The legislation to continue the state’s private option Medicaid expansion passed through House and Senate committees this afternoon after passing in the full chambers this morning. Observers at the Capitol are bullish that the House will be able to pass the appropriation for Medicaid when the fiscal session begins next week, but in the Senate, a rump group of ten senators opposed to the private option are threatening to shut down the government if they don’t get their way. 

Senate Bill 1 and House Bill 1001 are identical bills to enact the Gov. Asa Hutchinson‘s plan to continue the private option, which he has re-named “Arkansas Works.” The twin bills exist as a procedural mechanism to quickly run the legislation through. Earlier this morning, the House passed their bill 70-30 and the Senate passed their bill 25-10. The bills will now flip flop chambers tomorrow; once approved, the “Arkansas Works” legislation will head to the governor’s desk. 


But this is all Kabuki theater. The real battle is next week, when a small minority of Tea Party legislators are threatening to hold the entire Medicaid budget hostage in order to try to kill the private option. The appropriation for the Medicaid budget — that’s not just the private option but all Medicaid services, including children on ARKids, the elderly in nursing homes, the disabled — is generally thought to require 75-percent approval in both houses. Theoretically, just nine senators (or twenty-six in the House) could shut down all of that funding if the overwhelming majority didn’t give in to their demands.

The governor, who will sign the bill at a public ceremony tomorrow morning, released the following statement: 


I was pleased by the strength of the vote margin for the passage of the Arkansas Works. The results exceeded our expectations and are a clear indication that a very strong, bipartisan majority supports this policy for Arkansas.

“This impressive vote is a solid foundation for the funding approval in the Fiscal Session.

The vote count today in the House, while short of 75, is higher than most lawmakers were predicting when the special session began (and significantly higher than the original enabling legislation for the private option in 2013, which passed with 62 votes before eventually getting 77 votes for the appropriation). Finding five more votes won’t be easy, but most lawmakers believe it’s doable — note that there are likely a few who oppose the private option but aren’t willing to play shutdown games and will vote for the appropriation. 

The Senate, however, remains a massive headache for the governor. Ten senators voted NO today, and most of them are in the unflippable, “hell no” camp. The governor’s office needs to pick up two votes and they’ll be focusing on Sen. Missy Irvin and Sen. Cecile Bledsoe, as well as (more desperately) Sen. Alan Clark and Sen. Blake Johnson. Or (really desperately) Sen. Bart Hester, an AFP darling rumored to be eyeing a run for Congress. Irvin has voted for the PO in the past, but the appropriation needs Irvin and one more. These are all rigid Tea Party ideologues, some of them funded by anti-PO advocacy groups. It’s slim pickings. 


Keep in mind, however, that just because a handful of senators block the appropriation, that doesn’t mean they have the votes to pass something in its place. Remember, opponents of the private option are a tiny minority in the legislature. There is absolutely zero chance of getting the needed supermajority to pass the Medicaid appropriation with the private option stripped out. The aginners can try to pass their own appropriation but they will fail because, again, they are a tiny minority of the legislature. They almost certainly couldn’t even get it out of committee.

If the appropriation falls short next week, in other words, it doesn’t mean the private option ends. It means we’re at a standstill. It means we’re in a game of chicken. Private option opponents have leverage only insofar as they’re actually willing to shut down the government’s provision of medical services. Threatening to kick the elderly out of nursing homes in order to try to force the overwhelming majority of the legislature to cave to a tiny minority’s demands may prove politically awkward. The aginners’ position is that their passion to kick 275,000 Arkansans off of their health insurance is so high that in order to achieve their goal, they’re willing to kick granny out of her bed, kick hundreds of poor kids off their health insurance, and leave the severely disabled with no access to medical care. It’s really quite something.

The truth is that the aginners don’t seem to have much of a plan other than to scream and shout as long as they can. If past is prologue, a few will cave as the heat turns up and Arkansas will avoid the humanitarian disaster that would occur if the Tea Partiers shut down the Medicaid program. 

“Today’s bill was a bill about policy,” Rep. Charlie Collins said.  “The vote today is a statement about each member’s preference for the policy. … Dial forward to the budget session, now we have a different vote. Now I’m voting on something else. I’m voting on the funding plan for the Department of Human Services in the state of Arkansas. [Am I voting for funding for foster children or am I voting against funding for foster children?*] Similarly, am I voting to fund the needs of disabled people on traditional Medicaid? That vote was not on the table today, but the DHS budget funds those programs, and if you vote against those things, you are voting against those programs.”   


* UPDATE: The Division of Children and Family Services is not part of the relevant Medical Services appropriation, so that funding stream for foster children would not be on the chopping block unless there is a change in how the appropriations are organized. Collins’ point stands for the elderly, the disabled, and children on Medicaid, but not DCFS. 

*UPDATE 2: While DCFS funding is in a separate budget, medical services for thousands of foster children is funded in the Medical Services appropriation and would be on the chopping block. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.