First, a little background. (You can skip the next four paragraphs if the Medicaid expansion kerfuffle is old news to you.)

Medicaid is a state-based program that, before The Era of Obamacare, mostly only covered kids, moms, and pregnant women. In its original form, the Affordable Care Act hinged on a state-by-state expansion of Medicaid for people who can’t afford health insurance on the newly created exchanges (so, for people making about $15,800 a year or less). The idea was that the federal government would pay for the new Medicaid enrollees entirely until 2016, and gradually taper down the federal subsidy to 90 percent of the new costs in future years. In general, the expansion is seen as a pretty good deal for the states.

But the 2012 Supreme Court case made the expansion optional for states, throwing a wrench into the Obama administration’s plan to get all of the nation’s poor covered through Medicaid. Most estimates show that states who expand Medicaid could reduce their uninsured populations by around 50 percent or more.

So far, 24 states have opted not to expand Medicaid the way the ACA wants them to. To conservatives, their resistance is seen as a bulwark against an ever-increasing entitlement system. To liberals, it’s viewed largely as, well, a middle finger to the Obama administration: Most of the states have Republican governors or predominantly Republican legislatures, and even though the expansion would be largely paid for by the federal government, accepting it could seem like an acknowledgement of the healthcare law’s legitimacy.

Now, nearly eight million people are left without health coverage because they live in these non-expanding states, and it’s an especially heavy burden on large cities, which are home to a disproportionate share of uninsured, indigent people, as my colleague Emily Badger reported.

The New York Times recently reported on Willie Charles Carter, a Mississippi man who doesn’t qualify for the state’s Medicaid program because he has no dependent children. The free clinic where he goes for medical care is scheduled to close soon due to lack of funding, and this is his strategy for getting healthcare after that point:

“I’m scared all the time,” he said. “I just walk around here with faith in God to take care of me.”

To make matters even more depressing and racially thorny, almost every state in the Deep South rejected the expansion, as this map of states that aren’t doing the expansion, based on estimates from late last month, from the Advisory Board Company, shows.

Advisory Board Company

But eventually, Arkansas found a way.

There’s one thing the state’s Republicans are fans of, and that’s private enterprise. So earlier this year Beebe called Health and Human Services Secretary Kathleen Sebelius and asked for a special favor. In late September, it was granted: Arkansas got a waiver to use the federal Medicaid money to buy private insurance for the people who would otherwise have been eligible for the Medicaid expansion. The state’s legislature had approved this “private option” earlier this year.