Gov. Sanders is right: We don’t need another Medicaid expansion
6 min read

Gov. Sanders is right: We don’t need another Medicaid expansion

Safety Net
Feb 23
6 min read

This week, Governor Sarah Sanders joined Congressman French Hill and Senator John Boozman on a panel at the University of Arkansas for Medical Sciences (UAMS) to discuss maternal health in Arkansas. Arkansas consistently ranks near the very bottom in terms of maternal health outcomes, a trend which has worsened in recent years.

But the headline came in a post-event press gaggle, where Governor Sanders said the state does not need to further expand Medicaid to cover Arkansas moms post-pregnancy. 

The reason for this is simple – this coverage already exists:

"We want to see that [post-pregnancy] coverage continued, whether that's through the private marketplace or other Medicaid options…Those are already available. We just need to do a better job of moving those moms onto those other coverage opportunities."

And she’s right, as we’ve detailed in our award-winning newsletter (non)Debatable:

  • A plethora of healthcare options exist for vulnerable Arkansas women;
  • Arkansas spends record amounts on Medicaid while maternal health outcomes have gotten worse;
  • Spending more Medicaid money won’t improve health outcomes and would only shift more costs onto state taxpayers.

(If you are not a subscriber of (non)Debatable, you can sign up for free here.)

But of course being right did not stop the state media from going ballistic, slinging around liberal talking points and citing far-Left think tanks to demonstrate that Governor Sanders is wrong. So, as always, Opportunity Arkansas is here to set the record straight.


Today in Arkansas, low-income moms have lots of options to obtain health coverage. Specifically:

  • Women below 214 of the poverty level (a family of four earning more than $66,000) are already covered through Medicaid, for up to two months after delivery of a baby;
  • Women who earn up to 138 percent of poverty (more than $43,000 for a family of four) can also qualify for endless Medicaid coverage through the state’s ObamaCare expansion program;
  • Women above that 138 percent threshold can qualify for virtually free-to-them coverage through the ObamaCare exchange;
  • Arkansas women can also receive free care (different than coverage) at one of Arkansas’s many federally-qualified health centers.

And of course, these options do not include additional options like employer-sponsored insurance, short-term health plans, health-sharing ministries, and more.

Here's a graphic from the Department of Human Services that gives a good visual representation of many of these options:


As part of the discussion at UAMS, health experts identified a laundry list of problems that they believe are driving the maternal health crisis. There seemed to be consensus about most of them and they all seem fairly accurate to me. But yet not a single one of them had anything to do with a lack of coverage, nor would any of them be solved by expanding Medicaid.

The primary themes that experts cited as driving the maternal health crisis:

  • Lack of providers, especially in rural areas (60% of Arkansas hospitals no longer provide labor and delivery services);
  • Chronic substance abuse in much of the state
  • Maternal mental health problems;
  • Shortage of OBGYNs, prenatal specialists, and midwives;
  • Lack of education about existing options and the importance of prenatal care;
  • Lack of coordination and communication;
  • Low levels of breastfeeding;
  • Lack of transportation;
  • Plenty of resources but “lack of knowledge” that they exist;
  • High levels of teen pregnancy, including frequency and recurrence of teen pregnancies;
  • Low reimbursement rates through Medicaid;
  • Low quality of care and communication from hospitals;
  • Lack of prenatal visits prior to delivery.

The panel mentioned these problems numerous times, and they are a serious list of concerns. But expanding Medicaid services would not solve a single one of the problems.  And in fact, there are some that expanding Medicaid would make even worse.


Indeed, Medicaid access is now nearly universal in Arkansas, so long as Arkansans keep their incomes low. Medicaid spending is at record levels and consumes nearly a third of all state spending. And yet, what’s happening with maternal health outcomes? They’re getting worse.

In 1999, Arkansas had 12.2 deaths per 100,000 live births. But in the 2020s, we are now seeing a staggering 35 deaths per 100,000 births.

However, over the same period, Arkansas’s Medicaid enrollment increased from roughly 370,000 enrollees to about 835,000 enrollees in 2019, an increase of approximately 125 percent.

Welfare lobbyists and the healthcare industrial complex assure us that the solution is very simple: just spend more money on Medicaid. Yet, clearly, adding hundreds of thousands of Arkansans to Medicaid over the last several decades has done absolutely nothing to reduce maternal mortality rates.


According to the most recent report from the Arkansas Maternal Mortality Review Committee, there were 35 deaths per 100,000 live births in Arkansas between 2018 and 2020, equal to about 38 deaths total over that period.

However, according to the same report, 68.4 percent of all pregnancy-related deaths occurred during the pregnancy or within 42 days of the pregnancy. During this entire period, Medicaid coverage already exists.

In other words: the overwhelming majority of pregnancy-related deaths in Arkansas are occurring during the time frame in which Medicaid coverage is already available.

But tragically, Medicaid isn’t stopping these deaths from occurring.


Here’s something else you won’t read in the newspaper: Medicaid is not health care. Period. If anything, it is health coverage. But that will never be the same thing as actual medical care or treatment.

The problem Arkansas faces today is that not enough women, pre- and postpartum, are getting the care they need. And expanding Medicaid, once again, will not solve this problem, as many Arkansas doctors do not new accept Medicaid patients–and up to nearly 20 percent of OBGYNs on average do not accept Medicaid patients either.

According to the UAMS panel discussion, the real problem is a lack of providers, not a lack of coverage, as there are not enough providers in many rural parts of the state who provide maternity care. That’s an actual problem that we should probably figure out.


Governor Sanders is right to press pause and examine other ways we can address these maternal health issues–a move that takes a lot of courage, by the way, surrounded by every Lefty reporter and Big Healthcare lobbyist in the state, from inside the state’s largest hospital that has been openly pushing for this expansion of welfare.

Maternal health is a serious problem in Arkansas, and it’s time to have a serious conversation about the underlying causes. The quicker we can move on from the bad idea of expanding Medicaid, the sooner we can have that conversation.

A much better solution – or that is to say, an actual solution – is to focus on education of vulnerable, low-income women so they know what options already exist, encourage them to utilize these options, and work towards expanding health care providers across the state, rather than just throwing more money at a broken system.

Image of the story authorNicholas Horton
Founder & CEO

Nic Horton is a native Arkansan and Founder & CEO of Opportunity Arkansas. He has spent more than a decade in the conservative movement as an expert on election, disability, tax, welfare, and workforce reform.

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