Arkansas's Medicaid Folly

On Tuesday, the Arkansas state legislature failed to renew a bill authorizing its expanded-Medicaid plan, an innovative approach to Obamacare that allowed the state to use federal funds to purchase private insurance for the state's low-income residents. Arkansas's unique plan was a compromise between the state's Democratic governor, Mike Beebe, and the Republican-led legislature, and made the state one of the few ultra-conservative ones to bother expanding Medicaid. In the 25 states that didn't expand, many of the poor are still doing without insurance, because the federal subsidies weren't designed to kick in until people made above a certain threshold. If Arkansas doesn't renew its Medicaid program, more than 87,000 people who've gotten insurance this year will suddenly lose it again.

Opponents are complaining that the plan is expensive. To begin with, the entire cost is paid for by the federal government until 2016, and after that the state will never chip in more than 10 percent. Right now, that means the state is saving $90 million a year because it would have been on its own if it hadn't expanded Medicaid. Buying private plans for low-income residents was always going to cost more than a state-run Medicaid system would, but the jury's still out on whether the more expensive Arkansas plan is cost effective because the recipients might be geting better care.

Lest you think this is actually about saving money, Republican state Representative Nate Bell admitted in the Arkansas Times last week that he wants the state to stop advertising the program so that people quit signing up.

That’s entirely my goal here, to stop this thing from expanding, to lock it where it’s at. Let me explain … the bulk of the enrollment has come from what’s been known as the auto-enrollment, where they take the people in existing programs, send them a letter that says: you’re eligible … please check here and we’ll enroll you. My language takes that ability to do that away.

(Nate Bell is the same state lawmaker who tweeted, after the Boston Marathon Bombing, that he wondered how many "Boston liberals spent the night cowering in their homes wishing they had an AR-15 with a hi-capacity magazine?")

Even though the state leadership has promised to bring the bill to reauthorize funding for the program up for a vote every day this session until it passes, it does seem that Arkansas has pulled what I like to call the "Full Huckabee." That is, when the former governor Mike Huckabee entered the presidential campaign in 2008, he did so with a record of running a state government that he believed actually had the power to help people, even if he disagreed with Democrats on how to do that. Now, he is a hatemonger for Fox who has abandoned all sense of compassion. Arkansas, too, had been a better state in which to be poor than, say, Mississippi, but it seems content to abandon that ethos entirely now that it's made the full transition from blue to red.

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