By the time the 2013 Arkansas legislative session rolls around in January, members of the newly elected Republican majority may be asking themselves if they really want the job after all. The primary reason for this can be summed up in a single, very expensive and confoundingly complicated word: Medicaid.

The enormity of the problem was laid out clearly last week, when the Arkansas Department of Human Services provided lawmakers with the most complete picture to date of what Medicaid in the state might look like in the next two years. The picture wasn’t pretty.

Failing an infusion of lots of cash, the state is looking at cutting $460 million worth of medical services currently being provided or subsidized through Medicaid, effectively dropping 75,000 people — most of them elderly or disabled — from the program.

The looming shortfall isn’t a surprise — lawmakers have been talking about it for more than a year and it was a frequent topic of conversation for those running for re-election in 2012. What was new in the department’s presentation were the specifics of what might be cut:

The amounts paid for patients needing “level 3” nursing care. Essentially, those are people who cannot move from bed or feed themselves.

Participation in the community care program that allows elderly people to remain in their homes.

The AR Health Networks program, which is designed to help people who work for themselves or in small businesses afford private health insurance.

There’s more, but you get the idea. The cuts would be deep, drastic and painful.

Ironically, John Selig, Department of Human Services director, said one way to reduce the number of cuts in programs is to accept the federal government’s offer to expand availability of Medicaid to another 250,000 people in the state.

As part of the Patient Protection and Aff ordable Care Act (most people know it as Obamacare) the federal government will pay nearly 70 cents of every dollar paid out for Medicaid benefi ts in exchange for expanding the program. The new money would drop that $460 million shortfall to more like $138 million. That’s still a big number, but it would mean fewer cuts in existing programs.

Much of that new Republican majority got elected by promising not to expand Medicaid. Those promises were, of course, made when they hoped Mitt Romney would win the presidential election and provisions of Obamacare could be unraveled. Since that didn’t happen, they are faced with some dift cult choices.

Sticking to their guns could mean some absolutely draconian cuts to current services. Accepting the Medicaid expansion will look like a reversal of the pledges made during the election. And, unlike in past sessions of the General Assembly, the Republicans are in the majority and will have the responsibility of setting the legislative agenda.

Don’t misunderstand: We’re pretty sure the Democrats would trade places with the Republicans in a heart beat, and the Republicans have no intention of giving up those hard won majorities without a fight. It’s just that the issue likely to dominate their first session in power is one of the most diftcult and complicated in recent memory. No viable solution will be reached without compromise and statesmanship.