After four failed attempts, the Arkansas House of Representatives voted yesterday to renew the expansion of Medicaid. Photographer: Matt Meadows via Getty Images
After four failed attempts, the Arkansas House of Representatives voted yesterday to renew the expansion of Medicaid. Photographer: Matt Meadows via Getty Images

It's one case, in one state, but the renewal of Medicaid expansion in Arkansas is a big deal.

The state legislature voted last year to accept federal money for an expansion of Medicaid that relies on the purchase of private insurance. The program needs to be reauthorized every year, with large supermajorities required for passage in both houses. That means lots of Republicans had to support it.

And yet, it survived.

This is a big deal because it’s another indication that Medicaid expansion is almost certainly going to be a one-way street. Once states get in, they aren’t going to drop out. Eventually, all 50 states will adopt the expansion.

The gradual implementation of the Affordable Care Act is making it more difficult for Republicans to champion repeal (as Greg Sargent observed yesterday). That's because, over time, repeal would mean taking away people's insurance. I'm not making a prediction that Obamacare will become popular. Nor does it mean that the ACA is “working.” My point is only that very few politicians want to take away benefits from a large number of voters. And, in the case of Medicaid expansion, those benefits accrue to important organized interest groups, including hospitals.

Arkansas is significant because the supermajority renewal requirement made it a rare state in which Medicaid expansion wouldn’t have a legislative advantage after implementation, and the opportunity for repeal was as good as it would be anywhere. If repeal is a nonstarter there, the odds that Medicaid expansion really is a one-way street look better and better .

To contact the writer of this article: Jbernstein62@bloomberg.net.

To contact the editor responsible for this article: Max Berley at mberley@bloomberg.net.