HEALTH CARE IN DIXIE: Gov. Mike Beebe and Gov. Steve Beshear of Kentucky, two of the only Southern governors to opt in for Medicaid expansion.
Gov. Mike Beebe
hosted a panel this morning on the private option
— the state's plan using Medicaid funds to purchase private health insurance for low-income Arkansans — at the Southern Governors Association
meeting in downtown Little Rock. I'll have more on the panel discussion later today, but it's impossible to talk about this policy without acknowledging the politics, so I want to quickly highlight some comments from Beebe on the coming legislative fight over re-appropriating the private option in 2015. Beebe used the occasion to make a prediction — more bold, aggressive and blunt than we're accustomed to from Beebe, nearing the end of his term. The private option isn't going anywhere, Beebe said, because ultimately the overwhelming majority of the legislature supports it.
That may sound straightforward, but of course the wrinkle in Arkansas is that — unique in the nation — the state constitution demands (at least until a court says otherwise
) a three-fourths majority for certain appropriations, including the private option. Getting 75 percent approval is a tough slog even for "mothers and apple pie," as Beebe puts it. Thus, despite large bipartisan majorities in favor of the private option in the House and Senate, it took a knockdown-dragout fight to pass the policy in 2013
and an equally dicey and contentious battle to get it re-authorized in 2014
. After the Republican primaries, the Senate appears to be two votes short heading in to the 2015 session, leading many to believe that the future of the private option is in dire jeopardy. But Beebe this morning made the political point that was always in the background of the 2014 re-authorization fight:
This isn't going away. [Barbara Lyons of the Kaiser Family Foundation] suggested that we have some things to worry about going forward, and she's absolutely right, you've got to appropriate this money every year. ... But let's say 26 percent don't want to do it and therefore you don't have the three fourths. What's that 74 percent going to do? Are they just going to roll over and play dead, stick their feet up in the air and say, okay, you killed me? Let's all go home? Nah.
When Roby Brock interjected with "compromise," Beebe responded, "Compromise? Not much." He continued:
Jonathan [Dismang], his colleagues, the Democrats, people who see how this is working—they may tweak it, they may change it, the circumstances may require that. Data may suggest it needs to be done. But you're not going to take an overwhelming majority of the legislature and let a small minority of the legislature wag that tail to the point that they're just going to roll over and play dead, in my opinion. I've been watching this stuff for 32 years. We wouldn't have done that when I was a senator. I wouldn't have let 26 or 27 percent of the folks overrule the overwhelming majority, [with support from] both parties, Republican and Democrat.
Fighting words! Of course, Beebe added, "I get to talk like that, I'm not running for anything else." Incoming Senate President Pro Tem Jonathan Dismang
, meanwhile, who
unlike Beebe will be one of the key players in trying to clear the 75 percent hurdle next year, was much more circumspect. Dismang said that the focus will be on providing the membership with the information they need and said he would be open to dialogue and compromise. He predicted that the debate would largely hinge on the developing facts on the ground, such as the 2015 rates that carriers will release in November.
"There will be tweaks," Dismang said. "It's not going to be easy. There are folks that are very adamant in their opposition ... some of their concerns are correct and admirable and probably in the right direction. It's our job to ensure that we provide the reforms in place that, again, may not get them to being a yes vote, but [move] the program in the right direction."
That's the right tone from someone trying to get a supermajority. But Beebe's point holds: the aginners determined to kill the private option are hoping that the overwhelming legislative majority simply caves to refuseniks who amount to 26 or 27 percent, perhaps of only one house of the legislature. Nobody
believes that private option opponents will be anywhere close to a simple majority in the 2015 legislature. Opponents may have the votes to block
the appropriation, but they don't have anywhere near the votes to actually pass something in its place. They do have one tool — they could threaten to block the entire appropriation
for Medicaid (including kids, nursing homes, etc.) unless the majority bends to their will and ends the private option. At least a few private option opponents are willing to play that game of chicken
. But that sounds like a politically ugly route, to say the least — this is an even more extreme version of the D.C. shutdown gambit, which at least involved the majority of the U.S. House. What if 26 percent
shut everything down unless their demands were met?
The future of the private option is in real doubt. Somehow, they have to pick up the votes to pass the appropriation, and that won't be easy. But the notion that the private option will simply end because of nine senators also seems far-fetched. Opponents may threaten the entire DHS appropriation and demand that a bipartisan majority ends the private option — kicking off 200,000 Arkansans from their health insurance and turning down billions in federal money. But I suspect that the majority is going to respond the way Beebe predicts: "Nah."