As you know, Texas has elected not to expand its Medicaid program. We have reported on that position many times in this column. It is not my place to express a personal view on this position, but to simply state the facts. We do know that such expansion has been encouraged as a component of the Affordable Care Act (ACA), and we also know that sincere people have different views on the topic. Both sides have their points. A large independent survey called the Gallup-Healthways Well-Being Index found a statistically significant drop in the uninsured rate for most states since ACA launched in 2010. Not surprisingly, states that expanded Medicaid saw bigger declines than the states that did not. But, of course, this improvement comes with a cost either now or later for the states.

A state known for its work in Medicaid modification is Arkansas. Being among the states that have achieved the greatest gains in reducing the number of uninsured individuals, Arkansas’ current expansion plan uses federal dollars to purchase private insurance for low-income individuals. For example, Arkansas allows those below 138 percent of the poverty level to enroll in plans like Blue Cross and Blue Shield through the state’s insurance exchange. The majority of Arkansas lawmakers thought this approach better than enrolling more people in its state traditional Medicaid program. This alternative allowed Arkansas to bring billions of federal dollars into the state economy, while expanding coverage to some of the state’s sickest individuals and saving hospitals millions in uncompensated care costs.

Before Arkansas could try this approach, it had to obtain a waiver from the federal government to use Medicaid money to pay for this experiment. The federal government is paying 100 percent of the costs for the program for the first three years and the state will eventually pick up 10 percent of the tab thereafter.

A recent article in the New York Times caught my eye that said that Arkansas’ Governor Asa Hutchinson believes some changes to the program are needed and would like to have permission from CMS to try some things like requiring enrollees whose income is above the federal poverty level to pay premiums equaling 2 percent of their household income and shifting people below a certain income level to traditional Medicaid. The governor also thinks that individuals who qualify for employer-sponsored plans should sign up for that coverage as opposed to Medicaid.

The reason I am writing about all of this is, hopefully, not to bore you with the Medicaid dealings of another state, but simply to say the type of experimentation being done and contemplated in Arkansas is exactly what I think should be happening. Throughout America’s history, the pendulum of states’ rights and federal power has swung back and forth. When states are allowed to try different approaches to whatever the issue, we end up learning lessons. The states make great laboratories in which to try solutions that, if successful, could be implemented across the country. I would like to see CMS give states the leeway to experiment with constructive solutions to their Medicaid programs. I think trying multiple approaches or experiments could produce a best practice that would be scalable across the nation.