LITTLE ROCK, Ark. (AP) - Supporters of using federal Medicaid dollars to expand private health care coverage for low-income residents in Arkansas were trying to rally support Wednesday as the Legislature approached a series of key votes on the issue later this week.
The "private option" proposal is a compromise between Republican legislative leaders and Democratic Gov. Mike Beebe as an alternative to expanding the state's Medicaid enrollment as called for under the federal health care law. Under the bill, Arkansas would accept the federal money intended to expand Medicaid but instead use it to purchase private insurance for 250,000 low-income residents, who earn up to 138 percent of the poverty line, or about $15,415 per year.
Lawmakers held a special public discussion on the plan at the state Capitol complex Wednesday, which drew pointed questions from representatives of the Arkansas chapter of American for Prosperity, which is lobbying against the plan. The group says the private option is no different than the Medicaid expansion called for under the federal health care law - a policy that many Republican lawmakers campaigned against last fall.
But House Speaker Davy Carter, R-Cabot, who has been gathering votes for the proposal, said he was "very optimistic" the House would grant final approval to the plan this week.
"There are no good outcomes from not doing anything - zero. There's a laundry list of good outcomes with the private option," he said. "When you have something that's that clear, as difficult politically as it may be, I've got confidence that at the end of the day the membership's going to do the right thing."
Republican Sen. David Sanders, a major backer of the plan, said he was confident the House would approve the measure and "cautiously optimistic" the chamber would approve a related budget bill that would need three-fourths support.
"What we're seeing is when you answer questions and even criticisms that members have, and they're legitimate questions and criticisms, it clearly opens the door for people to embrace the position," said Sanders, of Little Rock.
Republicans enjoy a 51-member majority in the 100-member House but are largely divided on whether to support the private-option plan. Plus, even if it passes the Legislature, the federal government would have to approve Arkansas' plan.
Arkansas is among several states where Republican leaders have scoffed at expanding Medicaid under President Barack Obama's health care law, but are now trying to come up with alternative plans that could provide health coverage for more low-income adults while potentially tapping into billions of federal dollars that are to start flowing in 2014.
The Arkansas plan faces an uncertain fate in the House, where Majority Leader Rep. Bruce Westerman has spoken out against it. On Wednesday, he said didn't think the private option had the 75 votes needed to win final approval in the chamber.
"People are still asking questions and wanting answers, which is the main reason I'm saying we need more time," said Westerman, R-Hot Springs.
The uncertainty over the health care plan has left lawmakers in a holding pattern on a proposed tax-cut package and negotiations over the state's $4.9 billion budget for the coming year. Beebe has said the savings from the private option could pay for a substantial amount of the $100 million in reductions that Republicans are seeking.
"I think there's room to cut taxes, but I think it's just easier if Medicaid is out of the way," said Sen. Jake Files, a Republican and chairman of the Senate Revenue and Taxation Committee.
Beebe said Wednesday that he was answering lawmakers' questions and urging them to vote for the plan because it would be cost-effective to expand health care insurance for low-income residents.
"In the final analysis, really what it does is get our own tax dollars back. We're already paying for this. We don't want to pay for California and leave Arkansas out," Beebe said.
"There is no Plan B if it doesn't pass," the governor added. "If it doesn't pass, it doesn't pass."
The House was expected to vote Thursday on the plan, and a final vote - which would require a three-fourths majority - could come Friday.
Carter, the House Speaker, said lawmakers would vote Thursday on several measures aimed at reforming the state's existing Medicaid program. Some lawmakers, he said, have pledged their support for the private option on the condition that the Legislature make changes to the existing program, which they say is rife with fraud, waste and abuse.
The proposed changes to the Medicaid program include setting up a new state office to investigate fraud and requiring recipients to use electronic "smart cards" so the state can better track their benefits and avoid abuse.
Associated Press writer Andrew DeMillo contributed to this report.
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