The main event for fiscal session: The private option

The so-called “private option” proposed by Gov. Mike Beebe had enough bipartisan support to be approved and funded by the Legislature through the 2013 fiscal year. In the 2014 fiscal session, the private option is up for review and another three-quarter vote in both chambers to keep the plan going.

Generally speaking, the private option rejects federal Affordable Care Act Medicaid expansion in favor of using an allocation of about $89 million in federal funds to buy insurance through the state’s private “marketplace” for an estimated 200,000 Arkansans who would have been eligible for federal coverage under the Affordable Care Act.

The private option needed a 2/3 majority vote in both the House and Senate to pass in 2013. The tally in the House was 77/23, and in the Senate it was 28/7. If the margin of success for the private option was narrow in 2013, most agree that it will probably only be narrower this year.

Paul Bookout, a former Democratic Senator who voted for the private option in 2013, resigned in August after admitting campaign finance violations. He was replaced in a special election by Sen. John Cooper (R-Jonesboro), whose campaign included a promise to vote against the private option.

The private option’s passage in 2013 was the result of compromise and negotiation between Republicans and Democrats. Democrats agreed to agree to tax cuts including exemptions for certain farm supplies and utilities and a 1/10 of 1 percent across-the-board income tax cut to be phased in over the next few years; Republicans in turn agreed to agree to the private option.

Sen. Jason Rapert (R-Conway) voted for the private option in 2013, but said last week that his continued support depends on the agreement’s adherence to its 2013 terms.

Rapert said that he was concerned by the “surprise move” by Arkansas Blue Cross & Blue Shield to pay specialist physicians 15 percent less for procedures within their area of specialization than primary care practitioners are paid for the same procedure.

Rapert called this 15-percent difference in compensation “an unusual arrangement” that “has caused tremendous turmoil for certain members of the legislature because this is not what we agreed to and expected,” and also said that ABCBS is “at the point now that if they persist in this decision it’s going to unsettle things enough that people may not support the private option.”

Rapert also said that he’d met with Gov. Beebe late last week to ask Beebe to urge ABCBS to reconsider the 15-percent arrangement.

Rep. Steve Magie (D-Conway), an ophthalmologist, said he agrees that the 15-percent disparity between specialist and primary care pay is “unfair,” but that it should be addressed independently of the private option question as a whole, which he’ll be voting in favor of this year.

Magie said that he agreed with the intent of paying specialists less: to promote primary care practice, especially when the modern trend in medicine has for years been a migration of “family” doctors away from rural areas. However, he said he’s met with ABCBS officials to ask them to “be fair to everybody, to physicians as a whole” in setting new ABCBS pay rates to accommodate uncertainty in the new healthcare marketplace.

“If they came out and said the rate would just be discounted across the board, I think physicians would look around and say, ‘yeah, it’s not ideal but everybody’s taking the same cut and we’re all in the same boat, so we can live with it,’” Magie said. “The rub comes now when there are physicians visiting with their representatives and they’re saying that they’re not happy with the situation. That doesn’t change my support for the private option because what Blue Cross/Blue Shield does doesn’t have anything to do with the private option’s goal of giving the most vulnerable people in our society access to healthcare.

“[The pay disparity] is another issue that may confirm some individuals’ feelings that we should do everything possible to end the Affordable Care Act and it might give them a reason to vote against it,” Magie said. “It’s a divisive issue at a time when there’s still such great uncertainty among legislators about whether we should pass it or not. I think there’ll be a lot of strong, vigorous debate, but I think people will see the light and it’ll pass.”

If ABCBS doesn’t change course on the 15-percent pay disparity, according to Rapert, “the private option has about a 50/50 chance of going forward or not.”

“The worst thing that can happen in business or government is one party finding out that the other has not stood their ground and lived up to their expectations,” Rapert said.

Reps. David and Stephen Meeks, brothers and Republicans from Conway and Greenbrier, respectively, voted against the private option in 2013 and said that they’d vote against re-funding it again this year.

“I have concerns with money from one taxpayer taken to buy insurance for another taxpayer, and also grave concerns about adding to the national debt; and this program would do that,” Stephen Meeks said.

The private option is a good concept, according to David Meeks, “but there are still some issues with it and I’ll be opposing it in the fiscal session.”

“I think [the private option] expands the cost of healthcare and expands the number of people who are on the government rolls and I think we’ve got to be careful about keeping a program that’s going to be unsustainable in the future.”

Rep. Douglas House (R-North Little Rock) has a different take on it.

“Personally, I think Obamacare will fail in three years,” House said, and in his opinion, Arkansas’ hospitals would be in danger of failing along with it for lack of compensation for health services they would have to continue to provide to anyone covered under it.

“As for the private option, it’s the best plan I’ve heard so far to keep our hospitals open,” he said, to explain why he’d be voting to fund it this year.

However the private option works out, Stephen Meeks said, “It’s going to be a very complicated issue to sort through.”

“Trying to predict politics is very difficult, but my general feeling is the way politics are, nobody’s going to get what they want,” he said. “If we want to defund the private option we’ve got to give people who’ve signed up for it six months’ notice, and who knows how the federal government will react. That, I suspect, is going to be the key fight for the fiscal session.”

As for other Arkansas health issues, Rapert said that he’d do everything in his power to keep the Conway Human Development Center and other similar facilities for mentally and physically impaired Arkansans adequately funded.

“Arkansas’ human development centers have been ignored in many regards,’ he said, but there was progress last week in efforts to bring licensed practical nurse (LPN) pay at these facilities up to a competitive level with other LPN positions statewide.

(Staff writer Joe Lamb can be reached by email at joe.lamb@thecabin.net or by phone at 505-1277. To comment on this and other stories in the Log Cabin, log on to www.thecabin.net. Send us your news at www.thecabin.net/submit)

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