LITTLE ROCK — Ending a budget standoff reminiscent of the fight that shuttered the federal government last year, Arkansas lawmakers have spared the state's first-in-the nation plan to use Medicaid funds to purchase private insurance for the poor.
But opponents said they're merely hitting the pause button on debating a program that has extended health coverage to nearly 94,000 people.
Democratic Gov. Mike Beebe plans to sign legislation to reauthorize the "private option" program that was approved last year as an alternative to expanding Medicaid under the federal health care law. The House voted 76-24 on Tuesday to continue the program, one vote more than was needed in the 100-member House.
Touted as a compromise method for Republican-leaning states to adopt a key part of the president's health care law, the private option had turned into a divisive issue for Republicans who control the Arkansas Legislature. With the clock ticking on a session intended to focus on the state's budget, opponents said they didn't want to mimic the health care fight that led to the federal government shutting down in October.
"I don't think that's responsible government to put the state in a position to shut the government down," said Rep. Kim Hammer, R-Benton, one of three lawmakers who reversed course to support the program's funding bill.
The program's future had been in doubt after failing to win enough support four days in a row in the state House last month. The state Senate had approved the funding measure without a vote to spare.
The votes will likely continue to be an issue in GOP primaries for legislative, statewide and congressional offices in May, as Republicans continue campaigning against the federal health care law. It's already taken center stage in some races, with House Majority Leader Bruce Westerman touting his opposition to the program in radio ads as he seeks the GOP nomination for a south Arkansas congressional seat.
Despite that push against the law derided as "Obamacare," top Republicans in the Legislature were the architects and biggest advocates of the private option. They argued that private insurers could provide services more efficiently than the government, and they cast it as a way to reform Medicaid.
The effort to keep the program alive continued through Tuesday, with the House delaying the vote as the speaker and state officials met privately with some of the opponents.
"I think the story is about political courage," House Speaker Davy Carter, R-Cabot, told reporters. "I think it's about Arkansas doing something different than the rest of the country. I think we're moving toward market-based health care, coupled with the reforms we put in place. I hope the rest of the country's watching, because Arkansas has tackled this issue together better than anyone else."
Hammer, however, said he was poised to oppose the private option during next year's session if he doesn't believe it is living up to what advocates promised.
"It's either going to be a great success, or it's going to be a miserable failure," Hammer told lawmakers on the House floor. "When we come back here in January, if it's not a great success, I will be voting against it."
GOP opponents said the private option was no different than embracing the president's health care law, and they said the state couldn't afford the 10 percent cost it would eventually have to contribute.
"Three years from now, how are we going to pay for it? Five years from now, how are we going to pay for it? Ten years from now, how are we going to pay for it?" asked Rep. Joe Farrer, R-Austin, who voted against the bill. "If you can't answer those questions, why would you vote for this?"
National health policy experts say Arkansas' compromise opened the door for other Republican-leaning states to consider similar models. Other states exploring or pursuing similar ideas include Pennsylvania, Iowa and Virginia.
Beebe said the case for keeping the program was stronger than last year, when lawmakers were uncertain whether the federal government would approve Arkansas' model.
"If anything, it was even more compelling to do it this time than it was last time," Beebe told reporters after the vote.
Beebe has said rejecting the $915 million in federal funds for the private option would jeopardize other state services. Beebe's proposed $5 billion budget relies on $89 million in savings he says the private option will create by cutting down on hospitals' uncompensated care costs.
The legislation had stalled last month despite amendments aimed at swaying opponents. The changes to the program included a ban on the state spending money to promote the private option or other parts of the federal health law.
The private option's enrollment continued to grow as lawmakers debated the plan's future, with many eyeing the Legislature's debate to see whether they would lose their coverage.
Lori Latch, 35, of North Little Rock said she was relieved to see that the program would stay alive. Latch said the private option is giving her health insurance for the first time since she was a teenager.
"I'm really excited. I'm proud of them for getting it done finally," she said.