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‘Private option’ plan for expanding Medicaid passes in Arkansas

By Carol Gentry | April 22, 2013

Arkansas' state legislature has passed a model plan to expand Medicaid, even though its Legislature is dominated by Republicans and the measure had to pass by a three-quarters vote, the Associated Press reports.

The Arkansas plan has emerged as model for expanding Medicaid — as called for by the Affordable Care Act — in some states with GOP-led legislatures or governors.

Legislators in Arkansas narrowly approved the plan, despite the House's conservative Republican Speaker opposed the plan, and Americans for Prosperity — a conservative group financed by the Koch Brothers — fought it.

The governor there, Democrat Mike Beebe, fought hard for the plan and went to Washington to negotiate for permission to use it as a substitute for traditional Medicaid. In the end, AP reported, half of the House Republicans in the state voted for what they called the "private option" plan.

Gov. Sam Brownback has yet to say whether he supports expanding Medicaid here.

Expansion would have a bigger impact in Kansas than in many other states. That’s because the state’s current eligibility criteria exclude all but the poorest adults. Only those with children and incomes less than 32 percent of the federal poverty level — about $6,000 a year for a family of four — can qualify. Implementing expansion would mean that adults in that same family of four could make more than $31,000 a year and qualify.

The Brownback administration has estimated that expanding eligibility for the $3.2 billion program would cost Kansas an additional $600 million over 10 years.

Whenever asked about expansion, Brownback says things that suggest he’s more likely to say “no” than “yes” to it. But advocates have said they remain encouraged by the fact he hasn’t rejected the idea.

Kansas Senate President Wagle — a Wichita Republican — has said that she is interested in considering the Arkansas model. “The health care debate is continuing. There are a lot of unanswered questions. As a state we need to remain flexible in determining our role,” she said.

The federal Affordable Care Act initially required states to expand Medicaid eligibility. However, the U.S. Supreme Court decision that upheld the law made expansion optional for states.

So far, 20 mostly blue states, plus the District of Columbia, have accepted the expansion. Thirteen GOP-led states have declined.

Among the 17 states still weighing whether to expand Medicaid, some Republican-dominated legislatures may be swayed by the consequences of not expanding Medicaid — such as tax penalties to businesses with more than 50 workers if those workers seek subsidized coverage through the insurance exchange.

In Florida, a plan modeled after Arkansas is currently before the legislature where if faces opposition from some Republicans and Americans for Prosperity.

Florida state Sen. Joe Negron — a Republican and chair of the Appropriations Committee — has proposed a plan to accept an estimated $51 billion in federal funds over 10 years to expand Medicaid to about 1 million of that state's low-income uninsured.

Republican Gov. Rick Scott has said he supports the expansion plan, on the grounds that it would be unfair for needy Floridians to go without coverage when those in other states will be covered; also, he said, the state sends tax money to Washington and deserves to get some of it back.

The ACA wanted states to expand the traditional Medicaid program to cover low-income groups that are now left out, and called for coverage for people with incomes up to 138 percent of the federal poverty level — about $15,760 for one person, about $32,500 for a family of four.

Coverage for the expansion population is 100 percent federally funded for the first three years, and at least 90 percent federally funded after that.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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