1. Courts and Medicaid Jeremy Johnson, Ph.D. Brian Matz, Ph.D.

2. Arkansas and Medicaid  A potential model for Montana  A private-based option: Negotiated with the Obama administration to expand by using federal dollars to purchase private health insurance plans on the open marketplace  So far considered successful in the media: over 200,000 enrolled  Problems: limitations under the waivers, the Arkansas budget, insurance rates  The biggest problem: politics

3. Medicaid and the Electoral Environment  Arkansas had a Democratic Governor and Republican Legislature before the 2014 election  Now unified GOP control  Arkansas requires ¾ of legislature to pass budget bills  Pro-Medicaid legislators lost; new governor has straddled on the future on the Medicaid private option

4. Lessons  Medicaid expansion is unlikely to be an issue to that will win large numbers of votes  With the passage of time Medicaid expansion is less likely to lose votes as Obama becomes less relevant. It may not be as necessary to disguise that Medicaid expansion is part of the ACA.  Political Science studies have shown that members of Congress (and probably state legislatures as well) pay no attention (as a aggregate) to the preferences of the lowest third of the income distribution  It might even be easier to enact a program through a ballot initiative  The complexities associated with a private option might suggest Montana CHIP a more viable option as a model

6. ACA and the Courts National Federation of Independent Business v. Sebelius (Jun 2012) Burwell v. Hobby Lobby Stores, Inc. (Jun 2014) Wheaton College v. Burwell (Oct 2014)

7. ACA and the Courts King v. Burwell (pending) Coons v. Lew (on appeal to SC) Looking ahead… More “full repeal” votes in Congress Votes to change/repeal individual provisions