Among the biggest ongoing issues in Arkansas politics is one that some Republican legislative candidates would rather avoid discussing, particularly if they’re running against another Republican.
That’s Arkansas Works, previously known as the private option.
The program uses mostly federal dollars under the Affordable Care Act – Obamacare – to purchase private health insurance for 250,000 lower-income adults. It was created in 2013 after the U.S. Supreme Court said states could choose to expand their Medicaid populations rather than be required to do so.
While most Republican-led states said no, Arkansas took a different approach under the leadership of some young Republican legislators and Democrat Gov. Mike Beebe’s administration. Instead of simply expanding Medicaid, a government program for poor and disabled people, it used that money to buy private insurance.
In addition to covering the 250,000 Arkansans, the private option strengthened the market for individuals who purchase their coverage through the Affordable Care Act’s insurance marketplace at HealthCare.gov. With that huge guaranteed customer base, insurers had an incentive to stick around – and compete. Unlike Arkansas, many parts of the country now have only one insurer offering plans through Obamacare.
Arkansas’ uninsured rate went from 16 percent in 2013 to 8.2 percent in 2018, according to the Census Bureau. Its 2018 rate was lower than all of its surrounding states – all of which other than Louisiana rejected Medicaid expansion. Texas’ uninsured rate was 17.3 percent, or more than twice as high as Arkansas’.
Hospitals here are treating fewer uninsured patients who don’t pay. Since Arkansas expanded Medicaid, only one rural hospital, De Queen Medical Center, has closed, as noted by the Arkansas Center for Health Improvement. (Crittenden Regional Hospital also closed, but it wasn’t rural.) At the same time, 52 rural hospitals have closed in surrounding states. Texas has lost 20.
So what’s not to like? Well, nothing in life is free. The debt-ridden federal government will spend $2 billion this year on the program. The state is responsible for 10 percent of the costs, so $177 million is coming out of its budget this year. Many opponents are philosophically opposed to Obamacare or any expansion of government health care.
For a while, the issue dominated every legislative session because a three-fourths majority is needed to pass any spending bill, including for the agency that administers this program. But supporters eventually have always found the votes.
When Gov. Asa Hutchinson inherited the program, he became its champion. To encourage wavering Republicans to vote yes, he created a work requirement and changed the name to Arkansas Works. But the work requirement likely won’t survive a court challenge.
Arkansas Works is probably here to stay, at least until there’s some humongous change to the national health care system. Still, a legitimate debate can be had over whether it’s the best way to cover that population.
But it’s a debate many Republican legislative candidates would rather avoid, at least during a campaign. The Arkansas Democrat-Gazette regularly features individual legislative races, and it always asks about Arkansas Works. Republican candidates who have Republican opponents often decline to express an opinion, as occurred recently in races for two House seats representing mostly Hot Spring and Saline Counties.
You can translate their silence in several ways. Either they’re uninformed about this pivotal issue, or perhaps they don’t want to box themselves in, or perhaps they actually support Arkansas Works, but don’t want to say so. In contrast, opponents tend to make no secret of their opposition.
Why the reluctance to discuss it? Because they’re trying to win their party’s nomination. In 2018, less than 12 percent of Arkansas’ registered voters voted in the Republican Party primary. That’s a small population whose members are more likely to oppose Arkansas Works than support it. Plus, it’s a hugely complicated issue that’s hard to explain but easy to criticize as “big government Obamacare.” For all those reasons, for Republican candidates, it’s easier to just base your campaign on being pro-gun.
The exception to all this is Senate District 21, where Sen. John Cooper, R-Jonesboro, who’s voted for Arkansas Works, is being challenged by Rep. Dan Sullivan, R-Jonesboro, who’s voted against it.
There’s no hiding their votes, so they’re actually discussing them. Arkansas Works probably won’t be the deciding factor in that hotly contested race, but at least voters can know where they stand.