Vacancies add to Medicaid plan's uncertain future

LITTLE ROCK (AP) — Vacant seats in the Legislature, a lack of answers on proposals to impose new restrictions and uncertainty about the future of the federal health care law could put Arkansas' hybrid Medicaid expansion back in a precarious position — the program's default mode since it was created four years ago.

Two legislators stepped down in recent weeks to take jobs with the Trump administration and a state senator died this month after a battle with cancer. The vacancies potentially leave the state Senate one vote shy of reauthorizing the hybrid expansion when the Legislature meets next year, and leave supporters with only one vote to spare in the House.

The state also awaits federal approval of its plan to impose a work requirement on some insurance plan participants and to move about 60,000 people off the program. It's also not clear whether Republicans in Washington will be successful in dismantling key parts of the federal health care law.

"I think a lot of members are still in a waitand-see holding pattern to some degree when it comes to Medicaid and Arkansas and what those external forces would be on any of those decisions," House Speaker Jeremy Gillam said last week.

The vacancies could be the biggest obstacles to keeping the program alive, especially in the Senate. Republican Eddie Joe Williams stepped down from the Senate this month to take a job on the Southern States Energy Board and GOP Sen. Greg Standridge died this month after a battle with cancer. In the House, Republican Rep. David Branscum stepped down to take a job with the U.S. Department of Agriculture. The special elections for those seats aren't expected to take place until after next year's fiscal session ends.

Williams this year was among the 27 members who voted for the Medicaid budget bill funding the hybrid expansion, giving the program the minimum number of votes it needed in the 35-member chamber. Standridge was among seven members who didn't vote on the program, which needed a three-fourths majority to proceed. Branscum supported the budget measure in the House, where it received 77 votes — two more than the 75 needed.

So far, Senate leaders say they're not worried about the prospect of the program's reauthorization falling short.

"I just think the ramifications of failing to fulfill our responsibility to fund (the Department of Human Services) by taking advantage of a couple of vacancies that are in the process of being filled would be pretty

harsh," Senate Majority Leader Jim Hendren said. "I don't see anybody really thinking of that as a reasonable path forward."

Hendren, however, floated the possibility of the Legislature holding off on the Medicaid budget bill and other appropriations measures for a special session later in the fiscal year when the vacant seats are filled if they fall a vote or two shy.

It wouldn't be the first time supporters had to find a workaround after falling short of the votes

needed for the program. Last year, the program survived through a byzantine procedural move that included lawmakers who supported the hybrid expansion voting for a budget measure with a provision calling for its end. Gov. Asa Hutchinson used a line-item veto to save the program.

Republican Sen. Bryan King, an outspoken opponent of the hybrid expansion, said he wouldn't be surprised to see the tactic used again.

King, who voted against the Medicaid appropriation this year, has criticized the program as not living up to its billing and being too costly to the state.

"As long as they continue to mislead and deceive people and the rest of the Legislature buys it despite the obvious fact of where we're at, yeah, it's difficult," King said.

The bigger question may be how the debate will be affected by efforts in Washington to repeal key parts of the health care law. State Senate President Jonathan Dismang said the federal uncertainty would be an argument against making major changes to Arkansas' program.

"If we start making major adjustments at this point, we're just responding to an unknown situation," Dismang said.