As I noted earlier today, Gov. Asa Hutchinson is hoping to add some conservative bells and whistles to the private option, but that doesn’t change the fact that he is recommending a continuation of the Obamacare-funded Medicaid coverage expansion in Arkansas.
Americans for Prosperity-Arkansas, the conservative advocacy group that has poured millions of dollars into legislative races in the last two cycles, is not satisfied with Hutchinson’s effort to re-brand. In a press release, AFP-Arkansas state director David Ray said, “These measures would provide marginal safeguards for taxpayers if the Obama administration approved to these requests, but at the end of the day, there is no way to transform a welfare program…into a ‘conservative’ plan.”
Whether or not you agree with Ray’s argument, it has the benefit of being straightforward: AFP generally opposes government spending on large safety net programs for poor people. That’s what the private option is. The fact that Hutchinson wants to create incentives for beneficiaries to participate in job training programs doesn’t change the fact that, unsurprisingly, a group like AFP is against Medicaid expansion.
What is surprising, at least a little, is that we really haven’t heard arguments like Ray’s on the Health Reform Legislative Task Force, which must make recommendations by the end of the year. At least so far, even the staunchest Tea Party opponents of the private option on the task force appear to be on board with continuing the coverage expansion with a new name and Hutchinson’s tweaks.
It will be interesting to see what role AFP plays in the coming months. The group opposed the private option back when it was first developed in 2013, but the policy nevertheless passed with a supermajority, largely thanks to the backing of prominent Republican lawmakers in the House and Senate. AFP then more or less sat out the very tough re-authorization fight in 2014 — it announced that it would not “score” the vote and reportedly worked behind the scenes to back the compromise put forward by Rep. Nate Bell, continuing the private option for a year with a few tweaks but banning state-appropriated funding for outreach. The group remained fairly quiet earlier this year when Hutchinson proposed continuing the private option for two more years and creating the task force to figure out what to do next; in a statement at the time, AFP said that it appreciated the governor and legislature’s desire to address the issue but asked for a “definitive end date to the Medicaid expansion” and said “there remains some concerns about the future of health care reform in Arkansas.”
Given the funding that AFP put in to helping usher in a Republican majority in the Arkansas legislature, many assumed that they would have an outsized influence in the GOP. But AFP has lost plenty of tight battles in the legislature when Republicans went the other way in the last few sessions — not just the private option, but on the Big River Steel project, laws relating to zoning and tort reform, General Improvement Fund pork barrel spending, and more. That said, they have plenty of money to throw around and could probably choose to make things hard on legislators aiming to continue the private option (or, sorry, to replace it with “Arkansas Works”). The state chapters of AFP have certainly played a major role in blocking Medicaid expansion in other red states, like Tennessee.
The private option has always been an awkward fight for AFP because the issue divides the state’s Republican party. Some opponents of the private option have been critical of AFP’s relatively muted response to the policy in Arkansas. When AFP stayed out of several primary races that featured challengers to pro-private-option Republicans in 2014, Sen. Bryan King griped, “I don’t even know what [AFP Vice President of State Operations] Teresa Oelke’s thinking. … I don’t understand it, it doesn’t make sense to me. There’s a lot of us conservatives…I don’t know what in the world she’s thinking. They say one thing and yet do something else. There’s something weird going on.”
Most Capitol observers believe that Hutchinson’s revised version of the private option will get the supermajority support of the legislature it needs next year without the knock-down, drag-out drama of the appropriation fights in 2013 and 2014. Conduit for Action and a slew of PACs and other organizations affiliated with Joe Maynard, a Fayetteville businessman rabidly opposed to the private option, will try to move the needle with primary challenges and pressure on legislators, many of whom campaigned explicitly on ending the private option. Will AFP throw its big bucks behind a similar effort? Stay tuned.
Here’s the full statement from AFP’s press release (Ray says that the program is for “childless” adults, which is wrong — many private option beneficiaries have children, and low-income parents who make more than 17 percent of the federal poverty level would lose coverage if the private option went away):
“These measures would provide marginal safeguards for taxpayers if the Obama administration approved to these requests, but at the end of the day, there is no way to transform a welfare program for able-bodied, childless, working-aged adults into a ‘conservative’ plan,” said AFP-Arkansas State Director David Ray. “The state needs to formulate a plan to end the ‘Private Option’ experiment. When Arkansas’s share of Obamacare’s Medicaid expansion comes due, our taxpayers will be left holding the bag for tens of millions and possibly hundreds of millions of dollars each and every year. When Arkansas taxpayers get stuck with the bill in just a few short years, lawmakers will have to choose between raising taxes or putting core functions of government such as roads, education, and public safety on the chopping block to pay for this new entitlement program.”