Matthew Moore: We begin this Tuesday edition of Ozarks at Large with our friend Andrew DeMillo from the Arkansas Advocate. He's the editor in chief there. Andrew, hello. How are you doing today?
DeMillo: I'm doing well, recovering from a very newsy week last week.
Moore: Yes, we've got a lot to cover. Let's see how much we can get into here in the next few minutes. I want to start our conversation by talking about Medicaid expansion in Arkansas. There's been a lot of back and forth of where are we, where aren't we? But I think it's important, Andrew, to start by talking about what Medicaid expansion looks like specifically in Arkansas and how is its model unique from other places?
DeMillo: Yeah, this is a really interesting story and very uniquely Arkansas story. Medicaid expansion was a key part of the Affordable Care Act, or some people call it Obamacare, and U.S. Supreme Court in 2012, in their ruling upholding the ACA, part of their ruling was that the federal government could not force states to expand Medicaid and left the decision up to states. In Arkansas that posed a challenge because Arkansas, at the time, the 2012 election, Republicans won control of the legislature. And you had a Democratic governor. And you really had to kind of find some compromise effort on it.
"And what Arkansas came up with was, well, at the time was called private option. It's gone through a few different names now, but it's essentially a hybrid model for Medicaid expansion where the funding for Medicaid expansion, those funds were used to purchase private insurance plans for people who were eligible. This was a first in the nation, very unique model. And Arkansas was the first southern state to expand Medicaid, and it was really because they were able to come up with this model that was able to get some bipartisan support.
"And it's been a focus of fights in the legislature over the years. Sometimes they've struggled to reach the three-fourths vote that's needed to reauthorize it. And now we're kind of in a new chapter of uncertainty about it, with the federal government saying that they will not extend the waiver for this program and really kind of leaves in limbo what's going to happen, not just for this program, but for more than 200,000 people who are receiving coverage through it.
Moore: Yeah. As you said, we're looking at potentially hundreds of thousands of people in Arkansas who would lose health coverage because of this decision. Do we have any sort of understanding as to why the federal government rejected the extension?
DeMillo: Yeah. And it's important to note, as of Monday, we have not seen the formal notification from the federal government, but from what we have heard from the governor's office and from state Department of Human Services, what this boils down to is an issue called budget neutrality. And essentially budget neutrality means that the program, a special program like this, cannot cost the federal government more money than it would if they did not do this special approach to it.
"Under the One Big Beautiful Bill law, the tax and spend cut measure that President Trump signed last year, there was new guidance that was issued to states regarding budget neutrality that essentially made it more difficult for states that have received these types of waivers for programs like this, made it harder for them to achieve budget neutrality or to prove budget neutrality. And that was essentially what this came down to.
Moore: We're not just thinking about people with insurance who would be impacted by this. As you have reported and as you have talked about too, we're looking at a wide range of people who will be impacted if the expansion of Medicaid goes away. Notably, in my opinion, would be the health care industry here in Arkansas.
DeMillo: Yeah. And this has really alarmed a lot of medical providers, a lot of health experts who have noted that Arkansas' health care system right now is at a very precarious point to begin with. We've seen some hospitals have to cut back services because of rising costs and because of low reimbursement rates. We have a very limited number of hospitals that do labor and delivery now. And so there was already a lot of concern about the strains that the health care system was facing.
"So the idea that you could have 200,000 people without coverage raises alarms because if these people don't have coverage, they're still going to get sick. They're still going to get injured, they're still going to go to the hospital. And the concern is that this is going to raise the uncompensated care costs, the cost to hospitals for caring for people without coverage. And so that's a big concern right now. And you have a lot of health officials, health experts saying that going without any kind of coverage would be a disastrous option.
Moore: So the federal government rejected the extension that would have gone through 2030. So at this current point, if nothing comes to pass, then Jan. 1, 2027, there will not be Medicaid expansion available for people. Am I understanding that right?
DeMillo: It's kind of unclear what's going to happen with it. And what the state has done is they've requested a temporary extension, a two-year extension of the waiver, which essentially would be a bridge until next year's legislative session, and give a chance for state officials and for legislators to really craft an approach.
"The two main options that they're talking about right now would either be putting those people onto what's called fee-for-service Medicaid, just Medicaid, or contracting with managed care organization. Both of those pose logistical challenges. They also pose political challenges as well too, because whatever approach they come up with, they have to be able to get approval for it, be able to get it through. But also they'd have to make sure that something that would pass muster to be able to get reauthorized, get that three-fourths vote every year. And that's going to be one of the challenges. And this is probably one of the biggest political challenges for this program since it was created.
