LITTLE ROCK — It’s a popular refrain for Democrats and Republicans alike in Arkansas, especially as they gear up for campaign season: We’re not Washington. We’re different.
They may need to rethink that line.
Less than a year after Arkansas adopted a first-in-the-nation plan to provide subsidized health coverage to the poor using Medicaid funds, the program’s future remains in limbo after a string of failed votes in the state House. It’s an impasse that’s putting the state in an all-too-familiar position: on the brink of a budget showdown over the federal health care law.
Though Democratic Gov. Mike Beebe and Republican leaders remain upbeat about the prospects of continuing the state’s "private option," the stalemate that heads into a second week threatens to turn Little Rock into a small-scale version of the Washington budget battle that shut down the federal government for 16 days last year.
At stake is a program that has extended subsidized health coverage to more than 87,000 people and is being heralded as a model for other Republican-leaning states to implement a key part of the law they’ve regularly derided as "Obamacare." Approved as an alternative to the Medicaid expansion called for under that law, the private option uses federal Medicaid money to purchase private insurance for low-income residents.
Unlike the budget battle that spawned the federal government shutdown, the fight in Arkansas over the private option isn’t a simple Democrat-Republican split. The program has deeply divided the Republican Party as it gears up for another election where the GOP plans to run against the president’s health care law.
On one side are Republican legislative leaders and architects of the private option, who cast it as a conservative effort to reform a government program they’ve long complained was bloated and inefficient.
"We saw this as a mechanism, a backstop against many of the negative elements in the Affordable Care Act," said Sen. David Sanders, R-Little Rock, who helped craft the private option law last year. "We didn’t put us in this mess, but certainly I feel we have an obligation to do what’s best for our state and advance a policy that may have long-term implications not just for Arkansas, but the country."
On the other side are Republican opponents who say the private option is no different than embracing the president’s health care law.
"Is Arkansas going to be an enabler for Obamacare and the Washington, D.C. interests who seek to impose their will upon us?" House Majority Leader Bruce Westerman, R-Hot Springs, said last week. "Or, are we going to hold the line on behalf of the people of Arkansas in opposition to this dreadful law?"
Complicating that split is the constitutional requirement that the private option win the approval of three-fourths of the House and Senate, a threshold that’s mandated for most appropriations bills. The $915 million in federal funding for the private option is included within the state Department of Human Services Medicaid appropriation.
Once considered the biggest question mark after losing two key votes, the Senate approved the private option by 27-8. That chamber secured the winning after Sen. Jane English, a Republican who had voted against the private option last year, agreed to support it in exchange for changes to the state’s workforce training initiatives.
The drama instead has been on the House end, where leaders had initially boasted they had the 75 votes needed.
The standoff is wearing thin on Democrats, who complain that they’ve conceded to measures aimed at swaying opponents only to see the vote fail back-to-back. They’ve raised the possibility that the impasse will prevent the Legislature from finalizing the budget for the coming year.
"To say that we’re frustrated is an understatement," said House Minority Leader Greg Leding, D-Fayetteville.
Even if supporters win the 75 votes needed to keep the private option alive, this is just a preview of the fights to come every year. The three-fourths vote requirement is giving opponents leverage to push for scaling back the private option, and it also offers holdouts a bargaining chip for other policies.
"I think going forward it’s going to be even more difficult," Senate President Michael Lamoureux, R-Russellville, said.