The Corner

The Arkansas Medicaid Expansion and the 2014 Midterms

As regular NRO readers will know, one of the key races that Republicans need to win in order to retake the U.S. Senate is occurring in Arkansas, where Representative Tom Cotton is challenging Democratic incumbent Mark Pryor. The race to replace Cotton in the House of Representatives, while not nearly as consequential, is also quite interesting, because a central issue in that campaign is the fact that the Republican-led state legislature worked with the Democratic governor to implement Obamacare’s Medicaid expansion.

Among the candidates for the GOP nomination in Arkansas’ fourth congressional district are Bruce Westerman, the majority leader in the Arkansas house, and Tommy Moll, an investment banker. Moll is running an ad accusing Westerman of having a “plan to implement Obamacare” and claiming that “only one candidate has always opposed Obamacare — Tommy Moll”:

This ad is misleading. Bruce Westerman was in fact the leader of the opposition to implementing Obamacare’s Medicaid expansion. I extensively covered the Arkansas Medicaid expansion on my Forbes blog, and even traveled to Arkansas to discuss the expansion with all of the key legislative players. Here’s what actually happened.

In November 2012, Arkansas Republicans gained a majority of seats in the state legislature, by a margin of 51 to 49 in the house and 21 to 14 in the senate. It was the first time Republicans had controlled either body since 1874. Democratic governor Mike Beebe, knowing that he now faced a legislature hostile to expanding Medicaid, tried to find ways to make the Medicaid expansion friendlier to Republicans, by effectively voucherizing it, something he called the “private option.”

Republicans were leery of the proposal, but agreed to hear out the governor. On January 25, 2013, Bruce Westerman introduced a shell bill, H.B. 1143, that could be later used, once amended, as a vehicle for sweeping, private-sector-based Medicaid reform in Arkansas.

A few weeks later, Beebe came back from a meeting with Kathleen Sebelius and announced Sebelius has “agreed to give us about everything that we’ve asked for. What that really amounts to is taking the Medicaid population that would be expanded . . . and use those federal Medicaid dollars to purchase insurance through the exchange. So they would buy private insurance through the exchange for the entire population, and [HHS has] given us permission to do that.”

I’ve long supported the concept of replacing Medicaid with premium-support subsidies for private insurance — think of it as doing for Medicaid what Paul Ryan’s plan would do for Medicare. So I was intrigued by Beebe’s statement, and also by supportive comments from Arkansas senate president Michael Lamoreux and house speaker Davy Carter.

I started writing encouraging commentary about the Arkansas situation. Beebe’s office published an estimate from consulting firm Optumas indicating that Arkansas would save money by privatizing the Medicaid program in this way.

However, on March 29, Kathleen Sebelius splashed cold water on the idea that Arkansas could do anything other than apply some private-sector window dressing onto the Medicaid expansion. Any expansion of Medicaid, HHS wrote, would have to adhere to the 1965 Medicaid statute enacted by Congress, with all of its fundamental design flaws and federal intrusion. (I discussed, in detail, the negative implications of Sebelius’s memo here and here.) The HHS memo also meant that Optumas’s cost estimates for the bill were wildly optimistic.

Conservative backbenchers in the Arkansas legislature, reading the HHS memo in the same way I did, rebelled against the so-called “private option.” The rebellion was led by none other than Bruce Westerman.

Westerman took his name off of H.B. 1143 on April 9, and fought against the bill the rest of the way. I know this firsthand, as I was in near-daily contact with Westerman and the other GOP leaders during this period.

Unfortunately, on April 17, Westerman’s side was defeated, and the bill was passed by a combination of unanimous Democratic support and fractional Republican support.

Nobody who was actually involved in the private-option debate agrees with Moll’s characterization of Westerman’s position. Michael Lamoreux, the then-senate president who strongly supported the bill, said to the Arkansas Democrat-Gazette, “I like Tommy Moll, but that ad does not represent the history of what happened . . . We were trying to recruit Bruce’s support because we thought it was critical. . . . Bruce was always polite, but as we continued to talk, his questions became more critical and his body language became less friendly. He left a meeting one day, and I told everybody, ‘We’re never going to have his support.’”

Arkansas house minority leader Greg Leding, a Democrat, told the same paper, “[the Moll ad] isn’t a fair assessment. . . . To claim he supported it or tried to get it passed is disingenuous at best. He was a clear, loud and vocal opponent pretty much through the entire process.”

It’s not merely unfair to describe Westerman as a supporter of the Medicaid expansion in Arkansas. Westerman was the leader of the opposition to that expansion.

While Moll says that he’s the only one in the race who “has always opposed Obamacare,” I don’t recall Moll weighing in at all during the legislative debate in Arkansas. (A Nexis search of “Tommy Moll and Medicaid” between February and May of 2013 yields zero results; a similar search of “Bruce Westerman and Medicaid” yields 113.) Those who opposed expanding Medicaid in Arkansas were outnumbered, and could have used Moll’s help at the time.

I appreciate that Republican congressional primaries often end up yielding to these “I’m more conservative than the other guy because of some technicality”-type ads. But it’s one thing to campaign on actual philosophical differences, however narrow. It’s another to misrepresent what actually happened.

UPDATE: I should mention that today, over at The Apothecary, my colleague Josh Archambault reports that the Beebe administration intends to seek a federal bailout of the substantial cost overruns that the Arkansas Medicaid expansion has already incurred.

Avik RoyMr. Roy, the president of the Foundation for Research on Equal Opportunity, is a former policy adviser to Mitt Romney, Rick Perry, and Marco Rubio.


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