Arkansas lawmakers voted Tuesday to move 60,000 people off the state's hybrid Medicaid expansion plan and require some remaining participants to work, despite Democrats' complaints that the restrictions are too burdensome and at least one conservative Republican's complaint that they aren't tough enough.
The House approved the changes on a 71-23 vote and the Senate backed them on a 23-9 vote. Final votes are expected on the measures Wednesday before lawmakers wrap up a special session focused on the program, which uses federal funds to purchase private insurance for low-income residents. More than 300,000 people are enrolled in the program, which was created four years ago as an alternative to expanding Medicaid under the Affordable Care Act, otherwise known as Obamacare.
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Republican Gov. Asa Hutchins earlier this year proposed the new restrictions, which must also be approved by the federal government. Supporters acknowledged the changes come despite uncertainty in Washington about Republican efforts to repeal former President Barack Obama's health care law.
"At some future point, there's no doubt in my mind that Congress will make changes and we'll have to deal with the situation at that time," Senate President Jonathan Dismang, a Republican, told lawmakers before the vote. "For the moment we have right now, it makes budgetary sense for us in the state of Arkansas to make these changes."
The proposed changes would lower the eligibility cap for those on the hybrid expansion from 138 percent of the federal poverty level to 100 percent. The 60,000 people who would no longer qualify for the program would be eligible for subsidies to purchase coverage through the insurance marketplace.
Arkansas and other Republican states had been rebuffed by the Obama administration on work requirements, but they are hoping for more flexibility from President Donald Trump, whose administration is considering a similar proposal that Kentucky submitted last year.
Democrats opposed the proposed new restrictions, calling the work requirement too punitive and questioning whether it would increase the cost of hospitals caring for patients without insurance.
"We have some real concerns about moving people off of the program and finding them insurance, and a workforce requirement when there might not be work available," said Rep. Michael John Gray, who is also the chairman of the state Democratic Party.
A Republican lawmaker who has been an outspoken opponent of the expansion program urged lawmakers to delay a vote on the measure, saying more analysis was needed and time to see if other restrictions could be pursued.
"The process needs to be stopped so we can have a more detailed discussion," Sen. Bryan King said before the vote. King ultimately did not vote on the legislation.
The Senate also approved a plan to divert more than $102 million in unused tobacco settlement money to a long-term reserve that can be tapped for budget shortfalls. Hutchinson and other supporters say the fund is needed to improve the state's bond rain. Opponents said the move circumvents a 2000 voter-approved law that directed the tobacco settlement funds toward health programs.
Associated Press writer Tafi Mukunyadzi contributed to this report.
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