- Associated Press - Saturday, March 12, 2016

LITTLE ROCK, Ark. (AP) - Campaigning on behalf of lawmakers who have supported Arkansas’ hybrid Medicaid expansion, Gov. Asa Hutchinson hoped to shore up fractured support among his fellow Republicans as he tries to keep the program alive. A bigger challenge may come from Democrats who are tired of seeing their support for the expanded coverage taken for granted.

The boost that the hybrid expansion received in its supporters’ recent primary victories is now being overshadowed by rising concerns among Democrats who have been the strongest and most-unified backers of the program since its inception three years ago.

“There’s just some general heartburn about the issue right now,” said House Minority Leader Michael John Gray, a Democrat from Augusta.

That heartburn was on full display last week as a task force endorsed Hutchinson’s push to keep the “private option,” which uses federal funds to purchase private insurance for low-income residents. Hutchinson wants to rename the program “Arkansas Works” and add restrictions, including requiring some participants to pay premiums.

The biggest resistance Hutchinson faces is his accompanying plan to have private companies manage Medicaid’s services for the mentally ill and developmentally disabled. The governor says the change is needed to reduce Medicaid costs for when the state begins paying for a portion of the expansion next year.



But the idea is facing opposition from Democrats and some Republicans. Eight lawmakers on the 16-member panel voted for Hutchinson’s plan, a vote shy of a majority, while seven other voted for a competing plan by opponents of managed care.

The top Democrat in the Senate criticized Hutchinson for having too much influence on the panel and warned that the governor risks losing Democratic votes with his push for managed care.

“The unintended consequence of this is now I think some people who were pretty solid Arkansas Works people now have questioned it because of the issue of managed care,” said Senate Minority Leader Keith Ingram, a Democrat from West Memphis.

The concerns add a new wrinkle for Hutchinson, who’s said he’s more confident he’ll get the three-fourths support needed in both chambers to keep the program alive another year. The enabling legislation approving the changes Hutchinson will seek during a special session next month only require a simple majority. But the higher threshold is needed for the Department of Human Services budget measure that includes the funding for the expansion, and that will come up during the fiscal session set to begin April 13.

Republicans hold a majority in both chambers, and Hutchinson will need the near-unanimous support of Democrats in the House and Senate because of the divide within his own party over the expansion. He’s already warned lawmakers that ending the program would have widespread consequences, creating a $100 million budget hole that could prompt up to 6 percent cuts for most state agencies.

Democratic leaders say they’re also hearing concerns about the restrictions Hutchinson is proposing for the Medicaid plan, including eliminating the 90-day retroactive coverage for those on the program and requiring participants to enroll in employer-based insurance if available - with the expansion funds paying for premiums.

Another obstacle may be soothing the fears of Democrats who face the prospect of tight re-election bids this year or in the future. After conservative groups sent out a flurry of mailers trying to unseat Republicans in this month’s primary over the private option, Gray said, “imagine what Democrats are going to face.”

Unlike the GOP lawmakers in this month’s primary, the Democrats won’t be counting on the governor to come to their aid when they come under fire. And they don’t want to put themselves even further in conservative groups’ crosshairs if it means restricting access to a program they’ve touted as a success or if the savings from it are only used to help Hutchinson’s agenda.

Democrats say they want to keep the expanded coverage alive for the more than 250,000 people on the program, but say they’re not ready to blindly support Hutchinson’s plan without more details.

Hutchinson says he understands the challenge, saying there are also some who won’t support the expanded coverage without the savings he says will be created by shifting the programs to managed care.

“There is a very fine balance there,” he told reporters.

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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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