LITTLE ROCK, Ark. (AP) - A plan to use federal Medicaid money to buy health insurance for low-income Arkansans faced an uncertain future Thursday - winning support from most House members but not reaching the 75 votes that will be needed to approve its budget bill.
The "private option" Medicaid plan touted by Gov. Mike Beebe and embraced by several legislative leaders passed the House Thursday, a dozen short of the supermajority votes that will be needed when the budget bill for the proposal is considered later.
Legislators hope to wrap up work April 19, but several legislators have suggested delaying key votes on the Medicaid plan so they can analyze it and explain it to their constituents back home.
"I am going to spend some time this evening reaching out to House members to hear those concerns one on one," House Speaker Davy Carter, R-Cabot, said after the vote. "That will certainly be taken into consideration, depending on how widespread that is."
Arkansas is deciding whether to enact an alternative to the Medicaid expansion called for under the federal health care law. Last year's Supreme Court ruling left it to states to decide whether they want to expand Medicaid.
With Thursday's House action, a majority of lawmakers in the Legislature have approved the compromise reached by Beebe, a Democrat, and Republican legislative leaders that would allow Arkansas to accept the federal money intended to expand Medicaid but instead use it purchase private insurance for 250,000 low-income residents.
The plan's future, however, hinges on lawmakers in both chambers approving a separate budget bill for it.
Senators last week approved the plan 24-9, three votes short of the required supermajority. House members took two votes on identical versions of the plan Thursday, passing them by margins of 62-37 and 63-35.
Rep. John Burris, the House sponsor of the bill, told lawmakers that although the decision was not "black and white," the proposal was the most conservative option for the state, since it would provide residents with private insurance and include cost-sharing provisions that include incentives for making cost-effective decisions.
Other Republican supporters of the bill said they were reluctantly agreeing to the proposal as the best way to proceed under a federal health care law - a policy that many GOP lawmakers campaigned against last fall and remains unpopular in the caucus.
House Republican Leader Rep. Bruce Westerman urged his colleagues to reject the proposal because, he said, it would replace an entitlement program with one that merely "has a more palatable name."
Westerman has repeatedly said he thinks lawmakers should delay a decision on the proposal so they can obtain more-concrete approval from the federal government and explore the full implications of the plan.
A growing chorus of conservative lawmakers echoed those concerns on Thursday, arguing that the process was moving too fast.
Sen. Jason Rapert, a Republican who did not vote for the proposal when it came up last week, urged for a delay on the private option vote for about three weeks so lawmakers could explain the proposal to the public.
"The private option is the best probably that could be done in this scenario," he said "But I do not believe it has been completely sold to the people in a way they believe that."
Proponents of the private option said they were opposed to delaying the vote, even as they acknowledged the challenge of finding 12 more supporters in the House.
Burris said after Thursday's vote that he expected some lawmakers who voted against the proposal to nonetheless support its budget. He also said he opposed delaying the vote, which is expected on Friday, but acknowledged supporters would have to be flexible if they aren't able to secure a supermajority.
"If three-fourths of the House and three-fourths of the Senate don't concur with me and say that they're also comfortable then we need to pick a Plan B," he said. "We need to take whatever time it takes to get there."
Beebe, a Democrat who has been pushing legislators to allow Arkansas to tap the federal Medicaid money, said he thought lawmakers could easily explain the proposal to constituents without having to recess for a long period. He said Thursday he was cautiously optimistic about passing the proposal
"A lot of hard work by a lot of people with innovative thoughts, with a kind of bipartisan working together to figure all this stuff out have gotten us much farther than a lot of people ever thought," he told reporters after the vote. "Now we're close, let's don't ever quit now."
Associated Press writer Andrew DeMillo contributed to this report.
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