In the coming months, state lawmakers and key constitutional officers will be making critical decisions on Arkansans' options for health insurance through Medicaid, an insurance exchange, or the pure free market.

Interestingly, all state elected officials have the ability to opt into a generous state health insurance plan and more than half have done just that.

The state's health insurance plan, like other large group plans, is generally less expensive than individual or smaller group plans since insurance coverage risks are spread over a large array of participants — approximately 143,000 state employees, public school employees, retirees, their spouses and children combined.

Also, the state — as an employer — makes contributions to the plan, which can lower an employee's out-of-pocket monthly cost from zero dollars for individual coverage to a maximum of $419.62 for family coverage, according to the 2012 rate chart.

Statistics provided by the Arkansas Auditor of State's office indicate that 82 of 142 state elected officials (135 state legislators and 7 constitutional officers), or 57%, are enrolled in a health insurance plan through state government. Federal health information privacy regulations prohibit the release of names of individuals in the state plans, but through research conducted by Talk Business 10 lawmakers voluntarily explained their personal health insurance experiences and rationales.

BACKGROUND
The recent U.S. Supreme Court decision on the individual mandate's constitutionality opened up debate about the state's role in expanding Medicaid programs, a provision in the federal health care law.

The high court ruled that states could not be penalized for opting out of the Medicaid expansion, which is expected to lead to months of wrangling among Arkansas policy makers.

Also, the court ruling will re-ignite a contentious discussion of a state health insurance exchange — an online marketplace where various health insurance companies can offer policies for lower-income Arkansans and potentially other citizens.

Although every legislator will ultimately vote on aspects of the federal law — such as budget items, policy construction, and program development — key lawmakers sit on committees that will dictate the early direction policy leaders may go.

For instance, the Joint Budget Committee should hammer out critical financial parameters that could control how far — if at all — Medicaid is expanded. The Insurance Committees of the legislature will likely take up debate of health insurance exchanges again and the Public Health Committees could wrangle over qualifications for Medicaid eligibility.

With that in mind, Talk Business quizzed a variety of legislators from both political parties and both chambers of the General Assembly for their takes on their personal health insurance options and how this may influence their actions.

ROLL CALL
State Sen. Cecile Bledsoe, R-Rogers, sits on three influential committees that will be involved in the Arkansas health care debate: Insurance and Commerce, Public Health and Joint Budget.

The wife of a physician, Bledsoe joined the state health insurance plan in 1999 during her stint in the Arkansas House. When her term ended in early 2005, she stayed on the state plan through a provision known as COBRA, which allows people to stay on an existing plan for an additional 18 months as long as they pay the premiums.

The main reason Bledsoe opted for the COBRA extension involved her husband, who had successfully recovered from kidney cancer and had trouble finding affordable health insurance due to his pre-existing condition.

Once the Bledsoes' COBRA ran out, the couple bought a high-dollar deductible catastrophic policy and paid out of pocket for medical expenses, she says.

Bledsoe returned to the legislature through the State Senate in 2009, and today she qualifies for Medicare being over the age of 65.

“I became eligible for Medicare and decided that this insurance would be best for me,” Bledsoe said.

She is opposed to the federal health care law and advocates for a “repeal and replace” effort.

“Here's the bottom line of why I'm not for the Patient Protection Act,” says Bledsoe. “It was done in the middle of the night without the public knowing what was going on.”

While she doesn't believe the federal law is good, she says that a replacement of Obama's signature legislative accomplishment should maintain some items, such as a provision that requires coverage in spite of pre-existing conditions as well as allowing children to stay on a parent's plan up to the age of 26.

She contends other changes that should be made to health insurance reform include national tort reform, looser restrictions on health savings accounts, and permission to sell insurance across state lines.

State Sen. Joyce Elliott, D-Little Rock, is enrolled in a s

tate health insurance plan. A former school teacher, she has had health insurance options throughout her working career. Before coming to the legislature, she worked for a nonprofit, which provided her insurance, but she switched once her legislative duties ramped up.

“When I began serving in 2009, my private job became part-time, which meant I was no longer eligible for health benefits through that company. The state was my other affordable option, fortunately,” she said.

