Don’t miss Jay Barth’s column in this week’s Arkansas Times on the evolution of opinion on Medicaid expansion among Arkansas GOP voters. Barth digs in to a doozy of a finding in a recent Talk Business poll, one I also noted last week: A substantial plurality of Arkansas Republican primary voters now support Medicaid expansion.
The Talk Business poll found that 41.5 percent of likely Republican primary voters in the state support “Arkansas Works,” the Medicaid expansion program that uses Medicaid dollars made available by the Affordable Care Act to purchase private health insurance for low-income Arkansans (this is the same program once known as the “private option” until Governor Hutchinson re-branded it, concluding that the old name had become “politically toxic”). That’s compared to 25.5 percent who oppose it and 33 percent who don’t know.
That represents a dramatic reversal from the beginning of the Medicaid expansion debate, when GOP primary voters strongly opposed the policy. The Affordable Care Act passed in 2010 and Republicans put every ounce of their political energy into a crusade against “Obamacare.” When the Supreme Court kicked the decision on Medicaid expansion to the states in 2012, the leader of the new Republican majority in the Arkansas House, Bruce Westerman, stated flatly, “our view is that supporting Medicaid expansion is really embracing President Obama’s law.” In 2014, Republican candidates continued their mantra as they rode a wave election to total dominance of state politics. “There are only three things for certain in life,” GOP strategist Bill Vickery said at the time. “Death, taxes and the unpopularity of Obamacare in the South.”
The word “Obamacare” is still unpopular among Arkansas Republicans, of course (and poll findings consistently tilt quite a bit depending on whether that word, or Obama’s name, is used in the question). But when it comes to Medicaid expansion — a policy funded by the Affordable Care Act and an important component of the law — opinion has softened. Barth traces the evolution:
In 2012, as debate over Medicaid expansion began, 64 percent of GOP respondents opposed the notion of Medicaid expansion with only 21 percent supportive. During the debate on reauthorization of the program in Beebe’s last fiscal session in the spring of 2014, GOP voters still opposed the program by a healthy 54 percent to 23 percent margin. Two years later, with Governor Hutchinson having become a strong supporter of the program rebranded and somewhat restructured as Arkansas Works, Republicans were split with 34 percent in opposition, 32 percent favoring, and the final third unsure about their views.
And now here we are, with a strong plurality supporting Medicaid expansion. The Talk Business poll is especially striking because primary challenges were supposed to supply the pressure that would push the legislature to roll back the policy despite the obvious political risks of booting hundreds of thousands of people off of their health insurance. Leading this charge has been Joe Maynard, a Fayetteville businessman who has poured money into campaigns for candidates opposing Medicaid expansion via a dizzying array of PACs and other entities. Barth notes that a few Republican lawmakers or candidates have lost primaries in part because of their support for the Medicaid expansion (though others survived just fine). But it does seem like the tide has turned at this point. Lately, Maynard-backed candidates have been trounced again and again.
If Medicaid expansion has the support of GOP primary voters — or no longer fires them up enough to swing primaries — it’s here to stay. (This dynamic might be worth remembering as Sen. Tom Cotton continues to try to repeal the coverage expansion in Congress and Attorney General Leslie Rutledge tries to kill it via the courts.)
What accounts for the shift in opinion? Part of it may be influenced by the benefits of the policy, which was enacted by the state in 2014. Hundreds of thousands of Arkansans have gained coverage, the uninsured rate has been cut in half, hospitals have reduced uncompensated care costs by hundreds of millions of dollars, and billions of federal dollars have flowed into the state’s health care system.
Part of it, also, is the embrace of the policy (with some re-branding and conservative alterations) by Republican lawmakers. Arkansas became one of the first states in the South to move ahead with Medicaid expansion in large part because a group of key Republican lawmakers took ownership of the “private option.” And Hutchinson, after bobbing and weaving on the issue throughout his campaign for governor, has steadfastly fought to keep it in place since taking office.
Hutchinson, in addition to lending the policy a new name, has also managed to create bureaucratic hassles for Medicaid beneficiaries, including a new mess of red tape this year in the form of work requirements. He has made the program worse in the name of stale Republican talking points. Those alterations themselves probably help move the needle on GOP public opinion. But Hutchinson also given the core policy — coverage for hundreds of thousands of poor Arkansans, mostly funded by the federal government — the imprimatur of a popular GOP governor. It’s hard to overstate the power of that. I can still recall reporting at Republican victory parties in November 2014. The diehard opponents of Medicaid expansion were giddy. Meanwhile, many moderate Republicans who backed the private option, who ostensibly should have been happy that night, looked like they had just seen a ghost. The private option had barely gotten the legislative supermajorities it needed in 2013 and 2014. The enormous wave that November, including a large number of candidates who had campaigned specifically on ending Medicaid expansion, seemed to spell doom for the policy.
But then, a few months later, Hutchinson gave a speech announcing his intention to keep Medicaid expansion around. He appointed a task force to spend a great deal of hours and expense in order to conclude what was plainly obvious at the time: The policy was a good deal for the state and there was no alternative that would maintain coverage for the citizens who depended upon it for health insurance. The right-wing legislature went along. Hutchinson backed primary candidates who supported the policy and in 2017, he stuck with it through yet another dramatic uphill battle to secure approval (he even helped engineer an unprecedented procedural move to get it over the finish line). Thanks to Hutchinson, Medicaid expansion lives on in Arkansas. Long live Obamacare.