It was the best of times; it was the worst of times. For two free health care clinics, that is. In Mena, Arkansas, the 9th Street Ministries free clinic closed its doors after 16 years, its services no longer needed by the low income residents in poverty-stricken Polk County who have now obtained health insurance thanks to the Affordable Care Act. But at the Arlington Free Clinic located just outside the nation's capital in one of the wealthiest counties in the United States, the lines are still long as those without coverage hope and pray they win the monthly lottery to see a doctor.
There's no mystery as to why. While Arkansas accepted Obamacare's expansion of Medicaid, the GOP-controlled Virginia legislature did not. And for those out of luck in booming Arlington, that difference makes all the difference.

Back in April, Mena's 9th Street Ministries announced the closure of its free clinic because "the mission is complete."

"Because people are qualifying for insurance coverage through the Affordable Care Act, also known as Obamacare, our free medical clinic will not be needed anymore," Stacey Bowser RN, 9th Street Ministries Clinic Director, stated. "We've gone from seeing around 300 people a month on a regular basis, but as people were enrolling in Obamacare, the numbers we were seeing have dropped. We were down to 80 people that came through the medical clinic in February, all the way down to three people at the medical clinic in March. Our services won't be needed anymore, and this will conclude our mission."

As the free clinic's founder, Dr. Rick Lochala put it "I am so thankful that we were able to serve the Lord by serving these people for the time we have. We will just look for other opportunities to serve."
Those new opportunities to serve were made possible by President Obama, Democrats in Washington and the leadership of outgoing Democratic Governor Mike Beebe. Arkansas is one of the few red states which chose to extend federally-funded Medicaid coverage to its residents earning up to 138 percent of the federal poverty level (FPL). Under its unique "private option" agreement with the Obama Department of Health and Human Services (HHS), the state is using those federal dollars to enable lower income Arkansas to purchase private insurance coverage. (Polls show that private option approach is very popular among Arkansans, unless they are first informed that it is part of Obamacare.) As Gallup polling and recent HealthCare Finance News reporting explained:

Arkansas has seen the sharpest reduction of any state in its uninsured rate -- from 22 percent at the end of 2013 to 12.4 percent in June of this year.

For Arkansas, a state whose health care system had been ranked 50th in the nation by the Commonwealth Fund, the impact has been immediate and dramatic. But in 24th ranked Virginia, Republicans conspired--literally--to block Medicaid expansion and with it, coverage for 400,000 people.
Despite its two Democratic Senators and having twice voted for Barack Obama for President, the increasingly blue state of Virginia has stopped Obamacare's Medicaid expansion dead in its tracks. While now-disgraced former Governor Bob McDonnell said yes to thousands in gifts and cash from his top supporter, he also said no to federally-funded health insurance for hundreds of thousands of his constituents. And when newly elected Democratic Governor Terry McAuliffe promised to reverse course, Virginia Republicans promised bribes to lure Southwest Virginia Democrat Phillip Puckett to quit the state Senate days earlier, throwing control of it to the GOP. As the Washington Post reported, the governor left Puckett a seething voice message:

"Hey, Phil? Terry McAuliffe. I want you to know we just lost the vote, 20 to 19, in the Senate. Medicaid is done. I hope you sleep easy tonight, buddy."

No doubt, Puckett the turncoat is sleeping more easily than the hundreds of thousands of Virginians he turned away from health insurance. Among them are many in Arlington, where 4 percent unemployment and a median household income of about $100,000 a year make it one of Forbes' 25 richest counties in America.
That's the word from the Washington Post, which recently profiled the Arlington Free Clinic ("For Arlington's Poor, Medical Care is the Prize in a Free Clinic's Lottery"). One of more than 50 such clinics in Virginia, AFC employees 32 full-time staff and 500 volunteer to provide "whole-person" care for more than 1,700 patients. Regardless of their resources, patients can receive treatment for any physical or mental health need. But only if they literally win a lottery:

One by one, the winning lottery numbers were called, 20 Arlingtonians who suddenly had a shot at medical care they could not afford anywhere else.
More than 90 patients-in-waiting had lined up outside the Arlington Free Clinic for the drawing -- whites, blacks, Hispanics and Asians, many with children in tow. All had little money and big medical worries. All waited to see if this was their day.
"Was that D-3? What was the letter?" someone asked.
"Z as in zebra," answered Jody Steiner Kelly, director of clinical administration. A person in the crowd exhaled audibly.

As unemployed construction manager Paschal Nash, 53, gushed about her luck in the draw, "Excited? You just don't know. This is good, so good."
Good to be sure, but not as good as having health insurance, as hundreds of thousands in Medicaid-expanding states including Arkansas and Kentucky now do. But the situation could also be even worse. For the poor and elderly dependent on rural hospitals and clinics in states like Georgia, North Carolina and Tennessee, the rejection of Medicaid has become a matter of life and death.
An analysis in Health Affairs estimated that by leaving millions uninsured, the Medicaid opt-out states could see between 7,000 and 17,000 of their residents needlessly die every year. But those reddest of red states are really being hit with a triple whammy. It's not just that "they'll pay $152 billion to extend the program in other states--while receiving nothing in return." The likes of Nathan Deal (R-GA), Bill Haslam (R-TN), Pat McCrory (R-NC) and other Republican governors will be forced to pick more of the tab for long struggling rural hospitals and clinics that disproportionately care for the poor. (While so-called DSH payments to hospitals are declining, these states refused to accept the federal Medicaid dollars designed to provide coverage for the indigent and uninsured.) That's why in Texas, where Governor Rick Perry's rejectionism left well over one people without coverage, hospitals are desperate for Medicaid expansion.
Meanwhile, a joint survey by the Arkansas Hospital Association and Arkansas Chapter of the Healthcare Financial Management Association, hospitals found significant reductions in uninsured patients across all service settings:

For the first half of 2014, overall inpatient hospital admissions have increased less than 1 percent, while the number of uninsured hospitalized patients with no source of payment fell by 46 percent.
The survey, representing 80 percent of hospitals in the state, also found that uninsured emergency department visits have declined 35 percent and uninsured outpatient clinic visits fell by 36 percent.
"The survey completes a picture showing that the (Arkansas Private Option) is successfully doing what it was intended to do," said the Arkansas Hospital Association.

Yes, the Arkansas Private Option for Obamacare's Medicaid expansion is indeed "successfully doing what it was intended to do." But that success may not continue, simply because the new Republican Governor Asa Hutchison and his larger GOP legislative majority may not let it.
If that happens, the 9th Street Ministries free clinic could find itself back in business. And tens of thousands of Arkansans will find it's the worst of times, too.