States that spurn the expansion and "fund uncompensated care costs themselves could face budgetary strain," Moody's noted recently. Alternatively, those states could "leave hospitals to absorb the costs which will increase rating pressure on the hospitals."

That's why ObamaCare's fiercest opponents are searching for a life line — really a waiver — that would let hospitals stay afloat and politicians keep their principles.

There's some hope that Arkansas has hit upon a solution: agreeing to the coverage expansion — but only if the new beneficiaries get private insurance, not traditional Medicaid.