By John Lyon
Arkansas News Bureau

LITTLE ROCK — At a legislative hearing at the state Capitol last week on the new federal health care law, the contention that surrounded the issue just a few months earlier was notably absent.

While state Surgeon General Dr. Joe Thompson testified on the law’s impact on Arkansas before the House Public Health, Welfare and Labor Committee, some Republican legislators who earlier pushed for the state to challenge the law asked polite questions and others listened quietly. No one angrily denounced the law.

It was a different atmosphere from four months ago, when GOP lawmakers pressed Attorney General Dustin McDaniel to join other state lawsuits opposing the law on constitutional grounds and asked him to issue an opinion on whether the law violates state sovereignty.

McDaniel, a Democrat, did neither.

Rep. John Burris, R-Harrison, who wrote the letter asking McDaniel to weigh in on the issue, said last week he still has concerns about the health care overhaul, particularly the cost to the state when Medicaid is expanded.

The expansion will start in 2014, but the federal government will pay 100 percent of the cost of the expansion until 2017, when the state will begin paying a portion of the cost. The eventual cost to the state has been estimated at up to $200 million a year.

“We already have a massive shortfall in Medicaid, $250 million a year just to pay for the liabilities we have, and now we’re going to have 250,000 new people on the rolls because of the expansion,” Burris said. “Somebody needs to tell us how to pay for this.”

But the pros and cons of the law are not worth debating at this point, Burris said.

“I think it’s going to hurt Arkansas, but there’s no point in debating it now. The question is, how do we best cope with and handle the situation that Democrats in the Congress and the White House have put us in?” he said.

Rep. Ann Clemmer, R-Benton, said she is concerned about the financial impact on the state and skeptical that the law’s universal mandate to buy health insurance can be enforced, but she said the time for arguing has passed.

“The policy’s been made, it’s been decided. We’re not in a position to stop it, so really what it is the point of arguing at this juncture?” she said.

Thompson told legislators Wednesday that the law will extend health insurance to between 400,000 and 450,000 currently uninsured Arkansans. He said the mandate to buy health insurance will address the problem of people who don’t buy insurance until they get sick, which he said has driven up everyone else’s premiums.

Rep. Jon Woods, R-Springdale, said later he disagrees with the mandate, but he said he didn’t object when Thompson spoke favorably of it because “the debate is over.”

“We’re just like, OK, it’s coming, how do we make this work and how do we fit it into our health care system in Arkansas and maximize the benefit and do what’s best for Arkansans? That’s where we’re at right now.” Woods said.

One group that does not think the debate is over is Secure Arkansas. In April the grassroots organization filed its own lawsuit challenging the federal health care law after McDaniel declined to do so.

Secure Arkansas alleges the mandate to buy health insurance exceeds the federal government’s authority.

The health care overhaul is “chipping away at the Constitution and the belief that limited government is good government,” the group’s chairman, Jeannie Burlsworth, said in April.

McDaniel said at the time he believed legal challenges to the law would not succeed and were politically motivated.

Shortly after the law passed in Congress, Gov. Mike Beebe said he would not have supported it because of the increased cost to Arkansas, though he acknowledged that some provisions would benefit the state and said Arkansas would obey the law.

After Wednesday’s legislative hearing, Burris said Thompson’s presentation seemed at odds with Beebe’s past comments.

“He (Thompson) seemed very favorable towards health care reform, and that was a new tone, I think, from the administration,” Burris said, adding that the executive branch seemed to be sending “mixed messages.”

Beebe said he hasn’t changed his views, but he said he and Thompson approach the issue from different perspectives.

“Dr. Thompson is the surgeon general. He’s a physician. His No. 1 priority is getting as many people covered with health insurance as he possibly can,” the governor said.

“I certainly support trying to make our people as healthy as we can make them, but I also have other concerns that weigh into my consideration, and — you know me — the chief of which is money,” he said.

Beebe will be out of office by 2017, but he said he has an obligation to think farther ahead than the immediate future. He said he still does not know how the state can come up with an additional $200 million a year.

The governor also said the health care overhaul fails to address cost containment, which he called “the No. 1 thing they should have been dealing with.”

In the absence of action at the federal level, Beebe said the state is developing a pilot program that would seek to control costs by rewarding medical providers for results rather than the number of tests they perform.

“The old fee-for-services system is unsustainable, with or without a Medicaid bill, with or without a health care reform bill,” he said.