Moore: Another very consequential ruling that happened recently was around the 2023 law that restricts access to library materials that was recently sent to the Court of Appeals. They repealed the original ruling in a lower court, which now makes this 2023 law in place. What we're hearing from library directors across the state, large districts, small districts, is that this law is still pretty vague, and they're seeking clarity as to what they are and are not supposed to do here.
DeMillo: Yeah, that's right. This has created a lot of uncertainty and kind of repeated a lot of the concerns that we had heard before from library directors about this, and they really want some guidance on how to apply this, how to enforce this. Because this is a law that still some of the definitions aren't completely clear. Librarians could face criminal penalties for providing what's considered harmful materials to minors. How do you define harmful materials, and you get into various issues.
"One of the topics that was brought up in the story that we had today was, what about like little free libraries? How do you enforce that for something like that where you don't have a staff member standing next to it checking IDs? And you've had some libraries that are kind of preemptively enforcing it. Now there's one library system that has restricted access to forms of comic books and graphic novels. And even that raises concerns too, because you've got some graphic novels that are considered great forms of literature, and Maus is one of the examples I think of, that my children would not have access to because of this law.
"So I think there's a big concern about just kind of lack of clarity on it. And we still have that rule pending before the State Library board as well, too. That would also restrict access, and kind of how do these interact? So I think you're going to see library directors just asking for just more clarity on this and really trying to figure out a way forward on this that keeps materials open in some way, but does not put them in a position of worrying about prosecution.
Moore: Finally, a different federal case came up last week that dismissed an equal protection claim in a lawsuit challenging Arkansas' ban on, quote unquote, indoctrination in public schools. Can you get us up to speed on what happened, what this is around and what's next here after this ruling?
DeMillo: Yeah, this has to do with provision in the LEARNS Act that is aimed at restricting quote unquote indoctrination in public schools. Arkansas is among several Republican led states where you've seen efforts to place restrictions on how race is taught in schools, how issues dealing with sexuality, gender identity is taught in schools. And this was a provision that had raised objections, that had been the focus of a lawsuit in federal court.
"Lee Rudofsky, who's a federal judge who's appointed by Trump, he dismissed the equal protection claim. And basically it said that the desire to protect students from quote unquote left wing indoctrination does not equal discriminatory intent to adversely affect African American students. You talked about how there's no such thing as white ideas or black ideas. And so that takes away a key part of the challenge to this.
"Now, the interesting thing with this is he still left open another part of the lawsuit that deals with whether the statute is unconstitutionally vague, and he's asked for further briefing, further arguments on that. And this is kind of similar to what we've talked about with the library book restrictions where the concerns about, how do you determine what's indoctrination, what's not indoctrination? How is this enforced? What's the standard? And so it's very similar issues. And so that's kind of what we're going to be watching for with this is how does the state define this? And what does this really say about these types of laws? Because this could have ramifications well beyond Arkansas.
Moore: It may seem obvious, but as two people who deal with words all the time, it's very clear that words matter, that we need to understand what a word means when we say a word. And I think that's why we keep hearing this idea of vagueness being brought up time and time again, is that if you're going to enforce a rule, we need to understand what you mean and what the ramifications are.
DeMillo: Yeah. And the state has said that somebody's bringing up like just a discussion of critical race theory or discussion of certain topics doesn't necessarily equate indoctrination, doesn't violate this provision that has to do with compelling. The standard that they're using has to compel someone to believe something. Then again, the issue of how do you measure that? And also the chilling effect that it can end up having, where teachers may be afraid to even bring up a topic because they don't know where the clear line is on it. And so I think that's the big concern that you're seeing from teachers about this topic.
Moore: Well, lots of really important stuff going on here that we're able to cover thanks to our friends at the Arkansas Advocate and Andrew DeMillo. You can keep up with all of that reporting when you go to ArkansasAdvocate.com. Andrew, thank you as always, to you and your team for your hard work.
DeMillo: Thank you.
Ozarks at Large transcripts are created on a rush deadline and edited for length and clarity. Copy editors utilize AI tools to review work. KUAF does not publish content created by AI. Please reach out to kuafinfo@uark.edu to report an issue. The audio version is the authoritative record of KUAF programming.
