Two of the states with the greatest success under Obamacare are Arkansas and Kentucky. They are also two of the
three states—including West Virginia—that voted in Republican governors or legislative majorities on Tuesday. So here's the $30,000 question: which of them is likeliest to follow through on promises made during the campaign to repudiate Obamacare and nix the Medicaid?
The least likely, it seems, is Kentucky. That's where even Mitch McConnell had to acknowledge that the state's version of it, called Kynect, is popular. While his contortions on the issue were total bullshit, they reflected one reality and that's that Kentucky likes the program (as long as it's not called "Obamacare"). Even in Tuesday's exit polls, 50 percent of voters gave Kynect the thumbs up, while just 37 percent said it isn't working. Kentucky also retained a Democratic majority in the state House. For now, the expansion seems safe there, even though the state just re-elected the senator who ran on repealing it. No one can accuse the Kentucky electorate of being rational.
West Virginia, too, seems to be putting Medicaid repeal on the back burner. Probably soon-to-be Republican state House Speaker Tim Armstead doesn't include Medicaid in this list of priorities which include "education reform, legal reform, infrastructure and tax and budget issues." Of course, it could sneak in on that "budget issues" line, but since for now the federal government is picking up 100 percent of the tab, it would be a hard case to make. Particularly since more than 150,000 West Virginians are now insured because of it.
But Arkansas, oh Arkansas. That's going to be a problem. A lot is going to depend on Republican Gov.-elect Asa Hutchinson and whether he can wrangle the GOP legislature. The state's private option Medicaid expansion passed largely thanks to a split among Republicans—hardcore tea party types versus actual moderates. The hardcore tea party types gained in numbers Tuesday. The problem is how Democratic Gov. Mike Beebe managed to get the expansion passed in the first place—by making it partially privatized and by agreeing to a reauthorization for it in 2015. Compounding that reauthorization vote is the state's constitution, which requires a whopping 75 percent majority vote—in both chambers—for appropriations, which this falls under.
That all puts Hutchinson very much in the hot seat. Because he's the number one ass on the line in 2018 if more than 200,000 people in the state lose their insurance, and if the states' hospitals lose all the benefits of the expansion and don't have to provide uncompensated care. It makes his job about as difficult as Mitch McConnell's will be, but even more fraught in many ways, because it's pretty much all on him. And it's going to be a very, very uphill battle, one that's probably not going to end well for the people of Arkansas. That makes Arkansas sort of the bleeding edge for this Obamacare repeal experiment, and well worth watching closely next year.
Bright side? There's always another election in two years.