French Hill Tom Cotton Rick Crawford Bruce Westerman Steve Womack Healthcare Arkansas

French Hill Called Arkansas's Low Medicare and Medicaid Rates 'the Most Fundamental Thing We Can Fight For.' He Voted for Trump's Budget Bill Without a Fix.

In an Oct. 15 debate, French Hill called Arkansas's low federal health care payments the 'most fundamental thing we can fight for.' Trump's budget bill passed the House 218-214 with all four Arkansas votes, and by his own account those payments still aren't higher — while the state's Medicaid expansion lost its renewal under the same law.

MAGA Report Cards · Oct 31, 2026

On October 15, French Hill stood on a debate stage against his Democratic opponent, Chris Jones, and was asked about health care. Here is part of what he said, as transcribed by former congressman Vic Snyder in the Arkansas Times:

"One of the worst decisions took place before any of us were thinking about being in Congress. And that is how CMS, the Medicare-Medicaid system in the U.S., reimburses in Arkansas. It is systematically unfair. And since I've been in Congress working with John Boozman, with Tom Cotton, we've tried to get that reimbursement rate higher. And it's not. That's the most fundamental thing we can fight for."

Read the last two sentences again. The rate is still too low. And it is, in Hill's own words, the most fundamental thing Arkansas's delegation can fight for.

So here is the question Snyder asked, and the one we're asking too: when Arkansas's Republicans had the most leverage they will ever have — when Trump's signature bill could not pass without them — why didn't they fight for it?

The bill that needed Arkansas

In July 2025, the House passed Trump's budget bill, the "One Big Beautiful Bill Act," by 218 to 214. All four of Arkansas's House Republicans voted yes:

Rick Crawford — yes
French Hill — yes
Steve Womack — yes
Bruce Westerman — yes

A four-vote margin means two Republicans switching sides would have sunk it. Arkansas alone had four. As Snyder put it, the bill "would have not passed without our delegation's support."

In the Senate, Tom Cotton voted yes too, on a vote so close the vice president had to break the tie.

And this is not a delegation of backbenchers. Snyder lists what they run: Boozman chairs the Senate Agriculture Committee, Cotton chairs Senate Intelligence, Hill chairs House Financial Services, Crawford chairs House Intelligence, Westerman chairs House Natural Resources, and Womack chairs the appropriations subcommittee that writes the transportation and housing budget. Five committee chairmen and a spending "cardinal."

That much power, at the one moment it mattered most. What did Arkansas get for it?

What a senator who actually fought got

Compare Alaska. Sen. Lisa Murkowski was the deciding vote in the Senate, and she used that leverage to force changes that steer more federal money to her state, CNN reported. Staffers rewrote parts of the bill to win her over. Alaska got carveouts from the new food-aid work rules and from the cost-shifting on food stamps.

She also got a bigger special tax deduction for whaling boat captains.

"Whale boat captains!" Snyder wrote. "Surely Arkansas hospitals and affordable health insurance for Arkansans are as important to fight for as whale boat captains."

There's one more detail in CNN's account worth sitting with. Right before the final vote, Senate leaders had already doubled the bill's fund for rural hospitals, from $25 billion to $50 billion, and were still trying to make it more appealing to Murkowski. Susan Collins lobbied to grow it too. In the debate, Hill pointed to that same $50 billion when Jones accused him of voting for health care cuts to pay for tax cuts for billionaires. Hill said Congress didn't cut rural hospital funding and added $50 billion for rural health care.

That is the point. The fund Hill is taking credit for grew while senators held out for more. Arkansas's four House votes were twice what it would have taken to sink the bill, and by Hill's own account, the payment rate he calls fundamental still isn't any higher.

What Arkansas got instead

Here is what the bill Arkansas's delegation passed did to Arkansas.

Since 2014, Arkansas has run its Medicaid expansion its own way — using Medicaid money to buy low-income adults private insurance. It now goes by the name ARHOME. Snyder calls it "a godsend for Arkansas families, workers, and providers including our financially stressed hospitals."

This summer, the Trump administration verbally denied the state's request to renew it. The reason federal officials gave is that the program doesn't meet new "budget neutrality" rules — rules the administration says it gets from the 2025 budget bill. About 200,000 Arkansans are covered by it. We laid out how that rule traces back to the delegation's votes in August.

And beyond ARHOME, Arkansas stands to lose an estimated $8.9 billion in federal Medicaid money over the next ten years under the same law, according to KFF.

So Arkansas went into the bill with health care payments its own congressman calls "systematically unfair," and came out with those payments unchanged, billions less in Medicaid money, and its Medicaid expansion on the chopping block.

Why didn't they raise hell?

Snyder, a former congressman himself, lists what a delegation with that much power could still do. Raise hell about the ARHOME denial. Attach clarifying language to a must-pass bill. Meet with the president and ask for an interpretation that keeps the program alive — and if that fails, slow down the president's priorities until it's fixed.

"They have that kind of power should they choose to use it," he wrote.

Instead, here is what Tom Cotton said at a press conference two weeks after the denial: Medicaid "is an important program for sick children, pregnant women, the elderly, and the poor." A nice sentence from the man who voted for the law that put the program on the clock.

Snyder offers a hunch about why — and he is clear it is a hunch, not an answer. A Republican consultant told him that Boozman likely won't run again in 2028. His guess is that some in the delegation are more afraid of a 2028 Republican primary — where "billionaire money and Donald Trump will still be active" — than of voters on November 3.

"What I perceive as powerlessness may be political fear for 2028," he wrote. "Too bad for affordable health insurance and robust rural hospitals now."

What the record shows

French Hill told voters on October 15 that raising Arkansas's Medicare and Medicaid payments is "the most fundamental thing we can fight for" — and admitted the rate still isn't higher. Trump's budget bill passed the House 218 to 214 with the votes of Hill, Rick Crawford, Steve Womack and Bruce Westerman, and the Senate with Tom Cotton's — and by Hill's own account, the rate still isn't higher. The same law is behind the federal refusal to renew ARHOME, which covers about 200,000 Arkansans, and an estimated $8.9 billion cut to the state's Medicaid money over ten years.