So, call it "Arkansas Works," or anything else that will keep Arkansas' private option health insurance program going.
The name really doesn't matter, except to shield politicians from constituents who don't see the good in providing health insurance coverage to thousands and thousands of their fellow citizens.
The "private option" itself, imagined by Republican lawmakers who needed to avoid embracing "Obamacare," provided a way for Arkansas to accept the additional Medicaid dollars that Obamacare extended.
But the program had a twist that had to be approved by the federal government, allowing Arkansas to expand its Medicaid rolls by buying private health-insurance policies on the health-care exchange. Obamacare itself would have just allowed the state to make more people eligible for traditional Medicaid.
The private-option approach was an improvement, one that some other states sought to mimic; but it barely survived in tough legislative sessions.
Now, the state Legislature is even more Republican than it was when the private option's appropriations so narrowly passed.
And Republican Gov. Asa Hutchinson has the responsibility of dealing with continuing opposition to it, despite obvious benefits to the state budget and, more importantly, to so many of the state's citizens.
So, it is his idea to rename whatever survives in 2016 as "Arkansas Works."
The new program will be tweaked yet again, including new restrictions, if he has his way.
The Health Reform Legislative Task Force has endorsed the general idea, although specifics aren't quite clear.
Plus, whatever Arkansas proposes to do will require federal approval to keep those additional Medicaid dollars flowing. The governor will meet with the secretary of U.S. Health and Human Services next month to find out what might be acceptable. Not everything being discussed may be allowed.
But the general idea from the governor and this task force is to require some who are eligible for the program to pay premiums, to impose asset limits and to require working people to enroll in employer-sponsored insurance if it is available. (The state would pay the employer-sponsored insurance premiums and co-pays for those who are otherwise eligible for the Medicaid money.)
The intent is to shave some of the cost off the program before the state must itself pick up a small percentage of the expense.
This is where you have to go back to the original federal Affordable Health Care Act, or "Obamacare," to understand the problem.
First, remember that the federal law extended Medicaid to more people, not to everyone. The newly eligible were those earning up to 138 percent of the poverty line, or $15,415 for individuals. Traditional Medicare has been for those earning even less.
The catch for the state governments that agreed to participate in the program is they must pay 5 percent of the cost beginning in 2017 and 10 percent by 2020.
Some states chose not to participate at all and still don't. Arkansas lawmakers came up with the private option to make the idea more palatable to their resistant colleagues (and constituents).
Again, the program has survived by the skin of its teeth as the Arkansas Legislature has grown ever more conservative.
Never mind that a consultant's study has suggested that the total fiscal impact of Medicaid expansion in Arkansas would still be a net positive of $348 million between 2017 and 2021.
And never mind, as Hutchinson himself has said, that Arkansas is a compassionate state.
The test of that hypothesis is coming, not just for Arkansas lawmakers but for Arkansas voters as well.
Lawmakers will get the test whenever the governor calls an expected special session to address the issue. Presumably, sitting lawmakers will get the call sometime during the 2016 election year.
But 2016 voters may influence how they respond nevertheless.
The state will hold its preferential primaries on March 1. It is an early vote so the state can have a stronger role in presidential primaries. Importantly, all of the Arkansas primaries will be held that day.
The vote will include 22 legislative contests, some of which feature Republican lawmakers who are being challenged by other Republicans who are even more conservative than the ones who've let the private option survive. Most of the primary races are among Republicans, a few with three in the race.
What happens in those contests, particularly the ones involving sitting legislators, will be heavy on the minds of all lawmakers when they get around to that special session on Medicaid reforms.
It will likely fall between the primaries and the general election, when even more legislative races will be decided.
If farther-right candidates take out those who've been supporters of the private option, others with contests to come in the general election may be too skittish to let Arkansas "work" for the 200,000 or so of the state's citizens who need this health insurance.
Commentary on 12/30/2015