February 18, 2014; Arkansas Business (Associated Press)

Some states are seeking to find compromises between legislators and governors who want to expand Medicaid in order to provide health insurance coverage to lower-income people and those who oppose expanded Medicaid, ostensibly because of future budget risks.

Arkansas had put into place what was called the “private option,” in which the state would use Medicaid dollars to purchase private health insurance for lower-income persons. It received approval last year from the federal government as an alternative to expanding Medicaid enrollment numbers in the state. It would seem that the impetus behind the private option might have been less about budgetary concerns and more about sending the health insurance business toward private corporations, as opposed to government administration of Medicaid reimbursements.

Nonetheless, when the private option came up for renewal by the Arkansas legislature, the Arkansas House rejected it—needing 75 votes to continue the program, the House fell five votes short. House Speaker Davy Carter, a Republican, supported the private option, questioned what the “small minority of members who want to hold everything up” had in mind as an alternative, and promised to keep bringing the bill up for a vote daily until they get to 75 votes in favor. In the Senate, unlike the House, it appears that at least 27 senators have expressed support for the extension of the private option, which is enough to ensure its passage in the 35-member body.

Eighty-seven thousand people had already obtained insurance coverage in Arkansas through the private option, so why would the state reverse course after less than a year? The motivation of the opponents is obvious. House Majority Leader Bruce Westerman, another Republican, feared that the continuation of the private option would make Arkansas “an enabler for Obamacare and the Washington, D.C. interests who seek to impose their will on us.” He and his colleagues who voted against the private option want to “hold the line on behalf of the people of Arkansas in opposition to this dreadful law,” Westerman added.

Supporters of the private option agreed to amendments such as prohibiting the expenditure of public dollars on promotion or outreach for the private option and prohibiting government funds being used for an insurance marketplace, but those concessions didn’t do the trick.

For some legislators at the state and federal levels, when it comes to the Affordable Care Act, their stance is to say no to anything and everything. What would they do for the people left in the gap between existing Medicaid and the subsidized insurance available on the federal exchange? They don’t say, perhaps they don’t know, and sadly it may be that they don’t really care.—Rick Cohen