President Obama is so disliked in Arkansas that even most Democratic politicians try to disassociate themselves from him. It is hard to pinpoint the cause for such intense hostility. Obamacare is the reason most often cited by his critics but a desire to provide adequate health care to all Americans would seem an unlikely motive to inspire such deep-seated animosity. If Obamacare was the real basis for the hatred, wouldn’t other people who show concern for the poor, like preachers, also be despised?

Arkansas legislators devised a money laundering scheme to avoid being associated with President Obama. The idea was to take the dirty Obama Medicaid expansion money and pass it through the state legislature to private insurance companies and presto, it becomes Private Option money. Lately, Arkansas legislators have been debating whether to accept $915 million in Medicaid money to continue the program for the next fiscal year. The House adjourned Thursday without taking action.

About 100,000 poor Arkansans are already benefiting from this program. Another 150,000 are projected to eventually enroll in the Private Option. These are people who would otherwise fall into a coverage gap created by the Supreme Court when they allowed states to opt-out of the Medicaid expansion. These low income Arkansans make too much money to qualify under existing Medicaid rules but too little to be eligible for government subsidies under the new health care law. In states that opt-out of the Medicaid expansion for example: A single person with an income of $10,000 would receive absolutely no financial help in obtaining health insurance while a person with $12,000 in annual income could receive insurance coverage for free after the government subsidy was applied. This is the situation that will prevail in every state that refuses the Medicaid expansion.

During the first week of the fiscal session, the House and Senate approved an amendment to the Private Option supposedly to placate that program’s opponents. The Amendment was proposed by Rep. Nate Bell, R-Mena. This amendment prohibits the state health, human services and insurance departments from using any appropriated money to advertise or promote the Private Option or the Arkansas Health Insurance Marketplace. It would also prohibit the agencies from using any appropriated money to fund the activities of the in-person assisters who have been helping people enroll for coverage. What kind of person would come up with such an asinine compromise? It is saying in effect, if we consent to allow the Private Option to survive, it must be kept a secret. Incidentally, the only legislator who has switched from opposing the private option to supporting it because of this reprehensible amendment is Rep. Bell.

Harvard University recently published a study in health affairs detailing the health and financial impacts that will occur as a result of states opting out of the Medicaid expansion. Much of the study was based on data from the Oregon Health Insurance Experiment (OHIE). In 2008, Oregon expanded their Medicaid program through a lottery system. As a result, comparisons could be made between those who obtained Medicaid coverage and those who didn’t. The OHIE "found that after an average of 17 months of exposure to Medicaid coverage, improvements occurred in rates of depression and catastrophic medical expenditures. In addition, OHIE found that acquisition of coverage led to increased utilization of most types of health care, including several types of care that has been linked to improved outcomes such as diabetics receiving medication to treat their diabetes and clinically indicated mammograms and cervical pap smears."

The Harvard study predicted the annual national level consequences for the states that are currently opting out of the Medicaid expansion: "We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in those states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance as well as 3.1 million women who should receive regular pap smears."

These statistics show that Arkansas legislators who vote against the Medicaid expansion are literally playing Russian roulette with the lives of poor Arkansans.

Assuming that the Private Option passes this time, it is expected to be a recurring issue in future legislative sessions. When as few as nine senators or 26 House members can obstruct funding for the program, they will continue to hold the health care of hundreds of thousands of Arkansans hostage to their political whims. House speaker Davey Carter, R-Cabot, expressed his concerns: "Setting the Private Option aside, having an issue, whatever it is that’s important to the state, that allows the members, the last handful of votes in the appropriation process, to bargain with things," he said. "There’s going to have to be a lot of attention given to that. That’s concerning a little bit."

By Constitutional requirement, appropriation bills in Arkansas generally require "the votes of three-fourths of the members elected to each House of the General Assembly." This requirement gives excessive authority to a small minority of legislators. It could be changed by a Constitutional Amendment referred to the voters by the General Assembly or by an initiative petition. Amendment 7 of the state Constitution says: "The first power reserved by the people is the initiative. Eight percent of the legal voters may propose any law and 10 percent may propose a Constitutional Amendment by initiative petition …"