LITTLE ROCK — State House members say a proposal to limit enrollment in the so-called private option to a certain period of time each year may provide a way to end the stalemate over the program, but they admit it raises a number of questions.
"It is not something that can be completely analyzed and figured out in a course of days," said House Speaker Davy Carter, R-Cabot. "This is a weeks, months-type process. And it should be, because if you make that call then that triggers other things, and you’ve got a whole laundry list of issues that that develops."
As outlined by Carter and others, the proposal calls for the state Department of Human Services to request permission from the federal government to impose a limited enrollment period each year on the private option, the state’s program to use federal Medicaid money to provide private insurance to people earning up to 138 percent of the federal poverty level. Currently, people can enroll in the program year-round.
The proposal grew out of talks between House members seeking to resolve an impasse over renewing funding for the private option. The proposed budget for DHS includes a $915 appropriation of federal funding to continue the program that launched last year, but the House has failed in multiple votes to muster the three-fourths majority needed to pass it, though the Senate approved it in a single vote.
Earlier in the session, an attempt was made in the House to reach a compromise by adding language to the appropriation to bar the state from promoting the private option or the Arkansas Health Insurance Marketplace. That amendment by Rep. Nate Bell, R-Mena, was adopted but ultimately secured only Bell’s vote, and now some proponents of the private option are wondering how the Bell amendment would affect the new proposal.
"If we’ve already agreed not to fund outreach and publicity efforts, it’s going to be very difficult to let the people of Arkansas know when they can enroll in the plan," said Rep. Warwick Sabin, D-Little Rock.
DHS spokeswoman Kate Luck said that if enrollment becomes limited to certain times of year, the agency will not be able to spend money advertising the change, but the information will be available.
"We think that the insurance brokers and agents, are doing a really good job of letting people know what benefits are out there for them, and on our website obviously people will be able to find information," she said. "And as the program goes on, there’s more word of mouth."
Luck said legislators are talking about implementing the enrollment period starting in 2015. Full participation in the private option is projected at 250,000 people, and about 189,000 have already applied, so by 2015 "we could be approaching that," she said.
If a person were to apply outside of the enrollment period and be found eligible, the person would be placed on Medicaid until the next enrollment period comes up, Luck said. That temporary Medicaid coverage would be funded the same way the private option is: The federal government will pay 100 percent of the costs for the first three years of the program, after which the state’s share of the cost will increase gradually to 10 percent.
The process for switching people from Medicaid to the private option still needs to be worked out, Luck said.
Sabin said the proposal runs counter to the goals of the private option.
"(The proposal) in a lot of ways defeats the purpose of the private option, which is to make this insurance available to as many people as possible when they need it and to be flexible as people move through different income brackets," he said.
Rep. John Burris, R-Harrison, one of the architects of the private option, said legislators are discussing an enrollment period that mirrors the open enrollment period of the insurance marketplace. Under the rules set by the federal government, open enrollment in the marketplace for coverage starting in 2014 runs from Oct. 1 of last year through March 31 of this year, with a second open enrollment period expected to start in November.
"The benefit would be that you’re applying the same enrollment period to all exchange members and that you’re encouraging people to enroll inside that period, which is something they should get used to," Burris said. "I think a year-round enrollment just incentivizes people to realize, ‘There’s no real urgency. I can walk in the door when I need it and enroll.’ There ought to be an incentive to do like the rest of us do, and that’s enroll inside of a window."
The proposal would need approval from the feds, but Luck said that should not be a problem.
"They’re anxious to do what it takes to get it passed," she said.
Democratic House members are unlikely to withdraw their support because of the latest proposal. Republicans who oppose the program say they would prefer to end it or cap enrollment — they have raised concerns about its effect on the national debt and the state’s ability to pay its eventual 10 percent share of the cost — but lacking support for that approach, their choice may come down to accepting the latest compromise or ending the session without approving a DHS budget.
Rep. Bruce Cozart, R-Hot Springs, said the proposal is not enough to get him to vote "yes," but he speculated that it may be enough for some members who are ready for the stalemate to end.
"They’re tired. I think we’re all tired," he said.