Medicaid is likely the biggest issue facing the Legislature when it convenes in January.

The projected Medicaid deficit in the state, along with potential expansion through Obamacare, will create a powder keg. The challenge, however, may present a unique opportunity for reform.

Arkansas House Speaker-designate Davy Carter agrees that Medicaid, along with tax reform, will lead the legislative agenda: "We have two issues as I stand here today; everything else is inherently secondary," he said shortly after his election as speaker. "We have Medicaid issues and we have tax reform. And those are going to at some point collide. That will likely be the heart of the session so we have got to get those two issues resolved."

The projected Medicaid deficit for the next fiscal year is listed at $298 million. In what might seem counterintuitive, Gov. Beebe has proposed fixing the deficit – at least in part - by expanding the program. In short, expanding the Medicaid program to 133 percent over the poverty line would be funded by the provisions of the new federal health care legislation, or Obamacare. According to the governor’s number crunchers at the Arkansas Department of Human Services, the increased federal funds would save the state millions of dollars and prevent cuts to programs such as level 3 nursing home facilities.

In other words, take the new federal Medicaid funds or kick granny out of the nursing home. That seems an easy choice.

However, the expansion of the Medicaid program is one of the few areas that the Supreme Court has ruled states are not required to enact. Republicans generally have been adamant in their opposition to Obamacare since its narrow passage three years ago along almost exclusive party lines. With congressional Democrats in the majority in both chambers in 2009, the minority party was unable to stop passage. But when 2010 elections rolled around, Republicans regained a House majority and gained ground in the Senate, largely on opposition to the president’s health care reform package.

The battle then moved to the courts — not really the preferred venue for most conservatives. Although opponents held out faint hope the court would find the new law unconstitutional, it narrowly upheld most provisions.

Opponents turned back to the electoral front, putting their hope in the presidential candidacy of Mitt Romney. Obama’s re-election foiled Republican hopes of overturning the health care law.

Pressure by conservatives now rests on legislatures in states such as Arkansas, where the law is not popular, in efforts to fight the battle. Some opponents are hopeful that defying the law and refusing to enact provisions could dismantle it.

That puts the Arkansas Legislature at a crossroads. For the past couple of years, Republicans and some conservative Democrats have been able to point to the court battles as well as the 2012 election as a reason to take a wait-and-see position. They argued that it would be wasteful to spend millions preparing for a law that might never be enacted.

That argument is gone. Opponents have lost every effort to stop the measure. The Arkansas Legislature now has to choose whether to go down the outright defiance path or try to work within the law, which no doubt will radically change the state’s and nation’s health care system.

If lawmakers choose the latter, there are still opportunities to create some lemonade from the lemons.

If defiance by Arkansas could stop the unpopular federal law, then opponents should, by all means, move full speed ahead legislatively. But if defiance is merely a last-ditch Hail Mary, it may be time use to view it as an opportunity to make Medicaid work better for taxpayers.

Opportunities don’t come around that often. Lawmakers may be looking at their best one for decades.


Jason Tolbert is an accountant and conservative political blogger. His blog — The Tolbert Report — is linked at His e-mail is