LITTLE ROCK, Ark. (AP) — Arkansas' first-in-the-nation plan that uses Medicaid funds to buy private insurance for the poor survived an effort to defund it Tuesday, as lawmakers gave final approval to continue a program that has extended health coverage to nearly 94,000 people.
The House voted 76-24 to reauthorize funding for the "private option" program that was approved last year as an alternative to expanding Medicaid under the federal health law. Arkansas was the first state to win federal approval for such an approach, touted as a compromise for Republican-leaning states.
The measure now heads to Democratic Gov. Mike Beebe, who plans to sign it into law. The measure needed at least 75 votes in the 100-member House.
House Speaker Davy Carter praised lawmakers for having "political courage" to reauthorize the program, despite deep opposition among Republicans to the federal health overhaul.
"This issue nationally is one of the most divisive issues that our country has seen in a long, long time, and for the membership of the House and Senate to come together twice now with a supermajority vote tailoring a plan that's good for Arkansas, and to do it in the face of all that adversity, is remarkable," Carter, R-Cabot, told reporters after the vote.
The program's future had been in doubt after failing to win enough support four days in a row in the state House last month. The state Senate had approved the funding measure without a vote to spare.
The votes will likely continue to be an issue in GOP primaries for legislative, statewide and congressional offices in May. Republicans control the Legislature and have made major gains in Arkansas over the past two elections by running against President Barack Obama's health care law.
Despite that push against the law derided as "Obamacare," top Republicans in the Legislature were the architects and biggest advocates of the private option. They argued that private insurers could provide services more efficiently than the government, and they cast it as a way to reform Medicaid.
Three lawmakers who had previously opposed the legislation voted for the bill Tuesday, with one vowing to push for the program's end during next year's session if it doesn't meet expectations.
"It's either going to be a great success, or it's going to be a miserable failure," said Rep. Kim Hammer, R-Benton. "When we come back here in January, if it's not a great success, I will be voting against it."
The measure's reauthorization also came as legislative leaders were talking about the possibility of adjourning or recessing the session if the private option remained stalled.
"I felt it was time that we moved forward," said Rep. Les Carnine, R-Rogers, who also switched his vote to back the measure.
GOP opponents said the private option was no different than embracing the president's health care law, and they said the state couldn't afford the 10 percent cost it would eventually have to contribute.
"Three years from now, how are we going to pay for it? Five years from now, how are we going to pay for it? Ten years from now, how are we going to pay for it?" asked Rep. Joe Farrer, R-Austin, who voted against the bill. "If you can't answer those questions, why would you vote for this?"
National health policy experts say Arkansas' compromise opened the door for other Republican-leaning states to consider similar models. Other states exploring or pursuing similar ideas include Pennsylvania, Iowa and Virginia.
Beebe said the case for keeping the program was stronger than last year, when lawmakers were uncertain whether the federal government would approve Arkansas' model.
"If anything, it was even more compelling to do it this time than it was last time," Beebe told reporters after the vote.
Beebe has said rejecting the $915 million in federal funds for the private option would jeopardize other state services. Beebe's proposed $5 billion budget relies on $89 million in savings he says the private option will create by cutting down on hospitals' uncompensated care costs.
The legislation had stalled last month despite amendments aimed at swaying opponents. The changes to the program included a ban on the state spending money to promote the private option or other parts of the federal health law.
Supporters have spent the past week talking with a handful of private option opponents, who had floated the idea of backing the bill if state officials agreed to try to limit the enrollment period for it.
They backed off the idea, however, after state officials said that those who applied outside the enrollment period would have instead gone on Medicaid.
"I think there was concern about unintentionally increasing the Medicaid rolls by having an open enrollment period, and people really didn't want to do that," state Human Services Director John Selig said.
Associated Press Writer Christina Huynh contributed to this report.
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