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Beyond the Basics: How the Medicaid...

Beyond the Basics: How the Medicaid Expansion Experiment has been a Disaster for Arkansas and Louisiana

By: Jonathan Bain - September 3, 2023

Jonathan Bain

Medicaid expansion has failed in both Arkansas and Louisiana. Advocates may claim otherwise, but diving into the numbers, it’s clear that expanding Medicaid has set these states on an uncontrollable path.

Last week, a Mississippi-based news organization published a series of articles highlighting the “successes” seen by Arkansas and Louisiana following their passage of Medicaid expansion. Tall tales of budget savings, conservative approaches to expanding welfare, and saving hospitals were sprinkled throughout the paragraphs as the yearning for Medicaid expansion grows at a rapid rate among the poverty peddlers in our state. 

But the truth remains hidden behind those tall tales: Has Medicaid expansion really been a success in Arkansas and Louisiana? Let’s find out together. 


I recently wrote an article detailing Arkansas’s Medicaid expansion woes in full, but here’s the short version. Arkansas expanded Medicaid in 2014 with a “private option,” which gives able-bodied adults private insurance—while the truly needy in the state are stuck with basic Medicaid. Let that sink in—able-bodied adults with low incomes are given robust, private health insurance plans while low-income children, pregnant women, seniors, and those with disabilities are given run-of-the-mill Medicaid benefits. 

Moral questions aside, this expansion model has also been wildly more expensive than traditional fee-for-service Medicaid. According to the Arkansas Department of Human Services, the cost to cover expansion adults was nearly three times higher than traditional Medicaid enrollees. This has led to expansion costing taxpayers billions more than state officials predicted, as their estimates have missed the mark time and time again. Keep that in mind when you hear the “projected” costs to Mississippi taxpayers. 

As Medicaid costs mount in Arkansas, other budgetary priorities have fallen by the wayside. From 2013 to 2022, Medicaid’s share of the budget has grown by 31 percent—with more than one in every four dollars going to the program. Meanwhile, education spending (K-12 and higher education combined) has decreased by nearly 20 percent over the same time frame. 

Expansion advocates often tout expansion as a virtually free program that not only comes at no harm to the state budget— it could even improve it! However, in Arkansas, Medicaid’s very real share of the state budget continues to grow, while other priorities, such as education, are getting less funding so that able-bodied adults can have taxpayer-funded private health insurance. 


Another neighbor of ours is beating the drum of Medicaid expansion, claiming that it’s been a success for their state. But once again, the truth shows that just isn’t the case. 

For starters, when Louisiana expanded Medicaid in 2016, the state Department of Health and Hospitals claimed that around 300,000 Louisianans would be eligible for the program. Within days, state officials upped these estimates to 450,000—a massive increase that still paled in comparison to the true enrollment. Today, there are nearly 771,000 Louisianans enrolled in Medicaid expansion—more than two-and-a-half times larger than the initial estimates and inching closer to tripling every day. 

Let’s put that into perspective: If you were hosting a Super Bowl party and expecting 30 guests to show up, but 77 walked through your door, you’d be a little flabbergasted. You would be unprepared, confused, and left wondering how your estimates went so horribly wrong. Would you be able to simply force your neighbor to pay for all the unexpected food costs? Of course not. But for some reason, when this happens in every expansion state, we don’t bat an eye and pretend it’s totally normal. 

Over-enrollment has obviously been a problem for Louisiana, as nearly half the state is on Medicaid, but what about spending? Well, that’s also been a disaster. From 20152022, Medicaid’s share of the budget has grown by more than 25 percent. In fact, the Medicaid program accounts for nearly 35 percent of the total budget for Louisiana. Meanwhile, other priorities have suffered. Over the same time frame, K-12 spending declined by 14 percent. And spending on higher education declined by a whopping 33 percent.

Once again, proponents of expansion often claim that it’s a win-win for the state. However, as Louisiana’s expansion enrollment has reached uncontrollable growth, Medicaid spending has soared, resulting in a massive blow to education spending.  

Medicaid expansion has failed in both Arkansas and Louisiana. While this was just a brief look into the truth behind the tall tales, the failures of expansion could fill a library. Advocates may claim otherwise, but diving into the numbers, it’s clear that expanding Medicaid has set these states on an uncontrollable path. Skyrocketing enrollment has outpaced projections at every single turn. Spending continues to soar as state officials steal from the children of their state to subsidize the health care of able-bodied adults.

And yet, in Mississippi, we are constantly told to look at these two neighbors and their “success” stories. If this is what success looks like, I want no part of it in our state.

About the Author(s)
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Jonathan Bain

Jonathan Bain is a Senior Research Fellow at the Foundation for Government Accountability, where he conducts research on a variety of topics, including: welfare reform, restoring a free-market to health care, cutting red tape and reducing barriers to work, and restoring integrity in elections. Prior to joining FGA, Jonathan spent time as an independent contractor developing a policy research and analysis skill set while finishing his degree. He holds a Bachelor of Arts in Political Science from Mississippi State University.