In roughly two months, Arkansas voters will participate in Republican primaries across the state. In some respects, the choices that Republicans make in primaries for the state Senate are the most interesting of all the primary battles, because the winner of some of these senatorial elections will not have to face a Democratic opponent in the fall — whoever wins in May will get to occupy the seat for the next four years. Three incumbent Republican Senators — who, coincidentally, have all supported the Obamacare “private” option — have drawn opponents who have pledged to dismantle the health care debacle. This week, we’ll examine the debate over the “private” option in these state Senate districts. For starters, let’s take a look at Senate District 18, where incumbent Senator Missy Irvin is being challenged by Phil Grace.
Right out of the gate, Irvin has come under fire from Grace for being the “deciding vote” on the Obamacare PO in the 2013 session. This narrative is almost certain to continue, given Irvin’s last-minute cosponsorship of the “private option.” Although she did reverse course and vote against its funding in the recent fiscal session, we might never have had the PO if she had voted ‘no’ last year.
Irvin was recently questioned on her campaign Facebook page (perhaps based on Grace’s criticisms) about her vote on the Obamacare PO. That public comment has since been deleted, but Irvin did post a screenshot of the question and her response:
Unfortunately, this statement demonstrates a fundamental misunderstanding of what the “private” option is and what the state’s options were. In particular, there are three aspects of Medicaid expansion which reasonably well-informed legislators should understand.
1. We didn’t have to expand Medicaid. Period. To say “We didn’t have a choice” about Medicaid expansion is flatly wrong. Every state that borders Arkansas chose not to expand Medicaid; unlike our neighbors, we expanded Medicaid. This expansion is driven by the Affordable Care Act, more commonly known as Obamacare. The Supreme Court gave states a powerful tool to fight back against Obamacare in its ruling on the law by giving each state the option to decline to expand Medicaid eligibility. Regrettably, Arkansas is the only Southern state to lay down this weapon against Obamacare: instead of fighting, we surrendered and implemented Obamacare via the “private” option.
(Some argue that the “private” option is not Medicaid expansion. This argument is groundless. The “private” option expanded Medicaid eligibility, drastically increasing the number of beneficiaries; these clients get Medicaid benefits. The way this works is that taxpayers fund insurance companies, which then pay money to doctors, who then supply Medicaid benefits.)
2. The “private” option is a central component of Obamacare. I cannot see how anyone could say that Medicaid expansion, through Obamacare, “is not approving or expanding Obamacare.” The “private option” provides Medicaid benefits to a new class of Medicaid clients. Arkansas expanded Medicaid for the first time in Arkansas history to about 250,000 able-bodied, working-age people.
3. The federal government is still in control of Medicaid. Irvin’s statement that the “private” option gives Arkansas “more of a say so in how it’s managed in our state” is also groundless. Every aspect of Medicaid expansion must be approved by the federal government, whether it runs through a “private” option model or not. The only way a state could exercise real control in this area would be to block Medicaid expansion – which Senator Irvin, in 2013, declined to do.
I appreciate that Irvin voted against funding Medicaid a few weeks ago during the fiscal session. And I appreciate her voting record on non-PO matters — putting aside Obamacare issues, she has one of the best voting records in the Senate. She was one of AAI’s Friends of Freedom, which means that she was in the top one-fifth of state senators when voting on matters of freedom and good government (at least as the Advance Arkansas Institute measures things). But the misunderstandings she has demonstrated about the “private” option in this Facebook post are troubling.
Many pro-expansion legislators have argued that Obamacare presented states with terrible choices, and that the choice they made to expand Medicaid was the best option of several bad ones. I strongly disagree with that argument, but it is at least defensible. In contrast, saying that states had no choice about whether to implement Obamacare is not defensible. In my view, it’s very important that public officials — and people who want to be public officials — understand and can accurately depict the challenges Arkansas faces.
I reached out to Phil Grace, Irvin’s opponent, to give him a chance to weigh in on this topic. He told me bluntly:
I am opposed to the private option and any other expansion of Obamacare in our state. We did not have to implement Obamacare Medicaid expansion and the Supreme Court was clear about that. If elected, I will vote to repeal the Obamacare Private Option if given the opportunity.
Stay tuned to The Arkansas Project, Arkansas’s truth detector: we’ll have more coverage in the next few days of the policy debates taking place right now across the state.