Arkansas Trip-Wire

In the struggle over the implementation of Obamacare, the “Arkansas option” has been a major talking point for those who have long predicted that Republican-governed states would eventually come around to accepting the vast federal subsidies offered to encourage an expansion of Medicaid, if only because powerful provider interests would force them out of their ideological foxholes. In Arkansas, Democratic governor Mike Beebe secured preliminary approval from the Obama administration for a deal whereby a Medicaid expansion would be accompanied by privatization of Medicaid services, considered a big carrot to Republicans determined to get rid of government-provided health insurance. Other Republican governors initially announced as opponents of the Medicaid expansion–John Kasich of Ohio, Bobby Jindal of Louisiana, and Paul LePage of Maine, along with Republican legislators in Texas and Florida–were reportedly interested in the Arkansas approach.

But now the “Arkansas option” is in danger–in Arkansas. Here’s Sarah Kliff at Wonkblog today:

The Arkansas House of Representatives is likely to vote Monday on whether to fund the legislation that would allow the private Medicaid expansion. We don’t know whether it will pass.

There was another important vote Thursday, where the House voted 62-37 in favor of enabling legislation for the Medicaid expansion. While that is a solid majority, passing the bill to appropriate funds to the program has a higher bar: It needs 75 votes to pass.

If advocates in both parties favoring the expansion-with-privatization deal fail to get those additional votes, it’s likely the “Arkansas option” will lose some of its appeal elsewhere.

[N]ot having Arkansas on board would likely prove a pretty big setback. State legislators and health policy experts I talk to were waiting on Arkansas as the litmus test. It’s supposed to show states whether such an arrangement is possible with the federal government.

If it doesn’t move forward, that means another state would need to take its place in forging an initial deal. Whether anyone would, at this point, remains an unknown.

Kliff also notes there are reports John Boehner is quietly joining the loud lobbying of Republican legislators in Arkansas by members of the state’s congressional delegation. That wouldn’t be unprecedented: in Texas, Republican senators John Cornyn and Ted Cruz have joined Rick Perry in arguing against any move towards an “Arkansas option” in the state that is making a strong bid to increase its lead among states with high percentages of citizens without health insurance.

Meanwhile, for all the talk of the “inevitable” success of the Medicaid expansion, Arkansas could well join sixteen other states–nine in the South–who have not joined this particular parade. It may seem (because it actually is) highly irrational for the states with the most to gain from the expansion fighting it most avidly, but it’s real. Ideology matters, folks.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.