The Private Option In The Republican Primary

New results from a Talk Business-Hendrix College Poll show that the private option is immensely unpopular among Republican voters, but its effect in primary races is mixed.

The latest statewide poll of 1,516 likely GOP voters found that 54% oppose the plan, while 23% favor it. Roughly 24% are undecided on the program that takes federal Medicaid expansion dollars and uses it in private health insurance exchanges to subsidize low income workers’ health care coverage.

The last question posed to voters in the April 29, 2014 survey was:

Q. As you may know, the Arkansas General Assembly has passed a law allowing Arkansas to spend federal Medicaid dollars to provide private insurance to low-income Arkansans through health care exchanges. Do you favor or oppose this “private option” health care plan?

23% Favor
54% Oppose
24% Don’t Know

The private option was originally passed in the 2013 regular legislative session by the smallest of margins needed for supermajority of votes in both chambers of the Arkansas General Assembly. In the 2014 fiscal session, renewed funding for the private option once again passed by the narrowest of margins with only one vote to spare in the Arkansas House and no votes to spare in the Arkansas State Senate.

Other reforms to Medicaid were also passed in 2013 as part of a comprehensive package that overhauled aspects of the state’s low-income health care program.

PRIMARY WARFARE
In a number of Republican political primaries this spring, the private option has been a major issue of contention. Several high-profile State Senate races pit those who voted for the private option and its funding against opponents who pledge to halt the program in its tracks if elected.

For instance in Senate District 9, challenger Rep. Terry Rice (R-Waldron) has bashed private option supporter Sen. Bruce Holland (R-Greenwood) with the issue. Rice, who opposed the measure in the last two sessions, contends that the state can’t afford its share of the private option costs in three years when it starts picking up a percentage of the tab.

“The payday’s coming and I hate for people to be hurt,” Rice said at an April debate in Van Buren. “I asked for this to be put off and let’s see what other states do around us. We were the only southern state —- no other state that touched us expanded Medicaid. It’s because the Supreme Court ruled we did not have to.”

Holland has defended his votes, saying the private option was the only viable response the state had to cope with the dilemma of doing nothing, expanding Medicaid, or cobbling together a state solution with federal funds.

“It’s accepting federal money that the federal doesn’t have. Well, I get that argument. I really get that,” Holland told the debate audience in Van Buren. “But there’s money that’s gone from this state to D.C. that I think we should take advantage of and allow these people and these hospitals the support through this private option. Now there’s nothing perfect about it. It’s the crappiest lemonade you could make out of these lemons. That’s a fact. But doing nothing was not a good option.”

Rep. John Burris (R-Harrison) is running for an open Senate seat against two primary opponents — Scott Flippo and Mountain Home Mayor Dave Osmon.  Burris has frequently explained his position that the private option was the only reasonable solution the state had. An architect of the plan, he says it is “misleading” to say the private option is Medicaid expansion.

“It reduces the number of people on Medicaid,” Burris wrote in a Family Council survey, which can be influential with Republican primary voters. “The program neither expands Medicaid or provides ‘health insurance through Medicaid.'”

For his role in the private option, Burris has faced a barrage of criticism from Flippo who has sent mailers and is running a campaign commercial attacking him on the subject.  Flippo is adamantly opposed to the private option and the other candidate in the primary, Osmon, says he doesn’t like the law but would support continuation of the private option if it was the only choice to consider.

MIXING IT UP
Several Republican candidates running for statewide or federal office have seen the private option injected in their races.  Polling data suggests an uneven application of the issue as an effective political weapon.

Fourth District Congressional candidate and House Majority Leader Bruce Westerman (R-Hot Springs) fares well with supporters and opponents of the private option. Crosstabs from the Talk Business-Hendrix College Poll show Westerman winning with those in favor of the private option and those opposed to it.

Westerman, an opponent of the private option, didn’t officially remove his name from legislation tied to the measure until later in the 2013 session, although his participation in the crafting of the eventual proposal ended early in the process. He filed his own bill to require a global waiver, which he argued would provide more state flexibility with federal funds.

His GOP primary challenger, Tommy Moll, is running a TV spot accusing Westerman of supporting Obamacare “twice” by being an early sponsor on the unmodified “shell” bill and for his “global waiver” bill.

Westerman and 19 of his legislative colleagues have responded that Moll is incorrect and they are circulating a letter stating that Westerman “led the opposition to Obamacare in Arkansas.”

“Anyone who claims that Bruce Westerman was anything but an ardent opponent of Obamacare is misleading the people of Arkansas,” the letter from the 19 lawmakers states.

Andrea Lea, a GOP candidate for State Auditor and supporter of the private option, has support from likely primary voters for and against the private option. Lea faces Ken Yang in the GOP primary.

Conversely, the data suggest that there is a split among GOP voters for State Treasurer candidate Duncan Baird, who supported the private option. He fares better with those who support the private option (17% to 13%), while his primary opponent Dennis Milligan does better with those who oppose it (19% to 11%).

GROWING PAINS
GOP strategist Bill Vickery with Little Rock-based Capitol Advisors Group, who does not represent any of the candidates in the Republican primaries this May, says the maturity of the Grand Old Party now downplays the relevance of singular issues like the private option in Republican vs. Republican races.

“In a vacuum, the issue exists and it’s top of mind for a lot of Republican primary voters. But the race doesn’t occur in a vacuum,” Vickery says. “You’ve got incumbents who are running that voted for the private option, but have an impeccable conservative record and true conservative bona fides in their districts and are known for that.”

While the private option may be an Achilles heel, a challenger may have a tax vote or other liability on his or her record, Vickery adds.

He also says that the private option vote has a variety of components to it, such as hospital funding, nursing home support, or aid to community health centers. It is also providing health insurance to many who didn’t previously have options.

That combination of outcomes makes the private option less black-and-white for a candidate and his community.

“The private option is unlike pro-life or pro-choice, which is a critical litmus test for a number of voters in Republican primaries,” Vickery said. “The private option has shades of gray to it, and I think it’s turning out where you’re seeing incumbents who voted for it still in a very strong, probable win position.”

The fate of the private option and its funding is certainly at stake in these primary races. How “strong” or “probable” its renewal will be next January when the General Assembly reconvenes could very well be determined by the end of the vote count on May 20th.