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name guaranteed to derail any political discussion in Arkansas — that it took some hope. +++ uring the 2012 election cycle, Republicans in Arkansas were fired up. For one thing, it looked like they were going to be able to take control of the legislature after being out of power for more than a century. For another, they were hopeful that Republicans nationally could vote out President Obama and repeal his healthcare law, a man and a piece of legislation that had inspired incredible fury among conservative Arkansans. In fact, Obama and taking back the Arkansas legislature were explicitly tied together — a common campaign theme was fighting Obama and Obamacare from Little Rock.
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Department of Human Services released an analysis on the fiscal impact, projecting hundreds of millions in savings to the state’s bottom line, with the savings continuing even as the match rate went down to 90 percent. The RAND Corp. released a study projecting that the state would add thousands of jobs, save thousands of lives and add a half-billion dollars annually in economic stimulus to the state GDP. None of it seemed to matter to Arkansas Republicans. They tried out lots of arguments against expansion, some coherent, some not. For many, given the tone of the campaign (“our view is that supporting Medicaid expansion is really embracing President Obama’s law,” as one party leader put it), the politics
whether to use it,” he said. Listing all of expansion’s benefits, he said, “We just have to say yes.” It was a strong speech, generally well received, and it made the substantive case for Medicaid expansion in starkly political terms. Some key Republicans in the audience, however, felt that Beebe was missing the mark. For them, all of the talk of “Obamacare” was beside the point, even condescending. Sen. Jonathan Dismang (R-Beebe), Sen. David Sanders (R-Little Rock) and Rep. John Burris (R-Harrison) had done their homework on healthcare policy, and they had a chip on their shoulders. They were infuriated when people — whether it was fellow lawmakers, hospital administrators, or this newspaper — called expansion a “no-brainer.” They
BRIAN CHILSON
+++ ast week, the governor signed into law bills that accept federal money through the Affordable Care Act (ACA) to expand healthcare coverage to low-income people in Arkansas. You’d be forgiven if your eyes have glazed over from time to time over the course of this long and often confusing debate. Healthcare reform is a subject that can get complicated quickly, with a lot of acronyms and numbers and jargon. It also has a real impact on real people’s lives. One in four Arkansans between the ages of 19 and 64 does not have health insurance; more than 200,000 of the state’s citizens will be gaining coverage from expansion. The decision will also have an outsized impact on the state’s fiscal future — the state will have hundreds of millions more in its coffers because of expansion, along with the economic impact of billions in federal spending in Arkansas. Whatever your position, it was one of the biggest questions before the legislature in years, if not decades. That question was turned on its head by the “private option” (that’s the common nickname for the new framework that HHS gave Arkansas the go-ahead to pursue). The private option achieves expansion of coverage using private insurance companies on the healthcare exchange instead of Medicaid. This new approach has gotten Arkansas national attention, representing the possibility of a third way for states trying to decide whether to go forward with expansion or stick with the status quo. Here at home, it turned Republicans who had been ferocious critics of the Affordable Care Act into advocates of using billions of dollars in government assistance to help the poor secure healthcare access. Without the private option, Medicaid expansion was all but dead in Arkansas. Now the state may well be the only one in Dixie to do right by its people. With states across the country filing into “yes” or “no” camps on expansion, how did Arkansas forge a different path? It took a group of clever and obstinate young Republican legislators who refused to go along with Medicaid expansion but weren’t ready to close the door on other ideas. They helped force a crafty veteran Democratic governor who was eager to go forward with expansion to consider alternative approaches. Throw in tireless and creative state health officials who happened to have a cozy relationship with their federal counterparts. Probably some luck. And, among everyone involved, it took a slightly crazy, seemingly unjustified optimism that somehow a solution was possible. You might even say — at the risk of conjuring up Barack Obama, a
DAVY CARTER: First Republican lawmaker to endorse the private option.
They wanted to take the country back. Well, they got Arkansas, but not the country. Obama was re-elected and the president’s healthcare reform act was the law of the land, with many of its key components set to go into effect in 2014. Meanwhile, the Supreme Court threw everyone a curveball with a ruling in June that upheld the law but allowed states to decide whether or not to expand Medicaid (see page 15 for a fuller explanation). Beebe announced support for expansion in September, but he couldn’t move ahead unilaterally — he needed a supermajority of the General Assembly to approve. A coalition of powerful interests in the state — particularly hospitals — began lining up in support of expansion. The
surrounding the healthcare law were toxic. “Coming into the session, we had a lot of people that had put themselves into a position where they’re fighting Obamacare, whatever that means,” Beebe spokesman Matt DeCample said. In his state of the state speech, Beebe gave the hard sell on expansion. He made the humanitarian case for the working poor, the fiscal case for the state, and the economic case for hospitals, jobs, and attracting small businesses. “The benefits, costs and insurance mandates that you like or dislike about the law many call Obamacare will continue going into effect this year and the next,” he said. The legislature had the opportunity to do the right thing for the state, Beebe said. “The money is available, it’s our decision
heard Beebe’s line “we just have to say yes” as insulting, suggesting an abdication of their responsibility as legislators. They understood that real harm was coming to the state if no action at all was taken. But they also believed that they had a principled objection to Medicaid expansion that was more thoughtful and nuanced than simple anti-Obamacare partisanship. Sanders recalls a conversation he had with an administration official a few weeks before Beebe’s speech: “I said, understand, our opposition to Medicaid expansion is not some crazy, right-wing, ‘there’s a Muslim Kenyan socialist in the White House’ thing. That’s not us. We don’t think this works for Arkansas.” CONTINUED ON PAGE 14
www.arktimes.com
MAY 2, 2013
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