Proposal Swaps Medicaid Expansion For Highway Trust Fund

May 22--An Arkansas Congressman has set his sights on the Affordable Care Act's Medicaid expansion to shore up an insolvent federal Highway Trust Fund that has required nearly 30 short-term extensions since 2009.

U.S. Rep. Bruce Westerman, R-Hot Springs, filed his Prioritizing American Roads and Jobs Act of 2015 on Thursday as a long-term solution to help fund a nearly $16 billion annual shortfall with the Highway Trust Fund and pay down some of the national debt.

"It's a huge injustice to traditional Medicaid when you have an able-bodied working adult getting more coverage than a blind, disabled person," Westerman said. "Even if it's not used for the trust fund, something needs to be done about it."

He said his plan would free up more than $15 billion per year in "mandatory spending that is going only to the three out of five states that expanded Medicaid."

The House voted to approve a two-month Highway Trust Fund extension this week. The Senate was expected to approve it too, 10 months after an $11 billion extension was passed to give lawmakers more time to come up with a possible six-year bill. The fund is also used for bridge and rail projects.

State transportation directors find planning long-term projects impossible with short-term funding.

Westerman's estimates show how what he calls a change in priorities could save $300 billion over 10 years. Roughly one-half could be used to build and fix roads in all 50 states while the rest could be used to reduce our national budget deficit, Westerman explained.

He said the road construction jobs provided by a solvent Highway Trust Fund could help able-bodied people who are using the Arkansas "private option" for health insurance.

"A lot of jobs are created when roads are being built," Westerman said. "Maybe it will provide a job for some able-bodied workers."

In Arkansas, the "private option," the state's unique take on Medicaid expansion, has provided coverage to about 248,000 Arkansans, according to an April 21 Arkansas News Bureau report. At least 66,000 Arkansans have obtained insurance through the Health Insurance Marketplace that was created under the federal health care law. Annual uncompensated costs for the state's 104 hospitals were over $300 million as recently as 2013. Uncompensated care decreased by about $18.4 million last year.

Gov. Asa Hutchinson's Health Reform Legislative Task Force is charged with finding a new model that could replace the private option, which is scheduled to end Dec. 31, 2016. The task force voted May 7 to recommend hiring The Stephen Group to help with that mission.

Rate Change Adds $20 Billion

To produce funding necessary to plug the hole in the Federal Highway Trust Fund, Westerman says his bill would change Medicaid expansion match rates established under the Affordable Care Act from a current rate of 100 percent to traditional Medicaid match rates.

In Arkansas, the traditional Medicaid federal match rate is 70 percent while the state picks up the remaining 30 percent. Nationally, the average is a 57 percent federal match rate and 43 percent picked up by states.

Westerman pointed out in a guest column in the Times Record on Friday that the average of 43 percent enticement premium adds up to more than $20 billion per year. The money was used "in luring 29 states and the District of Columbia into the expansion program."

U.S. Rep. Steve Womack, R-Rogers, said in early April he did not expect a long-term solution to the Highway Trust Fund to be resolved until after the next presidential election. However, he also believes the country must return "solvency and dependability" to the Highway Trust Fund.

"He is reviewing all proposals that could serve as a long-term fix," Claire Burghoff of Womack's office wrote Friday in an email.

Sen. Jim Inhofe, R-Okla. said last month he is working with top Senate Republican leaders like John Boozman, R-Ark., on ways to add billions of dollars to highway construction over the next several years. Inhofe is chairman of a committee also writing a long-term highway bill. Inhofe stated in mid-April the legislation is "mostly done," except for the two most critical components -- the time span and the cost," The Oklahoman reported.

House Majority Leader Kevin McCarthy, R-Calif., has said he hoped to tie a long-term Highway Trust Fund renewal to tax reform, The Hill reported this week. House Transportation Committee Chairman Bill Shuster, R-Pa., also said a short-term fix was not his preference and hoped to find the dollars and have a long-term surface transportation bill that's sustainable.

Westerman said he was glad Arkansans voted in 2013 for the half-cent sales tax to fund $1.8 billion in 35 set road projects, but it expires in 2023. The AHTD had to cancel 70 road projects and the two-month extension Congress passed this week kept 131 more road jobs from being cancelled.

About 70 percent of the highway projects taken on in Arkansas are federally funded by the Highway Trust Fund, according to AHTD spokesman Danny Straessel. An average of $490 million a year over the past five years has been used from the Highway Trust Fund in Arkansas, he added.

The Arkansas State Highway and Transportation Department is responsible for 16,398 miles of state and U.S. highways.

The trust fund has gathered less money over the years as cars and trucks achieved better gas mileage. Driers pay a tax of 18.4 cents per gallon of gasoline and 24.4 cents for diesel. The tax has not been raised since 1993. In Arkansas, compressed natural gas is taxed at 5 cents a gallon-equivalent.

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