The timing was so politically perfect, so legislatively fortuitous, that a cynic might wonder if the announcement was — timed. But let’s not be cynical, even if the — occasion — was politically perfect, legislatively fortuitous.
Pending: Governor Hutchinson’s proposed state budget for the fiscal year beginning July 1.
Pending: An extension of the “Arkansas Works” health insurance program for individuals and households with incomes too high to qualify them for traditional Medicaid coverage; without its renewal the budget outline would essentially implode, sending the numbers people in both executive and legislative branches scrambling in search of draconian spending reductions or — the unthinkable — a tax increase.
Pending: Mr. Hutchinson’s plan for additional tax reduction, which he has pledged to seek next January. No big federal bucks from the Medicaid expansion, no room for a smaller tax take.
Pending: A vote in the state House to approve Human Services Department spending, on which the larger General Revenue budget depends; the chamber’s leaders, who are Mr. Hutchinson’s fellow Republicans, and all the Democratic minority are on board, so no drama there.
Pending: A vote in the Senate, where there is some suspense. Or, perhaps, was; the ceremony in Mr. Hutchinson’s conference room, with a visiting VIP from the Trump administration at center stage, may have provided Arkansas Works the nudge it needed in the upper chamber, where the hardest of the GOP hard-liners have been eyeing not only the numbers behind the health program but the vote count needed to sustain it.
Some necessary detail:
Having secured millions in tax cuts from agreeable lawmakers in previous sessions, Mr. Hutchinson is, always has been, committed to continuing the Medicaid expansion, begun under his Democratic predecessor in concert with a band of young, preternaturally astute Republican legislators. The alternative was to strip tens of thousands of low-income Arkansans of the health insurance coverage that many were enjoying for the first time while simultaneously jeopardizing smaller, mostly rural hospitals and clinicians who were staggering beneath the costs of uncompensated care. Minus the extra Washington medical dollars, even the flat-lined spending embraced by earlier administrations, when the Great Recession was at its apex, would be insufficient to make ends meet. Ergo, the bi-partisan “Private Option” of the Mike Beebe years became Mr. Hutchinson’s bi-partisan Arkansas Works.
Bi-partisan: barely. The Medicaid expansion, five years ago, was preceded by labor pains heard across the nation. Such has been arch-conservative opposition in one or another, or both, houses that almost never was there a vote to spare, and the annual (thus far) reauthorizations have been root canals performed absent anesthesia.
In the half-decade since Private Option/Arkansas Works took hold — Mr. Hutchinson himself acknowledges it now is essentially embedded in the structure of Arkansas governance — many House members who once regarded it as anathema have warmed to it, however grudgingly; they’ve heard not only from many grateful voters but from medical providers whose financial losses have been cut substantially.
So the tension this time would be on the Senate side, where the most resolute of the Medicaid expansion opponents sit, their musculature abruptly increased, so it appeared, by a most unlikely turn of the cards: a trio of empty seats, vacated by Republicans who could be expected to side with the Governor. Two resignations and a death from illness, and suddenly the razor-close procedural mathematics of appropriations seemed rather more formidable: 27 senators must vote “Aye” to approve spending, and no matter that only 32 are in office.
Not that Mr. Hutchinson was disinclined to cut Medicaid spending to the extent possible even should Arkansas Works succeed. The more savings, the greater his tax cut options in the months ahead. For months he has reminded all who would listen that he has sought Washington’s consent to slash the eligibility threshold from 138 percent of the federal poverty level to an even 100 percent, which would disqualify almost 63,000 Arkansans, or nearly 20 percent of enrollment. The reduction in the state’s obligation would approach $20 million in Fiscal ’19.
Mr. Hutchinson might yet get his waiver. In the meantime, he will settle for what his visitor did bring: approval for the state to impose a work (or job training) requirement on some unemployed 40,000 clients classified as “able-bodied,” for whom non-compliance would mean exclusion.
Its long-term efficacy doubtful, in the moment the work standard may work, may assuage enough reluctant Senate conservatives to cross over, or give them the cover they need to defend their support for the program to hostile constituents. In which case — Arkansas Works. How well we’ll see.