After Standoff, Arkansas Medicaid Expansion Survives

The state's first-in-the-nation waiver to Medicaid seemed endangered in late 2014, but Governor Asa Hutchinson decided keeping people insured was worth it.

In Arkansas, a group of hard-core Obamacare opponents thought their brand of political hardball might spell the end of Medicaid expansion.

They found out their governor, Republican Asa Hutchinson, can play even harder, and now the state that invented the CMS waiver has a new one with a few tweaks to keep expansion alive, serving 267,000 residents who earn up to 138% of the federal poverty level, which amounts to about $16,000 for a single person or $33,000 for a 4-person family.

Arkansas’ “private option,” the first of its kind under the Affordable Care Act, seemed endangered when Hutchinson and additional GOP lawmakers were elected in November 2014. But the governor decided that taking Medicaid coverage away from people who had finally gained healthcare was not in the state’s interest, especially after rankings came out showing Arkansas leading the nation in obesity.

Hutchinson’s Arkansas Works plan, which replaces the original “private option” with a waiver that ostensibly requires more personal responsibility, survives due to some interesting maneuvers.

When the governor knew he wouldn’t get the required 75% vote to fund his updated program, he cut a deal with Medicaid backers to insert a clause that would have let the program expire at the end of the year. Hutchinson made it clear he planned to use his line-item veto on that provision, which would leave Medicaid fully funded.

Which was enough to cause the 2 of 10 lawmakers blocking the changes to cave, giving Hutchinson what he wanted in the first place—a vote to fund Medicaid. If the 2 hadn’t changed their minds, Medicaid would not be funded at all, something even Obamacare critics couldn’t defend.

The bill with the sham amendment passed Thursday and Hutchinson used his line-item veto to cancel the sunset language immediately.

Kaiser Health News reported that Hutchinson praised the “spirit of cooperation” in the General Assembly and described his moves as “transparency,” because, “Everyone knew what was happening. That’s not trickery.”