- Associated Press - Sunday, January 4, 2015

LITTLE ROCK, Ark. (AP) - During his successful bid for governor in 2006, Mike Beebe rarely mentioned health care in a campaign that often focused on school funding and tax cuts. As he’s preparing to leave office, the two-term Democrat is finding that his legacy could be shaped by the issue.

Overseeing the adoption of a hybrid Medicaid expansion that prompted other states to seek similar compromises and initiating an overhaul of the way insurers pay for services, Beebe is finding himself exiting public life as someone who’s been defined in recent years by health care.

It’s a major shift for someone who ran saying he wanted to focus on economic development and education in the state’s top job.

“Sometimes you’re dealt a different hand,” Beebe said in an interview in his office last week. “Sometimes circumstances force you to address issues or give you an opening or an opportunity to address issues that you didn’t envision you’d be addressing.”

Underscoring how much health care has emerged as an unlikely focus of his governorship, Beebe cited the state’s “payment improvement initiative” when asked what policy he thought he’d be linked to for years to come. Under the initiative, the state is trying to change the way private insurers and Medicaid pays for care.

The initiative moves away from a fee-for-service model to one where insurers pay for “episodes” of care rather than each individual treatment.

“It’s a sea change in the way we pay for health care that rewards both efficiency and quality and cuts down costs. …vIt has the greatest chance to improve health care and yet stabilize those soaring health care costs and insurance costs, more than perhaps anything else,” Beebe said.

Two of Beebe’s first moves when he took office nearly eight years ago were to roll back two key health initiatives by his predecessor, former Gov. Mike Huckabee, who had made healthy living and fighting childhood obesity a focus of his final years as governor. Beebe supported splitting up the Department of Health and Human Services into two separate entities, which had been merged two years earlier.

He also signed into law legislation easing the state’s tracking of school children’s body masses.

There were times when health care dominated Beebe’s agenda, including his successful push in 2009 for a tobacco tax to fund a statewide trauma care system and other initiatives. But the federal health overhaul that Beebe said he wouldn’t have voted for ended up overshadowing the final years of his tenure.

Beebe leaves office with the state’s “private option” Medicaid expansion in a familiar, uncertain spot. The program that Beebe and a group of Republican lawmakers crafted as an alternative to the Medicaid expansion envisioned under the federal health law faces an uncertain future. The Legislature’s ranks will include several opponents of the program, while Gov.-elect Asa Hutchinson has stopped short of saying whether he’ll back its reauthorization.

More than 213,000 people are receiving coverage through the program, which uses federal funds to purchase private insurance for the poor. Continuing the program will require a three-fourths vote from the House and Senate, a threshold supporters barely cleared last March.

Though Beebe says Hutchinson hasn’t told him what his plans are, he believes his Republican successor will keep the private option alive. He says he remains cautiously optimistic about the private option, warning that opponents could face the wrath of voters affecting by abandoning the program.

“It would be bad public policy in my opinion to do away with it and it would be politically disastrous for a lot of those people if they do away with it,” Beebe said. “After all, they’re political animals. They did run for office, and most of them do want to continue in office.”

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Andrew DeMillo has covered Arkansas government and politics for The Associated Press since 2005. Follow him on Twitter at www.twitter.com/ademillo

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