Arguably, the most successful plank of the Affordable Care Act has been the expansion of Medicaid, despite the unbalanced way in which some states have embraced it while others have fought it tooth-and-nail. But one state that accepted it, may try to turn back the clock and actually take away insurance from thousands of people in the process.
With the Medicaid expansion, there's been a new trend among the Republican-controlled states that initially rejected the expansion to reconsider. The GOP governors of Michigan, Iowa and Pennsylvania have been working with the White House to create hybrid, privatized plans that usually require some funds from the person being insured. Arkansas, one of the first states to get a privatized plan approved by the government, might soon decide to undo that Medicaid expansion when it votes to fund the program during its fiscal session starting this month.
As Dylan Scott at Talking Points Memo reports, the legislature's conservatives may have enough votes to block Medicaid funding. If that happened, 85,000 people would lose their insurance in 2015. Last February, the Arkansas "private option," which uses Medicaid funds to buy private insurance for low income residents, passed the Senate by a bipartisan supermajority, with one extra vote, according to the Arkansas Times. Since then one representative, State Sen. Missy Irvin, flipped from yes to no and another expansion supporter resigned after a campaign scandal, and was replaced by another no vote.
If the funding is blocked, this could be the beginning of a trend where right-leaning states take away insurance, simply because continue the fight against Obamacare makes political sense. Back in May, PBS found that some thought that Arkansas' compromise plan might convince other red states to present their own plans because it "looks less like government and more like business." The narrative then was to give people insurance without giving handouts. Within Arkansas's anti-expansion wing, the new narrative seems to be that once the state gets involved with the feds and insurance, there's no going back.
"I have serious questions about the flexibility the state will lose once we begin to participate," State Sen. John Cooper, wrote on his campaign page. (He also said Obamacare was "among the worst legislation ever passed.") "Trying to make deals with the federal government is generally an exercise in futility," he added. That's a narrative that could sway votes in red states with fragile expansion efforts.
Locally, if Arkansas blocks Medicaid funding, individuals making 100-to-138 percent of the federal poverty level would be eligible for subsidies for the private exchange. The irony is that those below the poverty level would be out of luck. And according to the Times, "the ripple effects on the Medicaid program, the insurance Marketplace, various state agencies and municipalities, and hospitals across the state would be immense." The state budget would be short $89 million and need to be renegotiated, and hospitals would have to do without the funds expanded Medicaid brings in. Additionally, the state would lose out on the $600 million the expansion saves them over the next decade, according to the Times.
The one thing that would be straightforward is taking away the benefits. "In terms of that aspect of it, it's that simple," an Arkansas Department of Health Services representative told the Times. "We inform folks that this program ends, we have no additional funding for it." Problem solved.