The private option, under which newly eligible Medicaid beneficiaries enroll in private plans through the exchange, was a compromise crafted between current Democratic Gov. Mike Beebe and Republican legislative leaders. Similar plans have been adopted in several other states with Republican leadership, most recently in Pennsylvania. Backers of the Arkansas scheme have received some welcome news in recent weeks. Most notably, the state saw its uninsured rate drop by the steepest margin in the country, from 22.5% to 12.4%, according to Gallup.
But expanding Medicaid by any means whatsoever remains deeply controversial among the GOP base. One of the architects of the private-option plan, three-term Arkansas GOP state Rep. John Burris, was defeated in a primary earlier this year that hinged largely on his support for expanding the healthcare program to households with incomes up to 138% of the federal poverty level.
Hutchinson has been noncommittal about whether he would scrap the Medicaid plan. “I view the private option as a pilot project; a pilot project that can be ended if needed,” he said in a statement. “As governor, I will assess the benefit of the private option and measure the long-term costs to the state taxpayers.”
Arkansas Sen. Mark Pryor, who is locked in a tough re-election fight, recently raised eyebrows by releasing an ad explicitly touting the benefits of the federal healthcare law. Most Democrats have largely avoided the topic. Barth suggested that Ross will be closely watching how that tactic fares in assessing how much to focus on healthcare in the coming weeks.
“If Pryor starts to show some benefit out of it politically you can expect Ross to go the same direction,” Barth said.
Arkansas is not the only Republican-leaning state where Medicaid expansion could prove a factor in the gubernatorial contest. In Georgia, Democrat Jason Carter (the grandson of former President Jimmy Carter) backs expanding the healthcare program and is locked in a dead heat with Republican incumbent Nathan Deal.
But Charles Bullock III, a veteran observer of state politics at the University of Georgia, says the issue has been largely dormant in the contest. Instead, Carter has been attacking Deal on education spending and questionable ethics.
Even if Carter wins, he would be hemmed in by a state law that explicitly prohibits the executive branch from moving forward with Medicaid expansion without legislative approval. “It's going to remain a Republican legislature whatever happens at the top of the ticket,” Bullock said.
Nicholas Easton, a political science professor at Columbus (Ga.) State University, agrees that Medicaid expansion hasn't been an issue in the race so far. But he thinks Carter may try to exploit it to raise turnout among African American and Latino voters. “That's where I think it could come up eventually,” Easton said. “It may well be a get-out-the-vote issue in the hood.”
In Arizona, current Republican Gov. Jan Brewer bucked many in her own party by moving forward with Medicaid expansion, touting the positive financial effect on hospitals. But her potential successor, state Treasurer Doug Ducey, won a six-way GOP primary last month by tacking hard to the right. The Democratic nominee Fred DuVal supports the Medicaid expansion and polls show the race in a dead heat.
Ducey's been noncommittal about whether he wants to scrap the Medicaid expansion. In a statement on his website, Ducey questions whether the federal government will follow through on its promise to fund at least 90% of the program in future years.
“As governor I will prepare for all scenarios, and I will not allow a massive new entitlement to grow into a huge financial burden for future generations of Arizonans,” Ducey said. “We will keep a lid on healthcare costs, period.”