With the election of Terry Rice and Scott Flippo to the Arkansas Senate there is 9 solid votes against the Private Option in the Senate for 2015. This is already enough to stop an appropriation bill related to the Private Option.
The liberal spin is that 9 votes is only a small minority in the 35 member Senate, and the Private Option will ultimately survive. Their assessment appears to be based on an assumption that 2015 will be just like 2014, when Private Option supporters only lacked a couple of votes to continue the Private Option and were able to chip away at opponents’ votes. Don’t expect 2015 to be same old scenario
I think the Private Option is in deep trouble. Private option opponents only played defense in 2014, but as opposition grows I expect them to mount an offense as well. A conversation needs to begin among Republicans and Democrats on what steps will be taken if the Private Option is terminated.
Why do I see the opponents’ position being stronger in 2015? Here is summary:
- The number of “no” votes is likely grow – both as a result of November elections and from defections by former Private Option supporters;
- To keep the Private Option, extreme pressure had to be applied by Governor Mike Beebe and Speaker Davy Carter, but they will not be in office in 2015; and
- Problems with the Private Option will continue to work against extension of the program.
These factor deserve a more detailed discussion and that it what I have tried to do below.
LIKELIHOOD THAT “NO” VOTES WILL GROW
You can’t assume that Private Option opponents will only have the bare minimum of votes and only be able to hold up an appropriation for a while as supporters chip away at opposition votes.
- There are a number of contested races in November and the addition of more “no” votes is a distinct possibility in both the House and Senate.
- A past “yes” vote does not mean the legislator was a solid supporter of the Private Option, nor can you assume that previous support will guarantee future support.
- Remember, some legislators voted for the Private Option, not out of support for it, but because they sought concessions for voting for the Private option or possibly because their leadership positions may have been threatened.
- With the likelihood of continuing bad news for the program, you must consider that previous support for the Private Option may not translate into future support. Problems for the Private Option were only beginning to mount during the 2014 Fiscal Session. Since then concerns about the Private Option have increased.
- During the 2014 Fiscal Session more than one Democrat member of the House was heard complaining about multiple votes, and their wish that the whole thing would just go away. Was that just frustration talking, or are there already cracks in support even among Democrats?
- Term limits in the House is another important factor that can’t be overlooked. Because of term limits over 1/3rd of the House membership will be first time legislators. This provides many opportunities for a shift in support.
EXTREME PRESSURE BY BEEBE AND CARTER WILL BE ABSENT
The Private Option was made possible in 2013 and 2014 by strong pressure from the governor and some legislative officers, such as Speaker Davy Carter. Will the next governor and the next legislative leaders be willing and able to play hardball to keep “yes” votes in line? If not, expect more cracks in Private Option support.
- Governor. Governor Mike Beebe carries a big stick. He was able to call in favors and offer concessions in order to secure votes for the Private Option. Will a Governor Hutchinson or a Governor Ross want to use up the great amount of political capital needed for this fight when he has his own agenda items? In addition a brand new governor will not have the same amount of clout that Governor Beebe had in his 7th and 8th years as governor.
- Speaker. Speaker Davy Carter forced vote after vote on the Private Option during the Fiscal Session and held the Department of Human Services budget hostage in order to maintain leverage. But Carter will be out of office. Republican Jeremy Gilliam was elected Speaker Designate and is likely to be the next Speaker of the House. Gilliam voted for the private option but how strongly is he willing to fight for it? Gilliam may see his clout being better used on other causes.
- A major strength of the Speaker is that he appoints the chairs and vice chairs of committees and subcommittees. Will Gilliam be willing to threaten some of his Republican colleagues with the loss of chairmanships for not voting for the Private Option?
- Carter was elected Speaker by aligning himself with the Democrat House members and gaining only a handful of Republican supporters. Is Gilliam willing to be viewed as the Democrat’s man, like Carter?
- The makeup of the House will be different for Gilliam as the Republican majority in the House is likely to grow.
- Gilliam knows he still must be elected Speaker and lead effectively. Will he risk alienating a number of Republican House members by adopting a hard core stand on the Private Option?
