Fight over health care expansion could enter new round


LITTLE ROCK — The fight over health care expansion that played out in the state Legislature this year could be fought anew at the polls in 2014 under a proposed ballot initiative to give voters the final say on the matter.

Debate over the proposal entitled “A Referendum on the Health Care Independence Act of 2013” could complicate matters for legislators who voted for the so-called “private option” for health care expansion and are up for re-election next year — and for U.S. Sen. Mark Pryor, D-Ark., who is seeking re-election after having voted for the federal health care law that made the private option possible.

Conservative talk show host and former Republican 4th District congressional candidate Glenn Gallas is the sponsor of the proposed referendum on Act 1498, the Legislature’s plan to use federal Medicaid dollars to buy private health insurance for an estimated 250,000 of Arkansas’ working poor. If the referendum gets on the November 2014 ballot, voters will be asked to affirm Act 1498 or repeal it.

Attorney General Dustin McDaniel certified the wording of the proposal last week, clearing the way for supporters to try to collect 46,880 signatures by Aug. 15 of this year in order to qualify the measure for the ballot.

Gallas is chairman of the group Arkansans Against Big Government. He said that if the referendum gets on the ballot, the group will work to “educate” voters about the arguments for repealing Act 1498.

“This piece of legislation is the largest growth of government, the largest expansion of health care in Arkansas’ history, and I think it is critical to have the citizens have their voice heard as far as whether or not they want to go forward,” he said.

Also likely to push for repeal is Americans For Prosperity, a conservative group backed by billionaire brothers Charles and David Koch that has generally opposed the federal Affordable Care Act and specifically opposed the private option in Arkansas.

“We were opposed to it during the legislative session; we continue to stand opposed to it now,” said Arkansas AFP Director Jason Clines.

Meanwhile, Rich Huddleston, executive director of Arkansas Advocates for Children and Families, said his organization and others that support health care expansion likely would campaign to keep the private option.

“Even if it gets on the ballot — and there’s still a lot of work they have to do to get on the ballot — I think we’re confident that in the final analysis the voters are going to … vote to keep the private option in health care for 250,000 adults, 80,000 of whom are parents,” he said.

The potential for the referendum to be on the 2014 general election ballot raises the profile of an issue that legislators thought they had resolved when they wrapped up this year’s legislative session. Republican legislators who voted for the plan, typically after having campaigned for office on their opposition to the law known as Obamacare, can count on being asked about their vote on the campaign trail.

Bill Vickery, a Little Rock-based Republican political consultant, said those GOP legislators should be able to weather criticism by saying, “Look at the body of the work I did (in the session), and then realize that we were dealt a hand of cards that were not our choosing, but we went in the most conservative direction possible with something that was being forced upon us.”

The Affordable Care Act proposes that states expand their Medicaid rolls to include people earning up to 138 percent of the federal poverty level. The private option — which still needs federal approval — is an alternative plan to use the federal funding that would have gone to Medicaid expansion to subsidize the purchase of private insurance for that population.

The federal government would pay the full cost of the plan for the first three years, after which the state’s share of the cost would increase gradually to 10 percent.

Sen. Missy Irvin, R-Mountain View, one of the Republican legislators who voted for the private option and is up for re-election next year, said she is prepared to defend her vote. She said she continued to oppose the Affordable Care Act but was glad to have voted for an alternative to Medicaid expansion that is expected to avoid $35 million in penalties to Arkansas businesses and help hospitals keep their doors open.

“We said (to the federal government), ‘It’s our tax money, but we don’t want to spend it your way. We want to spend it our way,” she said.

Vickery said the referendum, if it makes the ballot, could affect the dynamic of the general election — not so much in legislative races, where conservatives who oppose the private option are more likely to vote for the Republican candidate in any event, but in the U.S. Senate race.

If Democrat Mark Pryor draws a Republican challenger, his vote for the Affordable Care Act is sure to come under fire, particularly if the referendum on the private option is a hot issue at the same time, Vickery said.

“If there is a significant amount of money coming in from out of state to repeal the private option, then that will have fallout, less I believe on state legislative races and much more on the U.S. Senate campaign,” he said. “I would imagine (Pryor’s) campaign folks would like to see that not on the ballot and not have to deal with an ancillary campaign on Obamacare.”