Past Due Notice Arkansas is not the only state where Medicaid recipients who gained coverage under the Affordable Care Act disregard the new premiums. (Photo: Shutterstock)

When Arkansas lawmakers debated in 2016 whether to renew the state’s Medicaid expansion, many Republican lawmakers were swayed only if some of the 300,000 adults who gained coverage would have to start paying premiums.

This “skin-in-the-game” provision — endorsed by conservatives in Washington and in many statehouses — is designed to make Medicaid recipients value their government health insurance more and lead healthier lives.

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