law, an essential correction to post-Civil War extravagances that had
plunged the state into debt,29 has kept Arkansas free from the fiscal
stringencies that have recently handicapped some other debt-burdened
states from taking measures to improve the health status of their uninsured
Second, the state constitution requires every appropriations bill to pass
both houses of the General Assembly by a three-quarters supermajority
vote.30 Just twenty-six of the one hundred House members, or just nine of
the thirty-five senators, can block any spending bill.31 Due to these two
constraining features of Arkansas law, when it comes to government
expenditures, Arkansas is a tight-fisted state.
For example, the state’s pre-Affordable Care Act Medicaid program for
non-disabled adults was the most restrictive in the nation.32 Its income limit
was set at 17% of the Federal Poverty Level for working parents and 13%
for jobless parents.33 In dollar terms, that meant that a non-disabled parent
in a family of three who earned $3, 500 annually was too rich to qualify for
Medicaid.34 Childless non-disabled adults, no matter how poor, received no
Medicaid coverage at all.35
By contrast, children’s health coverage was relatively extensive. Low-income families obtained coverage for children through Medicaid, while the
state’s ARKids- B program covered children in many moderate-income
families.36 Three-fifths of Arkansas children received their health insurance
Revenue Stabilization Law is a complex accounting tool designed to insure that the
recipients of State funds receive monies only so long as cash is on hand. The appropriation
for each agency sets a top limit on the amount that may be paid to that agency, and the
Revenue Stabilization Law insures that no more is spent than is taken in and is allocated by
29. See id. 235 Ark. at 229-31, 357 S. W.2d at 541-42 (upholding the constitutionality of
the Revenue Stabilization Act and explaining its history).
30. ARK. CONST. art. 5, § 39, as amended by ARK. CONST. amend. 19, § 5 (1934). See
Humphrey v. Garrett, 218 Ark. 418, 236 S. W.2d 569 (1951) and Fisher v. Perroni, 299 Ark.
227, 771 S. W.2d 766 (1989) (explaining ¾ supermajority requirement).
31. See ARK. CONST. art. 5, § 39.
32. See How Will the Medicaid Expansion for Adults Impact Eligibility and Coverage?,
KAISER FAMILY FOUND. 4 (2012), http://www.edfoxphd.com/8338-4_copy.pdf (comparing
all fifty states and the Medicaid income eligibility limits for adults as a percent of the Federal
Poverty Level in Table 1).
33. Id. (referencing Table 1).
34. See id. at 5 (indicating that in 2012, Arkansas’ Medicaid limit for a jobless parent
was $2,409 and for a working parent was $3,150). In 2012, the Federal Poverty Level for a
family of three was $19,090. Annual Update of the HHS Poverty Guidelines, 77 Fed. Reg.
4034-02, 4035 (Jan. 26, 2012). Seventeen percent of that was $3,245.
35. Allison, supra note 7, at 1090.
36. See ARK. DEP’T OF HUMAN SERVICES, ARKANSAS MEDICAID PROGRAM OVERVIEW 2
(2012), available at http://humanservices.arkansas.gov/dms/DMS%20Public/Medicaid_