- Associated Press - Thursday, November 6, 2014

LITTLE ROCK, Ark. (AP) - Republicans’ sweeping victory in the midterm election further clouds the future of Arkansas’ compromise Medicaid expansion, with voters backing several candidates who vowed to end a first-in-the-nation program providing coverage to thousands of poor residents.

Democrats and Republicans alike acknowledge the state’s “private option” expansion faces an uphill fight after Tuesday’s election. Republican Gov.-elect Asa Hutchinson told reporters Thursday he’s still reviewing whether to push for the program’s reauthorization next year, and said he won’t announce a decision until late January at the earliest.

“We’ve got to work together to determine not just how it’s good for Arkansas, which clearly there’s the benefit to hospitals, there’s benefit to expansion of health care,” Hutchinson said at the state Capitol. “But there’s a cost aspect to it which I’ve said throughout the campaign needs to be measured.”

Crafted as an alternative to the Medicaid expansion envisioned under the federal health care law, the private option uses federal funds to purchase private insurance for low-income residents. More than 211,000 people are receiving coverage under the program, which was the first of its kind approved by the federal government. Twenty-seven states and the District of Columbia have expanded Medicaid. Arkansas would be the first state to drop out of its expansion if the private option isn’t reauthorized.

Continuing the program will require a three-fourths vote in the House and Senate, a threshold that supporters barely cleared this year. Republicans expanded their majority in both chambers and will hold 64 of the 100 House seats and 24 of the 35 Senate spots. They currently hold 51 House and 21 Senate seats.



The program has sharply divided Republicans between supporters who say it’s a conservative alternative and opponents who say it’s embracing the federal health overhaul.

The private option was already on shaky ground after two key Republican supporters of the plan lost their primaries. In addition to Tuesday’s election, outgoing Senate President Michael Lamoureux’s resignation to work as Hutchinson’s staff chief will remove another guaranteed vote for the program.

“Gov. Hutchinson is going to have his work cut out for him trying to salvage the private option,” outgoing Democratic Gov. Mike Beebe told reporters Wednesday.

Incoming Senate President Jonathan Dismang, who was an architect of the private option, said the election results mean changes will be needed to be made to the program in order to keep it alive.

“It was never intended to be a stagnant program. It was always supposed to better itself,” said Dismang, R-Beebe.

Incoming House Speaker Jeremy Gillam said those changes will ultimately depend on what Hutchinson’s decision is.

“If it moved forward, it would look I think a lot different than it did now,” Gillam, R-Judsonia, said “We’re just not there yet to make a path forward or backwards.”

But opponents say they changes they’re seeking likely would result in the eventual end or dramatic scaling back of the program.

“I don’t think what I’m proposing is a wind down to a complete termination but perhaps a wind down to a more sustainable program,” said Senate Majority Leader Jim Hendren, R-Gravette.

The private option’s uncertainty comes as health advocates are crediting the program for Arkansas having the largest drop in the uninsured in the country. A Gallup survey in August said the state’s share of uninsured dropped about 10 percentage points - from 22.5 percent in 2013, to 12.4 percent in the middle of this year.

Supporters of the program say they hope those numbers will help make the case for keeping the program. They also point to the savings the state expects to see from the private option reducing hospitals’ uncompensated care costs.

“I think there’s a misconception that this is a program you can lop off without any impact on the budget,” said Senate Minority Leader Keith Ingram, D-West Memphis. “Once they understand how intertwined all this is, this will give them a better basis for making this decision.”

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Follow Andrew DeMillo on Twitter at www.twitter.com/ademillo

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