LITTLE ROCK — Twice before, Gov. Mike Beebe has won three-fourths votes to raise taxes, among the most difficult of legislative hurdles. To expand the state Medicaid program, he would have to do so again — in a much-changed political climate.
Beebe, a Democrat, pushed an increase in the state severance tax on natural gas through the Legislature in a 2008 special session. In the 2009 regular session, he pushed through an increase in the state tobacco tax to support a statewide trauma system and other health programs.
The severance tax hike passed 82-17 in the 100-member House and 32-1 in the 35-member Senate. The tobacco tax hike was a tougher sell, passing 75-24 in the House and 28-7 in the Senate — with exactly the number of votes it needed in the former and only one vote to spare in the latter.
Earlier this month, Beebe said he is inclined to pursue adding between 200,000 and 250,000 Arkansans to the Medicaid rolls under a provision of the federal Affordable Care Act that the U.S. Supreme Court has ruled must be optional. The federal government would pay the entire cost of the expansion for the first three years and most of the cost in later years, but appropriating the federal money would require a three-fourths vote in the Legislature.
Last week, the governor said his position was bolstered by the state Department of Human Services’ estimate that the expansion would ultimately cost the state about $4 million a year instead of previous estimates of up to $200 million.
Beebe acknowledged that getting a three-fourths vote for anything is difficult.
In the 2008 and 2009 sessions, Democrats held sizable majorities in the House and Senate. However, Republicans made significant gains in the 2010 election and are pushing for control of both chambers in this year’s balloting.
Republican House Caucus leader Brice Westerman, R-Hot Springs, said last week that Republican opposition would make it tough to get a three-fourths vote in the Legislature to fund the Medicaid expansion now, and "I think it may be even harder after the election."
Republicans now hold 46 seats in the House and 15 seats in the Senate, as opposed to 25 in the House and eight in the Senate in 2009.
Another factor that could work against Beebe is the widening gulf between Democrats and Republicans, according to Hal Bass, a political science professor at Ouachita Baptist University.
"Clearly the rise of the Republican Party in the Legislature has carried with it increasing
conflict between the parties," Bass said. "I think in the old days one assembled majorities and supermajorities on a nonpartisan or cross-partisan basis, but now the party label on both sides matters more, and that’s just the nature of increased parity between the parties."
Republicans asserted their increased power in various ways in the 2011 regular session and the 2012 fiscal session, including blocking budget bills until Democrats agreed to pass tax cuts and proposing an alternative to Beebe’s balanced budget proposal.
But would Republicans say no to hundreds of millions of federal dollars that would help more Arkansas families obtain health care?
DHS officials said last week that the influx of new federal dollars under the federal Affordable Care Act, as well as the state income taxes paid on that money and the savings from reducing uncompensated care, should save the state $372 million by 2021.
"It’s going to be very, very difficult to turn this one down from a financial perspective," Bass said, but he said there are legitimate arguments to be made against it.
"There is the concern that we’re being kind of lured into a snare by signing on for a commitment, that it’s going to be difficult to sustain down the road as people my age, and I’m 63, get older and need more and more medical attention," he said. "Is this commitment we made in the New Deal-Great Society era truly sustainable going forward?"
Another factor that could influence the debate is the impact the expansion would have on hospitals. The Arkansas Hospital Association says the Medicaid expansion would reduce uncompensated care and help hospitals across the state stay open.
"My impression is that the hospital guys have been a pretty potent lobbying force in the past," Bass said. "What kind of response they’d get from the Republican legislators, I don’t know."
Beebe has already laid the groundwork for arguments that expanding Medicaid is the right thing to do for humanitarian reasons and that rejecting the money would just send it to other states.
"If it’s going to happen, do we let New York take it and California take it and Florida take it or whoever, and tell our people no?" he said last week.
Rep. Nate Bell, R-Mena, countered that "regardless of whether it’s federal money or state money, it’s still money that’s coming out of the pockets of taxpayers."
Some have predicted that, as with the federal stimulus of 2009, states ultimately will decide to take the money despite their misgivings.
"It’s hard to walk away from that much money, especially when you have 100 years of greater than average need and lower than average resources on your own," said Janine Parry, a political science professor at the University of Arkansas.
But Parry said that if Republicans find themselves in the majority in the state Legislature in 2013, "it could have the effect of making them more cohesive, and then of course that doesn’t bode well for what Beebe’s hoping for."