On Tuesday, the state Senate narrowly approved another year of funding for Arkansas Works, the program providing health care coverage to some 285,000 low-income adults through the Affordable Care Act’s Medicaid expansion. The final vote was 27-2, with three members not voting and one voting “present."
Senate Bill 30, which funds the Arkansas Department of Human Services’ Division of Medical Services, still requires passage by the House of Representatives. However, the Senate was seen as the larger hurdle by far. The House vote could come as soon as Wednesday.
Appropriations require a three-fourths majority of both legislative chambers for passage, and 27 “yes” votes were needed to approve the bill in the 35-seat Senate. In past years, the Division of Medical Services appropriation has passed with few votes to spare — or none. But the threshold appeared even more daunting this year after two senators resigned and a third died while in office in advance of the current 2018 fiscal session. With just 32 seated members, the Senate’s rules said the chamber still needed at least 27 votes to approve appropriations. Of those 32, seven refused to vote for the Arkansas Works budget in the 2017 legislative session.
That fueled speculation Governor Hutchinson — who supports Arkansas Works — might have to call a special session at some point after May elections, when the three vacant seats will be filled. Instead, the Senate managed to pass the Arkansas Works appropriation on the first try.
The necessary votes came in the form of two Republicans who have long been staunch opponents of Arkansas Works, Sens. Terry Rice of Waldron and Alan Clark of Lonsdale. Both addressed the Senate before the vote on SB 30.
“I still oppose the policy, and I continue to want to make that better,” Rice said. “But where I’m at today, with all the fight that I’ve done … I am going to support the budget today.” Rice acknowledged that the yearly fight over the budget had grown “wearying,” but said he would continue to push for changes to the program in advance of the 2019 regular session.
Clark said he still wished to defund Arkansas Works, but it would be futile to hold up the appropriation during the fiscal session if a post-election special session resulted in its eventual passage in May.
“If we’re not going to get it through but we’re going to have to come back in two or three months and we’ve got the votes to do it then, is it right to put the state through this?” he asked. “Let's not … go through all these gyrations just to come back and do what we’re going to do.”
Clark said he continued to oppose the program. “I’ve voted against it because it was always what I thought was the right thing to do, as you have voted what you thought was the right thing to do,” he told his colleagues. He said he still planned to withhold his support for SB 30 but would switch to a “yes” if the final tally was only one vote short.
When the roll was called, Republican Sens. Bryan King (R-Green Forest) and Linda Collins-Smith (R-Pocahontas) voted “no,” and Clark joined Republican Sens. Scott Flippo (R-Mountain Home) and Gary Stubblefield (R-branch) in not voting. Sen. Stephanie Flowers (D-Pine Bluff) voted “present.” Flowers was not available to discuss her vote after the Senate adjourned, but some Democrats have voiced displeasure at recent changes made to Arkansas Works by Hutchinson. Flowers, like every other Democrat in the chamber, has supported the program in past years.
Clark then switched his vote to a “yes,” allowing the measure to pass.
Since 2013, when the legislature first approved Arkansas's unusual public-private version of Medicaid expansion, the program has split legislative Republicans and sparked an annual fight over reauthorization of the DHS budget. Governor Hutchinson, who inherited the program from his Democratic predecessor, Mike Beebe, rebranded it as “Arkansas Works” in 2015 and has fought for its continuation.
He has also pushed to make Arkansas Works more conservative. On Monday, Seema Verma, the Trump administration’s top Medicaid official, announced the federal government had approved a waiver requested by Hutchinson that will allow the state to impose a work requirement on program beneficiaries. Beginning this summer, Arkansas Works recipients ages 19-49 will be required to prove they are working for at least 80 hours per month unless they meet one of several exemptions, such as providing care to a dependent. Those who do not comply may be kicked off the program.
“I’m very grateful for the senators that were able to support Arkansas Works and the DHS appropriation,” the governor said in a statement released after Tuesday’s vote. “Obviously the work requirement was a significant factor in showing the reform that we’re accomplishing, and I appreciate the Senate’s leadership in passing this on the first vote.”
Neither Rice nor Clark cited the work requirement as the decisive factor in their support of SB 30. Clark said in his address to the chamber that it was “a very big positive, [but] not enough of a positive for me.”
After adjournment, Clark clarified that he felt the policy was not stringent enough. “As a guy who works 80 hours a week, requiring 80 hours a month I don’t think is enough of a requirement, but it’s a start,” he said.
“The biggest complaints I get are from 20-somethings and 30-somethings whose friends are making fun of them for … working and being married and doing all the right things, and they’re telling them, ‘You can get this and you can get this and you can get that,’ ” Clark said. “It’s been very unfair to them, and so it is huge to have a work requirement.”
Opponents of Arkansas Works tend to see the program as a transfer of resources from workers to those who do not work. In stating her continued opposition to SB 30, Collins-Smith told her colleagues that the “the truly needy in Arkansas and the working poor are paying for this. This program is unsustainable.”
However, a 2017 study of the national Medicaid program by the Kaiser Family Foundation found about 42 percent of nonelderly adults who receive Medicaid are working full time, with another 18 percent working part-time. The study found 32 percent of the remaining beneficiaries were not working due to illness or disability, caregiving or attending school, leaving 7 percent who were not working for some other reason.
Arkansas Works is projected to cost more than $2 billion in the upcoming 2019 fiscal year, with the vast majority coming from federal funds. Arkansas’s share is expected to be about $136 million. Under the Medicaid expansion, Arkansas bears 6 percent of the cost of the program in 2018, rising to 7 percent in 2019 and maxing out at 10 percent in 2020.
Those figures do not include the cost of traditional Medicaid populations, including children covered by ARKids, the elderly and disabled adults. SB 30 includes the spending authority for those traditional Medicaid categories as well. The total amount of state and federal grants appropriated by SB 30 is $8.2 billion.
This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.