverage and kick people off insurance, as Hendren-Ballinger would have done. It ends the private option at the end of 2016 (already the end date by both the enabling legislation and the federal waiver) and anticipates covering the same population, potentially via new means, in 2017 and beyond.
Rep. Nate Bell (voted against the private option in 2013 and for it in 2014 for tactical reasons)
I have not had the time to personally review the proposal but what I’m hearing from folks, it sounds like something I’m okay with.
The general mood is: no matter how we felt about this thing originally, it is. And everybody understands that untangling ourselves from it, whether they support that or not, is a very complicated and difficult process. Personally, as I’ve said many, many times, I want us to detangle from it and move on. But I am more than conscious that that’s not something that you just pass a bill and walk away from. Based on the top lines, it looks to me like the governor has a pretty responsible approach to it.
Sen. Missy Irvin (voted for the private option in 2013 and against it in 2014)
I think the task force is a very good idea. I absolutely appreciate that effort. Because I think you have to look at the entire Medicaid program. … Making sure that we really listen to people out there in all parts of the state, especially rural Arkansas. We’ve got to make sure we provide a good access to care.
I asked about funding the private option for two more years.
I think there’s economic reasons why you do that. There’s going to be a lot debate about that. We’ll see. The debate is a good thing. This starts a dialogue and a debate.
Generally I loved his speech. It was very thoughtful and educational. It wasn’t a political speech, it was a professor’s speech. I appreciated that.
And here’s the response from AFP, the rightwing advocacy group that has been a big spender in Arkansas politics. Pretty meek. The group opposes the private option, but sounds like they might be sitting this fight out:
Americans for Prosperity Arkansas appreciates Governor Hutchinson and the legislature’s desire to address the so-called “private option” Medicaid expansion; however, on behalf of our 75,000 activists in the state, there remains some concerns about the future of health care reform in Arkansas.
While Governor Hutchinson’s proposal lays out some principles that we strongly support, such as seeking flexibility from the federal government and attempting to control costs, reservations remain. Taxpayers need a plan that will freeze enrollment in the private option, allows for an off-ramp that cycles people out of the program and ultimately contains a definitive end date to the Medicaid expansion.
Nevertheless, ending the private option, constructively reforming the health care system, and growing opportunity in the Arkansas economy remain a work in progress, and we looks forward to working with Governor Hutchinson and members of the legislature to achieve these goals.
Meanwhile, here are some thoughts from Democrats. Dems voted en masse for the private option the last two years, and it sounds like they’ll be on board for the Hutchinson proposal:
Rep. Joe Jett
The folks I’m talking to are kind of pleasantly surprised.
I think it’s still going to be a heavy lift on [the private option and the governor’s proposed tax cuts].
I’d like to think most of my colleagues on my side of the aisle are going to stick with the private option after we fought so hard to get it. [Asa Hutchinson] is the governor now. This is his plan, his vision, and it’s up to him get his votes.
Rep. Stephen Magie
I think he’s taking a real pragmatic approach. He understands the needs of Arkansans. And understands the importance of the program as it is, and feels that we can’t come in immediately to make major changes in it.
I think he sees the need for reforms in Medicaid to ensure that Arkansans get the right care at the right price and the right value.
I think he’s on the right path, didn’t want to rock the boat and make a lot of immediate changes – and risk losing it when so many Arkansans are dependent upon it.
Rep. Mary Broadaway
Another aspect of this is that I think the governor has a vision. Nothing works independently. He wants to pass these tax cuts for middle class Arkansans to give the working people a break, and he recognizes that the money that is coming in from the private option is absolutely critical to making his tax cut work. The state cannot afford it without it.
I respect his pragmatism and appreciate his vision for looking at the whole picture.
Broadway said that Hutchinson’s commitment to health care made her more comfortable voting for his proposed tax cuts.
Rep. Greg Leding
I think our Governor’s comments on the future of healthcare in Arkansas offered reasons to be both encouraged and cautious. We should absolutely work to create the best healthcare system we can, but we owe stability to those already on the Private Option and our hospitals, and we need to make sure all voices are represented in any and all discussions about how we write this next chapter. And I look forward to working with our Governor.