Like their counterparts in other southern states, Arkansas Republicans denounced "Obamacare" during this year's election campaign and called for its repeal. But now that they've won control of the Legislature for the first time in 138 years, GOP lawmakers are considering something that would be anathema to conservatives elsewhere -- expanding government health care in the state.
Instead of rejecting outright the idea of expanding the Medicaid program for the poor —an optional part of the new health insurance system — Arkansas lawmakers are exploring ways of adding up to 250,000 low-income residents to the rolls, which already include a fourth of the state's population.
"It's a one-time opportunity to strive for complete coverage and catch up to the richer states," said State Surgeon General Joe Thompson, who is pushing for the expansion. "It is not fair that a working mom in Arkansas could be disadvantaged in the same way that if she were in Maine, she'd be advantaged."
The legislative effort may fall short. Republicans are seeking more flexibility to contain Medicaid's costs, which the federal government and states jointly pay, and the Obama administration has ruled out some possibilities. Also, the move would require the support of three-fourths of the state House and Senate.
"I'm not naive about the fact that some of them campaigned against it and wouldn't change their mind no matter what," said Democratic Gov. Mike Beebe, who is supporting the expansion. "It's just a question of how many."
But the fact that the idea is under active consideration reflects a state where Republican dominance and strict partisan ideology haven't been entrenched for years -- unlike the states around Arkansas -- and where many working families subsist on modest incomes. Supporters hope the effort could produce a hybrid approach that could work in politically and fiscally conservative places.
"I think from the liberal and progressive side, people want to see more people covered by Medicaid. From the conservative side, people are worried about the long-term financial risk to the state," said incoming Senate President Michael Lamoureux, a Republican, adding, "There's a rare opportunity to couple the two."
Approved in 2010, the new health care law aims to provide insurance to about 30 million people who don't have coverage. Many of the middle-class uninsured would receive government subsidies to purchase private insurance. Lower-income workers who don't earn enough for the private plans would be added to Medicaid, which covers health care for the poor. But the Supreme Court, in its ruling earlier this year on the law, gave states the right to opt out of expanding Medicaid since they bear some of the costs.
In Arkansas, where chicken processors, trucking companies and discount stores are major low-wage employers, that decision would affect about a quarter million people making less than roughly $15,000 a year and families below about $31,000. The state's median family income is about $41,000, which ranks 44nd in the nation, and 19 percent of the residents have no health insurance, compared to 15 percent nationwide.
Families who would miss out on the new coverage are calling on the Legislature to find a way to include them.
"I pay my taxes and my taxes go to the federal government and I'll be basically paying taxes for people in other states to have the expansion when I can't get it myself," said Claudia Reynolds-LeBlanc, of Hot Springs, a part-time retail worker in her 50s who earns $20,000 a year. Her 12-year-old son is covered under a children's health program, but Reynolds-LeBlanc hasn't had insurance since 2000.
Most Republican-controlled states, including neighboring Louisiana, Mississippi, Oklahoma and Texas, have rejected the Medicaid expansion even though the federal government would pay the full tab for the first three years and 90% long term. Rising health costs rose have aggravated budget problems for many states. Arkansas is planning to cut $138 million in services from its program next year because of growing costs.
But the Republicans in Arkansas, where Democrats had long controlled the Legislature, say the expansion might work if they can require co-pays from some beneficiaries, mandate drug tests, impose stiffer penalties for fraud and use other measures to limit expenses.
"It goes back to being able to have a system that's solvent and sustainable," said Republican Sen. Jonathan Dismang.
Democrats say they're willing to listen to the proposals, but that the benefits of the expansion should be obvious.
"If we miss this opportunity," said Democratic Sen.-elect Keith Ingram, "...then shame on us."
Republicans were encouraged by Beebe's request for federal permission to cap state Medicaid spending over the next eight years and for more flexibility on how the money is spent. DHS officials haven't responded, but a similar waiver allowed Rhode Island more flexibility in how it cares for its seniors.
"We are open to really talking about anything that seems to make sense and helps us get to yes...," DHS Director John Selig said recently.
One option was foreclosed this week when the Obama administration said states couldn't opt to cover a smaller slice of the working poor and still receive all the federal money.
Thompson, the surgeon general, said he thinks the new sharing of power between Republicans and Democrats in the state could help.
"There are states that aren't having any conversations right now because they can't get past the R and D difference and sit down at the table to discuss where they want to go and what they want to do," Thompson said.
Andrew DeMillo can be reached at www.twitter.com/ademillo