Rep. Andrea Lea, R-Russellville, has the benefit of a spouse with a good insurance plan. Lea's husband works for Entergy Corp. and throughout her public career — city council, quorum court and the Arkansas House — she has eschewed participating in a public employee health plan even though it has been an option for her.

“It's a part-time job,” she said. “It just seemed consistent to me.”

Before coming to the state capitol, Lea pushed to restrict part-time elected officials from receiving full-time health benefits, in part because they were increasing the city's health insurance premiums.

Senate President Paul Bookout, D-Jonesboro, says he has never enrolled in a state health insurance plan, opting to garner insurance through his family's funeral home business or his current employer, St. Bernard's Health Care in Jonesboro.

“I've always had it through the business I've been employed by,” said Bookout, who added that he hopes the upcoming debates on provisions of the federal health care law at the state level remain as non-partisan as possible.

Employer health insurance, not the state, has also been the option of choice for the two men vying to lead the Arkansas House of Representatives in 2013.

Speaker-elect State Rep. Darrin Williams, D-Little Rock, said he's enrolled in his law firm's insurance plan.

“Because as a partner in the firm, I pay a huge chunk of money for insurance for my employees and me. It's more cost-effective to have it through the firm, to be honest,” said Williams.

Rep. Terry Rice, R-Waldron, who could serve as Speaker of the House if Republicans take control of the House, said as a self-employed small business owner he's always provided his own health insurance despite the opportunity to partake in a state-administered plan.

“I wanted health insurance and I will work to provide it as long as I can.  Also, it gives me a reason to get out of bed and work 60-80 hours a week,” Rice added.

Rep. David Meeks, R-Conway, filed a bill in the 2011 legislative session to repeal the federal health care law. He's also a skeptic of a potential Medicaid expansion that the law allows for and he still sees major problems with the concept of a health insurance exchange.

As a “full-time” part-time legislator, Meeks participates in the state's health insurance program.

“It was the only real option available to me,” he said. “We did look at private insurance to see how much it would cost. Financially, we might be able to afford it. We'd have to re-arrange some things in our budget to afford it… I don't think we'd want to go without health insurance.”

Rep. Kathy Webb, who co-chairs the Joint Budget Committee, but is term-limited, was an advocate for the federal health care law. She signed an amicus brief that was part of the historic Supreme Court decision.

Webb, who has owned a restaurant and now works for a hunger relief non-profit, joined the state-administered plan when her legislative service began nearly 6 years ago.

She had a work-related plan before her tenure in the legislature and expects to revert to a private plan once her service ends.

“I chose it [state plan] because the plan met my anticipated needs and seemed better for those unexpected possibilities as well,” said Webb.

UNUSUAL CIRCUMSTANCES
A couple of legislators have unique situations related to their health insurance coverage.

Rep. John Edwards, D-Little Rock, rose to the rank of Colonel in the Arkansas National Guard. During his active military service, he opted into TRICARE, a U.S. Department of Defense health care program.

Today, he is enrolled in a federal health insurance program through his wife, whose U.S. government employee retirement plan allows for the option. When Edwards turns age 60, he said he is eligible to re-enroll in TRICARE.

He says that resolving health insurance access and affordability for constituents outside of his urban legislative district will weigh as heavily on his decision-making as the upscale city neighborhoods he represents.

“One of my biggest concerns is how people in rural Arkansas get health care,” Edwards said. “We're all in this together. That's the lens I'm looking through.”

Sen. Michael Lamoureux, R-Russellville, is a lawyer who does a significant amount of real estate as well as public defender work. A mover and shaker in the Arkansas State Senate, he has been in the group health insurance plan through the Arkansas Public Defender Commission since before he entered politics. He says it was his best option and he's had no reason to change.

“My situation is unique. I am a 12-year employee of the Arkansas Public Defender Commission, which is where I have my insurance,” Lamoureux said. “If I was not, I would utilize the insurance offered as a member of the legislature.

Lamoureux said his decision to expand Medicaid and to work towards more solutions for health care access will be rooted in free-market principles.

“For those who are permanently on Medicaid, I want it to be the best system possible. For those who are on it temporarily, my goal is for them to move toward a private-based solution,” he said.

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