The Improbable Path to Success HB1219 | SB1020 Ray Hanley AFMC | 2013 The Arkansas Health Care Independence Act of 2013

1874 ARKANSAS Democrats could not vote until citizenship was restored Democrats could not vote until citizenship was restored Republicans control legislature Republicans control legislature

November 2012 GOP takes control of Arkansas Legislature for the first time since 1870’s DC Style gridlock forecast

Was there any hope to pass health care expansion for the 250,000 hard working Arkansans below 138% of poverty??

The Arkansas Times tracked chances of passing the expansion… “I put it this year’s session at 5%” Max Brantley, February 8, 2013

At least 150,000 adults below poverty would have no coverage option Arkansas hospitals would continue to suffer from uncompensated care while taking deep Medicare cuts, regardless Employers would be at risk for an estimated $35M in penalties Consequences of Failure (do nothing) were e n o r m o u s

The Obstacles Majority vote for the enabling legislationBUT… We had to have a “super majority” vote for the necessary appropriation 75 of 100 votes in the House 27 of 35 votes in the Senate

How did Arkansas succeed where so many other states have failed?

A Governor with a lifetime of political skill who could both work with the other Party’s ideas but who also could sell the Democratic HHS Secretary on the innovative private option plan no state has done before On getting a “super majority” of 75 votes in House and 27 in Senate: “It is almost impossible to get a 3/4 vote for motherhood and apple pie… to do so is the equivalent of scaling Mt. Everest.” Governor Mike Beebe

A talented, articulate, GOP Legislative leadership team who could have easily said “NO, it’s still ObamaCare,” ̶ BUT instead they said “we have a better idea.” Sen. Jonathan DismangRep. John BurrisSen. David Sanders

Senate and House Leaders who understood all that was at stake and who delivered the votes at crunch time Rep. Davy Carter Speaker of the House Sen. Michael Lamoureux President Pro Tempore

A dedicated, stalwart Democrat legislative team who reached across the aisle in the best interests of the people of our State Rep. Darrin WilliamsSen. Larry TeagueSen. Paul BookoutRep. Reginald Murdock

An HHS Secretary willing to work with Arkansas on a never-before-seen, innovative approach to further expand access to health insurance coverage through the Arkansas health insurance exchange. Secretary Kathleen Sebelius US Department of Health and Human Services “Recognizing the decisions facing your General Assembly and the impact on your health insurance marketplace, let me assure you that we will work with you on this innovative approach for Arkansas.”

A DHS Democratic Administration, leadership team who won the respect of GOP Legislators and who had the ability to put the complex, never done before “Private Option” into language that should win Federal approval John Selig Andy Allison

A Surgeon General willing to go anywhere to speak to any group on the merits of the Private Option Dr. Joe Thompson

A legion of grassroots organizations who came together to form the “AR Health, AR Jobs” Coalition

A dedicated group of public policy relations folks to help guide our public outreach… Clint Reed Chase Dugger Richard Bearden

A drafted AR Health, AR Jobs Coalition Leader

We worked the phone, , text… ran TV and radio spots, organized tele-town halls, lined the hallways and even the marble steps…

The Votes at Crunch Time… Senate 28 Senate 28 (we needed 27) House 77 House 77 (we needed 75)

What the Private Option would do… Allow DHS to purchase a private “silver” insurance plan within the State’s Health Insurance Exchange for any uninsured adult below 138%* of the poverty level *(approximately $15,000 for one; $32,000 for a family of four)

This accomplishes several things a regular Medicaid expansion could not…

Avoids “churn” – flipping on and off Medicaid as income goes over and under 138% of poverty Allows Exchange Commercial Plans to pay higher provider rates needed to assure access to care Protects businesses from penalties where the newly covered may work Stabilizes the State’s health care system for ending most uncompensated care

Other states openly discussing following Arkansas’ lead on the Private Option Oklahoma Florida Ohio Idaho Pennsylvania Louisiana Iowa Texas

What’s next DHS will write and submit to CMS for approval the necessary 1115 “Research & Demonstration” Waiver AID will be accepting proposals from private insurance plans to serve the expanded population within the exchange

AR Insurance Exchange How much competition??? Arkansas Blue Cross Blue Shield of Little Rock National Blue Cross Blue Shield Multi-state Plan QCA Health Plan of Little Rock (dba QualChoice of Arkansas Inc.) Celtic Insurance Co. of Chicago, through its subsidiary NovaSys… parent is Centene, a Medicaid managed care firm HQ in St. Louis

The REAL Winners… 250,000 low income, hard-working Arkansans The State of Arkansas who showed the nation how leaders come together to solve the most complex issues