The attack line from Arkansas Democrats is simple: If Rep. Tom Cotton had his way, at least 155,000 of the state's poorest residents would lose the health care coverage they just received under a bipartisan plan that other states have imitated.
Mr. Cotton, a Republican trying to unseat Democratic Sen. Mark L. Pryor, has an anti-Obamacare platform that would imperil the bundle of federal dollars that Arkansas is leveraging to buy private health insurance policies for low-income residents, they say.
Democrats in New Hampshire are lobbing similar barbs at Republican Scott Brown as he vies for a U.S. Senate seat. The former senator from Massachusetts is leery of a Concord compromise that also uses Medicaid dollars to buy commercial insurance for more than 50,000 residents.
For some state Republicans, the "private option" was a palatable way to insure residents making up to 138 percent of the federal poverty level — a key, yet optional, pillar of President Obama's health care law.
Now, supporters of Senate Democrats in tough re-election races want to paint Republican challengers into a corner by trumpeting bipartisan state efforts to insure low-income residents without bloating traditional Medicaid rolls.
"This is not an issue we've been shy about talking about," Pryor campaign spokesman Erik Dorey said.
Conservatives say Democrats should not confuse tough choices at the state level with success in congressional races. If Democratic incumbents want to dismiss Republican calls to repeal Obamacare, Republican challengers will counterpunch with tales of dropped health plans, higher premiums and narrower doctors networks in the run-up to November's mid-term elections, they said.
"The federal focus on Obamacare is about the narrow networks," Greg Moore, state director for Americans for Prosperity in New Hampshire, which has run ads against incumbent Sen. Jeanne Shaheen that paint her as the cause of limited health care choices in the Granite State.
Mrs. Shaheen has said she is committed to "doing everything I can to assist New Hampshire implement" the state's Medicaid expansion plan to cover 58,000 people under the state's private option plan, which the governor signed last month.
"A repeal of the federal health care law would also repeal the State's new Medicaid law, which would be extremely costly for New Hampshire and it would move about 50,000 New Hampshire residents to having no health coverage," James Demers, a Democratic strategist in the Granite State, said Monday. "That just doesn't make sense for those people and it surely doesn't makes sense for those who would have to pay."
Arkansas pioneered the private option as a way to embrace Obamacare's Medicaid expansion last year, while attracting enough GOP support to overcome the three-fourths voting threshold needed to pass appropriations in Little Rock. The legislature reauthorized the program in March, although it took a few tries because the issue is still contentious.
Their blueprint prompted other states to take a close look at the private option. Utah and Pennsylvania are mulling over their options, while Iowa and New Hampshire were able to put their plans into motion.
"I think that the [Republican-controlled state] Senate understood that this would be helpful in reducing uncompensated care that our hospitals and other providers deliver," said New Hampshire state Rep. Cindy Rosenwald, a Democrat.
Arkansas officials said about 155,567 people, or roughly 70 percent of 225,000 eligible residents, had signed up for coverage under its program as of March 31.
"These are families that are working, they're going to school, they're supporting their families," said Anna Strong, health policy director at Arkansas Advocates for Children & Families, a nonprofit that pushed for the private option.
Mr. Cotton, a Republican who assumed his House seat in 2013, voted along with the GOP majority last May to repeal President Obama's health care law. If Obamacare goes away, then so does the funding for the state's private-option health care, his rivals say.
But the Cotton campaign says Obamacare "is such bad policy that it has made every state choose between multiple bad options."
"Medicaid is broken and failing and we need to reform it instead of expand it," spokesman David Ray said. "The right way to lower health care costs for every American is to give the states the flexibility to reform the Medicaid program as it exists right now — that means fewer mandates and strings from Washington and not more."
New Hampshire's version of the Medicaid expansion is just getting started, with the initial wave of coverage slated to begin in July.
The federal government is slated to pay for 100 percent of the expanded Medicaid population from 2014 to 2016, a contribution that slides down to 90 percent in 2020 and beyond.
Mr. Brown, who made his home in Rye, N.H., his main residence ahead of the campaign, said the state needs to balance its safety net with scrutiny of the federal government's promises. Democrats fell short in assuring residents they could keep their health plans if they liked them under Obamacare, he said, so critics of Medicaid expansion are right to expect more of the same.
"Their concerns are what happens at the end of three years?" Mr. Brown said March 25 at Frisbie Memorial Hospital in Rochester, N.H. "Is it then going to be an unfunded federal mandate, that the citizens of New Hampshire will have a whole new program that they didn't really want? They want to be compassionate, but they really didn't want this plan — and how are they going to pay for it?"
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