coverage through these programs.37 Moreover, the programs paid for two-thirds of the state’s births.38 Partly as a result, by 2010 the state’s Medicaid
program was bleeding red ink.39 Necessity compelled invention.
Despite the antipathy of the voting public toward President Obama and
Obamacare, Arkansas Governor Mike Beebe aimed to accomplish an
expansion of health insurance for the state’s low-income adult population.
Beebe, a moderate Democrat and time-tested former state legislative
heavyweight with a reputation for political effectiveness and high public
approval ratings, had the advantage of a team of competent and experienced
health care advisers.40 Beebe’s team erected two initiatives that stood a
chance of overcoming both state constitutional constraints and ideological
opposition: the “private option” and the Arkansas Payment Improvement
III. ARKANSAS’S “PRIVATE OPTION”
Governor Beeebe and his health policy team faced a dilemma when the
General Assembly met in January 2013. Small-government Republicans
controlled both houses of the legislature.41 The very word “Obamacare” was
a vile epithet in the minds of many of the voters who had just elected
them.42 To expand health coverage to low-income adult Arkansans, Beebe’s
program had to be something different. It needed a label, a pitch, and a
concept that marked it as distinct from what the blue states were doing.43
The label: The “private option.” Private, not government. An option,
not a mandate. The style of the law (with “Don’t tread on me”
connotations): the Arkansas Health Care Independence Act.44
37. See id. at 9, 11 (indicating that in 2011 Arkansas Medicaid, including the ARKids
First program, insured 494,063 children, and that children age twenty and under composed
60% of Arkansas’s Medicaid population).
38. Id. at 9.
39. See Thompson et al., Arkansas’s Novel Approach, supra note 7, at 1279; Arkansas
Payment Improvement Initiative, supra note 21 (“By 2010, Arkansas’ Medicaid program
was facing a substantial budget shortfall resulting from an unsustainable growth rate that
exceeded the state’s general revenue growth.”).
40. Among the leaders of the team were Dr. Joe Thompson (Arkansas Surgeon General
and director of the Arkansas Center for Health Improvement), John Selig (director of the
state Department of Human Services), Dr. Andrew Allison (state Medicaid director from
2011 to 2014), and Eugene Gessow (Allison’s predecessor). Bill Simmons, State Soon to
Execute Medical Revisions, Ark. Democrat-Gazette, Mar. 18, 2012, at 1A, 6A.
41. See Margot Sanger-Katz, Election Results Endanger Innovative Arkansas Medicaid
Plan, N. Y. TIMES, Nov. 6, 2014, available at http://www.nytimes.com/2014/11/07/
42. See id.
43. See id. (discussing Arkansas Republican attitudes towards the PPACA).
44. Health Care Independence Act, 2013 Ark. Acts 1497 & 1498.