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Analysis: Report moves Arkansas panel closer to Medicaid proposals, but maybe not consensus


LITTLE ROCK, Arkansas — A much-anticipated report to lawmakers on Arkansas' hybrid Medicaid expansion won't resolve the muddied future of a program providing coverage to more than 200,000 people. But it could at least provide some clarity on the options the Legislature faces, and how difficult finding consensus on the program will be.

The task force formed to look at the state's "private option" is expected to hear from the Stephen Group, the consultant lawmakers hired to study the expansion and the overall Medicaid program. Wednesday's report by the consultant marks a turning point for the 16-member panel, with a December deadline fast approaching to issue recommendations on the Medicaid expansion.

"It's always easiest when you can say magically it'll happen somehow in the future," said Rep. Charlie Collins, R-Fayetteville, who co-chairs the task force. "(Wednesday) will be the hard cold snap of reality in my view where we're going to see sets of actual concrete choices."

Collins said the consultant's report will go beyond the "private option," which uses federal funds to purchase private insurance for low-income residents.

Crafted in 2013 as an alternative to expanding Medicaid under the federal health law, the program was spared for another year after lawmakers reauthorized it and created the task force at Republican Gov. Asa Hutchinson's request.

The report is expected to assess changes Hutchinson has said he wants to see in the program to limit its benefits and eligibility. Hutchinson told lawmakers in August he supports keeping the private option if the federal government gives Arkansas flexibility to impose the new limits.

The report will look at broader changes to Medicaid, and also likely will address how to find the more than $50 million in savings to the program Hutchinson has called for. Hutchinson has said the cuts are needed to prepare the state for when it begins paying for a portion of the expansion's cost in 2017.

Hutchinson's announcement has put the state's role in another key part of the health law in limbo. The governor asked a board to halt its work setting up a state-run marketplace where consumers can purchase insurance under the law. The state is currently using the federal exchange, but had been given conditional approval to set up its own.

The consultant's initial findings have already encouraged supporters of the private option, with a report in August projecting that the program would have a $438 million net benefit to Arkansas between 2017 and 2021.

Lawmakers on both sides of the debate say they're closely watching such numbers to see what the consultant's recommendations would cost the state and what they would mean for those on the program.

"The numbers should drive the decisions because we know what we're doing now is not sustainable," said Sen. Cecile Bledsoe, R-Rogers, an opponent of the private option who chairs the Senate Public Health Committee and is the acting co-chair of the Medicaid task force. "I think the numbers, that's part of getting to the solution."

The report obviously won't change the politics of the private option, which has become the definitive division among Republicans as they have taken over as the majority party in the state. GOP backers of the plan have touted it as a conservative alternative to expanding Medicaid, but opponents have cast it as an embrace of the law Republicans regularly deride as "Obamacare."

Democrats who have been unified in their support of the program have been wary of changing the program in a way that appeases conservatives but jeopardizes coverage.

The report coming this week is unlikely to change that dynamic. But it may at least offer a clue on whether there's a path forward that would keep together the uneasy union of private option supporters.

Andrew DeMillo has covered Arkansas government and politics for The Associated Press since 2005. Follow him on Twitter at http://www.twitter.com/ademillo

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