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Healthcare proponents face tough choice in Arkansas

For healthcare proponents in Arkansas, the choice is effectively: (a) kill Medicaid expansion; or (b) preserve Medicaid expansion but end state outreach efforts
Ray Sanford awaits a haircut in a barbershop in downtown Rogers, Arkansas, December 4, 2013.
Ray Sanford awaits a haircut in a barbershop in downtown Rogers, Arkansas, December 4, 2013.
To help advance Medicaid expansion in Arkansas, the Obama administration worked with state officials on a compromise policy that relied on private insurers. The result is a successful policy that's both popular and critical in extending coverage to tens of thousands of low-income Arkansans.
In recent weeks, Republicans in the Arkansas legislature have moved closer to ending Medicaid expansion altogether. Because of a quirk in the policymaking process, last year's vote that expanded access needs to be reauthorized this year, and many of the same GOP policymakers who backed the policy in 2013 are facing primary challengers in 2014. The policy is therefore in severe jeopardy.
Over the weekend, the Arkansas News Bureau reported on a possible compromise, but for those who support access to health care, it's not exactly an enticing deal.

The debate over whether to continue funding the so-called private option appears to have come down to two choices: End the program or continue it with provisions that would prohibit state outreach efforts on behalf of the private option and the Arkansas Health Insurance Marketplace. The directors of the state Insurance Department and the Department of Human Services say the latter option would be detrimental to the goal of expanding health care coverage in the state, but they prefer it to ending a program that has already provided insurance to thousands of Arkansans.

So, for health care proponents, the choice is effectively: (a) kill Medicaid expansion and allow Republican policymakers to take coverage from 85,000 low-income Arkansans; or (b) preserve Medicaid expansion but end state outreach efforts to bring coverage to those who need it and are entitled to it.
Under this "compromise," Arkansas wouldn't be able to spend a penny to promote the exchange marketplaces, encourage the uninsured to sign up for coverage, let residents know that Medicaid exists as an alternative, or rely on navigators to help Arkansans review their choices and pick the plan that's best for them.
That may sound horrible, but for Arkansas Democrats, if it's the only way to ensure Medicaid expansion remains in place, they don't feel like they have any choice. Indeed, Gov. Mike Beebe (D) has said he'd grudgingly back the "compromise."
John Selig, Arkansas' director of the Department of Human Services, told state lawmakers, "The administration disagrees with this. I think the governor believes in the private option -- certainly we do -- and believes you should do outreach and let people know what's available to them in the system. That said, I think we even more strongly are comfortable saying on behalf of the governor that the most important thing is to make sure that 100,000 people don't lose coverage that they just got."
It's not a done deal, but as of yesterday, it appeared to be where the debate is headed.
As for why Republicans in the state legislature would push for such a trade-off, I'll leave it to others to speculate.