The New York Times writes on a topic familiar in Arkansas — the divide between state-level Republican politicians and Republicans in Congress on use of the Affordable Care Act, or Obamacare, whose Medicaid expansion has added nearly a quarter-of-a-million Arkansanss to the rolls of the insured at no cost (and huge financial benefit) to the state.

Arkansas adopted the Obamacare Medicaid expansion and Gov. Asa Hutchinson has just, as expected, recommended its continuation. Arkansas’s Republican congressional delegation votes reliably for every measure offered to kill it.


In Arkansas, a centrist Democratic governor, Mike Beebe, found a novel way to expand Medicaid in 2013, using federal money to buy private coverage for 220,000 low-income people through the insurance exchange set up under the health care law. His successor, Gov. Asa Hutchinson, a Republican, said this month that he wanted to continue the expansion while adding some conservative features, including premiums and work incentives.

“I opposed and continue to oppose the Affordable Care Act,” Mr. Hutchinson said. But, he added, “we’re a compassionate state, and we’re not going to leave 220,000 people without some recourse.”

The March 1 Republican primary will include several key races in which some challengers to Republican incumbents who voted for the Obamacare expansion will essentially pose the question: What does oppose mean? Doesn’t it mean a “no” vote? The conventional wisdom is that the same realities that passed Obamacare Arkansas-style in the first place hold true: Billions in federal income; jobs for health care and insurance workers; a dramatic reduction in uncompensated hospital care; taxes generated by the infusion of money that support tax cuts for the wealthy. Oh, and, yes, some insurance coverage for poor working people. Hutchinson is rebranding, claiming his new AsaCare, with some work incentives and required payments by poor people, isn’t the same thing as Obamacare, though it would not exist without Obamacare funding.

Still, the divide grows, with national elections that could kill the program from the top down, particularly if a Republican wins the White House.


In state after state, a gulf is opening between Republican governors willing to expand Medicaid coverage through the Affordable Care Act and Republican members of Congress convinced the law is collapsing and determined to help it fail. In recent months, insurers have increased premiums and deductibles for many policies sold online, and a dozen nonprofit insurance co-ops are shutting down, forcing consumers to seek other coverage.

But in Arizona, Arkansas, Indiana, Iowa, Michigan, New Jersey, Nevada and Ohio, Republican governors have expanded Medicaid under the health care law or defended past expansions. In South Dakota, Tennessee and Utah, Republican governors are pressing for wider Medicaid coverage. And Republican governors in a few other states, including Alabama, have indicated that they are looking anew at their options after rejecting the idea in the past.