- President Pro Tempore of the Senate. Senator Jonathan Dismang was chosen as President Pro Tempore designee and is likely to be the next President Pro Tempore of the Senate. The Pro Tempore is powerful, but not as powerful but doesn’t have the appointment power of the Speaker. Dismang was a lead sponsor of the Private Option and he could be a major player in the fight to retain the Private Option. Still, Private Option opponents carry some hope that Dismang will be more willing to listen, based on Dismang’s statements in 2013 that he was willing to separate the Private Option issue from the appropriation bill for the Department of Human Services.
MOUNTING PROBLEMS FOR THE PRIVATE OPTION.
The Private Option promised free federal money and lots of state control. The concept sold to the legislature hasn’t lived up to its billing.
- Cost overruns. The cost of the Private Option is running higher than the federal limit for the per person cost. It appears Arkansas taxpayers will have to pay millions of dollars to the federal government for cost overruns. Some say don’t worry about the overruns because the federal government might give us more “free money” (and they insist that you don’t call it a federal bailout.) Will the feds actually agree to pay ALL of the cost overruns in order to maintain a more costly program? Even if a federal increase is granted, people understand that the money is not free. It comes from the federal taxes we pay and from a growing burden on future generations.
- Future Costs for Arkansas. Each day Arkansas draws closer to the date when Arkansas must start paying a percentage of the cost of this Medicaid expansion. This is in addition to having to pay for cost overruns.
- Not directed at the Most Needy. It turned out that the Private Option is not targeting our most needy. A substantial portion of the enrollees are able bodied working age people without children. The Private Option also puts our most needy citizens behind able bodied people in the Private Option because health care providers are more willing to accept Private Option coverage than traditional Medicaid.
- Federal terms and conditions still conflict with Arkansas law. In approving the Private Option the federal government imposed various terms and conditions on Arkansas. It is still the position of Conduit for Action that some of the terms and conditions are in conflict with the Arkansas law.
- Pro-Life and Plan B drugs. The Private Option became even more controversial when it was realized that it pays for Plan B or so called morning after drugs. The federal government calls these drugs contraceptives, but for those who believe that life begins at conception they are abortion drugs. The drugs cause the fertilized egg to die because the drugs keep it from implanting in the womb.
- National attention has been focused on the Plan B drugs because of the Hobby Lobby family’s appeal to the U.S. Supreme Court in an attempt to keep Obamacare from forcing them to pay for drugs they believe cause abortion and violate their religious convictions.
- The group, Arkansas Right to Life, has sided with those who say life doesn’t exist until the fertilized egg is implanted in the womb. Other pro-life organizations disagree. For example, Jerry Cox, President of the Family Council issued a statement saying life begins at the moment of fertilization and that the Family Council opposes Plan B drugs because they can be an abortifacient.[ii] A number of pro-life groups in other states agree with Cox. Others groups may disagree.
- The Private Option’s payment for Plan B drugs is likely an embarrassment to pro-life legislators who voted for the Private Option not knowing these drugs were covered. When I raised the abortion issue, some legislators expressed surprise. Two legislators suggested that the issue had been solved by Act 72 of 2013, which prohibits health insurance exchange policies from offering coverage for abortions except through a separate rider. They were wrong. Act 72 does nothing about Plan B drugs. In fact, the act doesn’t even apply if the woman is not known to be pregnant.
- More discussion among pro-life advocates is likely. For those who believe life begins at conception, this issue is much bigger than merely the Private Option.
A NEW CONVERSATION
After the election of Scott Flippo, Senator John Cooper said “This is going to change the conversation.”[i] It certainly has. It would also be wise for Republicans and Democrats to begin a conversation about what steps should be taken if the Private Option is terminated. There are important issues to be resolved:
- How best to shut down the Private Option?
- What steps do we need to take to offer meaningful assistance to needy citizens?
It doesn’t matter whether the conversations are public or held behind closed doors, but it would be wise to begin the conversation long before the frenzied pace of the 2015 Regular Session.
Special interest groups that benefit from the Private Option will continue to be very active in this fight in November as well as during the legislative session. They are likely to urge Private Option supporters to avoid having this conversation, and then to scream “the sky is falling” when the Private Option runs into trouble during the session. If someone wants to follow that kind of advice, fine, but if you want to have a voice in what will be done should the Private Option be terminated, now is the time to get involved in the conversation.