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Arkansas Politics

Revisiting Arkansas’s Obamacare Medicaid Expansion

By Conduit For Action

One of the pillars of Obamacare is the entitlement program Medicaid Expansion. It is government health coverage for people with low income. It is paid for by federal and state taxpayers.

Arkansas became the first southern state to pass Obama’s Medicaid Expansion in 2013.

Think all the states have adopted it by now? Wrong. Eight years later many states still refuse to implement the program, and it is not just southern states. These twelve states still refuse to adopt Medicaid Expansion: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. [i]  In Missouri the program was adopted by a ballot measure but has not been implemented because the Missouri Governor and legislature oppose the program and refused to fund it. Missouri’s refusal resulted in a lawsuit finding in favor of the plaintiffs who want implementation. [ii]

Problems with Obamacare Medicaid Expansion include:

  1. The program turned out to primarily cover able bodied working age adults who… (drum roll) … don’t work.
  2. Once a person goes on the low-income program it serves as a disincentive to work, especially when combined with other government entitlements. To hang on to free (or substantially free) health care a person must not work, limit the hours they work, or under report their income.
  3. The program requires states to pay part of the cost of the program which means it competes for funding with other programs in the state. In Arkansas, advocates for programs for disabled persons and mentally ill persons have seen funding limited, meanwhile money is abundant for Medicaid Expansion. It is a question of priority.

How was it that Arkansas passed Obamacare Medicaid Expansion? The program was adopted at a time when to get states hooked on the program the federal government offered to pay the full cost for the first couple of years. Second, liberals knew that was not enough incentive to get the Arkansas legislature to approve the program and devised a plan to sell it as Arkansas’ “conservative spin” on the program. The supposed conservative spin was the decision to run the day-to-day operations through an insurance company that would receive guaranteed profits. Advocates started calling it the “Private Option” even though it was still a government entitlement with the state holding the policy.

This conservative spin turned out to be a fake selling point as the cost of running the program through an insurance company exceeded the cost in other states where the day-to-day operations were handled by a state agency.

The only thing running it through an insurance company did beside result in a higher cost was to bring lobbyists for the insurance industry and lobbyists for the hospital industry together to push passage of the program.

The next fake conservative spin saw the program being renamed “Arkansas Works,” even though the entitlement program had nothing to do with work. Later, so-called work requirements were added to the qualifications for the program but this, too, was fake because doing actual work was just one of several options to continue coverage.  Eventually the so-called work requirements were disapproved by the feds.

This year the program was renamed again. This time the name is ARHome, which stands for Arkansas Health and Opportunity for Me program.  It is still the same entitlement program and is still being run through an insurance company with guaranteed profits. The Hutchinson administration is waiting for federal approval of the latest reincarnation of the same program, meanwhile the program is still being operated as Arkansas Works.

The rebranding of the program as ARhome (Act 530 of 2021) passed the Arkansas House of Representatives by a vote of 64 to 35 with 1 not voting and 1 voting present; and it passed the Arkansas Senate by a vote of 26 to 3 with 1 not voting and 4 voting present.

Arkansans are one of the highest taxed populations in the nation. If you were in charge of state funds what would be your priority for the use of state taxes?

 


[i] Status of State Medicaid Expansion Decisions: Interactive Map, KFF (Kaiser Family Foundation), Jul 23, 2021, https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/, Accessed July 26, 2021

[ii] ibid

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