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Can Jim Hendren Dismantle the Private Option?

Updated: Apr 13

Earlier today, state Sen. Jim Hendren passed a bill out of the state Senate’s Public Health Committee that attempts to enact Governor Asa Hutchinson’s future private-option plans. As you may recall, Governor Hutchinson gave a major speech last week on the future of the ObamaCare Medicaid expansion in Arkansas – also known as the private option. In his speech, he outlined a plan to continue funding the program for two more years while pursuing large-scale health care reforms. Sen. Hendren’s bill is an attempt to enact some of the best parts of Hutchinson’s private option goals. As a friend of mine said, the Hutchinson approach – as embodied in his speech the other day – is a perfect example of political compromise, because it has something for everyone to hate. As Hutchinson noted in his speech, the current situation – in which we have a spending battle over the private option every year – is awful. There’s something to the idea that we should get this settled, quit the fighting, and end the private option in two years. Now I will admit that I found Hutchinson’s speech a little confusing, and that its occasional ambiguity made it hard to distinguish what he said from the implications that others drew from it. I believe Senator Hendren has inferred that the governor’s goal is to end the program in two years, to pursue global reform of our entire Medicaid system (perhaps getting a block grant that would drastically reduce federal authority), and to make a decision about the future coverage of current expansion beneficiaries at that time. Whether we can produce that kind of ultimate large-reform outcome, which gives decision-making to the state of Arkansas and takes it out of the hands of the federal government, is of course highly uncertain. One of Senator Hendren’s goals, as I understand it, is shared with our new governor: to avoid the kind of yearly spending fights we see over the private option. He wants to require the legislature to start from scratch over the next two years and to make its own decisions about the post-2016 future of Medicaid expansion. That is highly preferable to the private option being on autopilot and lasting forever (an outcome I assume that Gov. Hutchinson doesn’t want, given that he’s called for an “end” and a “conclusion” to this exhausting fight). The Hendren bill has already been amended several times to ensure a true end date for expansion. Senator Hendren deserves praise for facing the real world. He attempted to end the private option last year along with Rep. Ballinger, but then acceded to reality when he realized he didn’t have the votes. As long as we don’t have the votes to end this gigantic expansion of government, Senator Hendren is attempting to create a dynamic in which every single member of the legislature has to take responsibility for a vote on continuing the Medicaid expansion past 2016. That will be a tough vote for Republicans and conservatives to cast — or so I hope. Senator Linda Collins-Smith took a different approach in committee; just after Sen. Hendren’s bill passed out of committee, Collins-Smith’s bill failed. Her bill called for the complete abolition of the private option as of the end of this year. She needed 5 votes for passage, but only got three: Flippo, Stubblefield, and Chairman Bledsoe. Senator Irvin’s vote on private-option issues has been unpredictable (she stayed silent today when her name was called), but I was surprised to see John Cooper vote against Collins-Smith’s bill — in part because Cooper’s special-election victory last year arguably had a lot to do with his attacks on the private option. It’s hard to see what good strategies are available to private-option opponents at this point — Senator Hendren appears to have counted the votes correctly and produced the only viable strategy that might undercut the program in the future. (If you can think of a better one, let me know.) He deserves praise for coming up with a realistic option. A few activists have contacted me to make sharp criticisms of Hendren’s tactical choices. But what I saw today in the Senate suggests that private-option opponents had no live alternatives. I wish we had more fiscal conservatives in the legislature, but I also have great respect for Hendren’s sharp-eyed realism.

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