Arkansas Governor Speaks Up About Chances of Medicaid Expansion Repeal

His state may become the first to repeal Medicaid expansion after becoming the first to enact it with a privatized model.
by | February 24, 2014 AT 4:00 PM
Arkansas Gov. Mike Beebe talks to reporters.
Arkansas Gov. Mike Beebe talks to reporters. David Kidd/Governing

Gov. Mike Beebe of Arkansas says that governors from a number of states that are still holding out on Medicaid expansion have approached him in recent days at a Washington, D.C. conference to ask about his state’s model—a first-of-its-kind approach that remains under threat of repeal in the Arkansas legislature.

While Arkansas House Speaker Davy Carter, a Republican, has insisted his chamber will find the votes to continue funding the expansion, Beebe kept his distance from the legislative debate.

“I don’t want to antagonize anybody,” Beebe, a Democrat, told reporters at a conference sponsored by Kaiser Health News and Health Affairs. Beebe is in the District for a meeting of the National Governors Association. “I don’t want anybody to think I’m taking it for granted… Don’t take my reticence to come out and beat my chest as anything other than (support).”

The legislature authorized the state last year to approach the U.S. Department of Health and Human Services with a proposal to enroll more low-income adults in private health coverage using Medicaid expansion money. That proposal won approval and has influenced other states pursuing Medicaid expansion on more politically perilous grounds, including Iowa, Pennsylvania, Utah and Tennessee.

Supporters of Arkansas' plan have argued allowing private carriers to compete for the new Medicaid money will help drive down costs and reduce the administrative burdens. And because the plan relies on private carriers, it's more appealing to Republicans, who often distrust government-run programs.

The Arkansas Constitution requires the approval of three quarters of lawmakers for certain types of spending, and the expansion model runs dry at the end of this fiscal year without reauthorization to accept the federal money that funds it. The Senate narrowly met that hurdle last week after the chamber won over a reluctant Republican with the promise of support for a workforce-development program.

The House, which has gained more “yes” votes since its initial tally, remains about four votes shy. Beebe told reporters that the House will continue bringing the issue to a vote but won’t resort to making special deals to coax reluctant lawmakers, some of whom face challenges from candidates running against the private Medicaid expansion plan.

“It’s not fair to make deals at the 11th hour,” he said.

Beebe said the fiscal reality of the situation is the best argument in favor of reauthorizing the expansion. The state has saved about $86 million in previously uncompensated care and from shifting more people to the federally funded expansion. That money was already returned as a tax cut, Beebe said, so refusing the privatized expansion requires filling a new budget gap.

He also said the legislative breakdown in Little Rock hasn’t splashed cold water on the idea of pursuing a privatized Medicaid expansion in Republican-controlled states. He wouldn’t name specific states, but he said a number of governors have approached him during the National Governors Association to ask about the benefits of Arkansas’ model because there’s a growing recognition that doing nothing effectively sends tax revenue to the states that are willing to expand.

“They are not going to impact the federal deficit or change what’s going on with our national debt whether they take it or not, and a lot of them have awakened to that,” he said.