Gov. Asa Hutchinson
CHANGE NEEDED: Gov. Asa Hutchinson weighs in on Senate health bill.
outlined four major changes he'd like to see in Republican-backed health legislation pending in the Senate.
In short, he said — if in more diplomatic words — the bill as written would be devastating to Arkansas. Hutchinson chose to put it more kindly. He said the Senate was moving in "the right direction" and said
"the status quo is not acceptable."
But he added: "There have to be significant changes in the current draft in order to give states like Arkansas options for the future and to continue coverage and not have a $500 million per year gap in our economy."
He said he'd spoken to Arkansas's senators about this,
but referred questions about their reaction to them. To date, Sens. Tom Cotton and John Boozman have resisted saying much of anything about the legislation, though Cotton was one of 13 white male Republicans who participated in the secret drafting.
The shortcomings have been self-evident for some time in states like Arkansas that took advantage of the Medicaid expansion provided through the Affordable Care Act, or Obamacare. House-passed
and Senate-proposed legislation would obliterate the Medicaid expansion and also severely restrict traditional Medicaid coverage for the elderly and disabled by going to per capita distributions to states. Both changes would devastate Arkansas, with a large traditional Medicaid population and more than 300,000 people now covered by the Medicaid expansion. Hutchinson said the state was already making changes to reduce costs and state cooperation should be a goal of congressional action. Some 60,000 would lose coverage by reducing coverage for those making 138 percent of the poverty level to 100 percent and by instituting work rules.
Hutchinson suggested these changes in what's under consideration:
* Exempt those elderly, blind and disabled covered by traditional Medicaid from the per capita cap on spending. Otherwise, the cost would be shifted to the state, he said. (He said later it was OK to put children's coverage, Arkids, under a per capital program because they were generally lower cost.)
* If the federal government moves to block grant funding for Medicaid, Hutchinson said the funding should include in the figuring the Medicaid expansion population. Some states didn't take the money. If the pot is redivided to cover all states equally, those who expanded will lose and those who didn't will gain. "This puts us in a difficult position to manage and maintain coverage," Hutchinson said. If the population is considered, he said, "the state can assume the risk and create savings and ensure coverage of the working poor."
* Senate legislation must "redesign" the tax credits, or subsidies, for those covered in the health insurance marketplace. Hutchinson echoed critics of the Senate legislation who say the subsidies are so small as to be worthless. "If the subsidy is not sufficient, an individual will decide they can't afford it." He said
"there have to be sufficient subsidies to make it work."
* The states must be given "flexibility" on how they spend money received under per capita reimbursements. He didn't specify some examples of what he had in mind. In some states, though, flexibility has meant not providing certain services (birth coverage for example) and measures co-pays, work, drug testing and other sometimes controversial ideas.
Hutchinson acknowledged that the Medicaid expansion, now known as Arkansas Works, by law must end if federal support is reduced. That's not an immediate concern because actual reductions won't occur for several years into the plan now outlined in Senate legislation. "They've given us a long glide path," he said.
Timing noted: Hutchinson finally weighed in with criticisms that have been voiced for weeks by many others following a week in which the Senate leadership's plan for a quick vote on the GOP fill
apart because of he couldn't keep all Republican senators on board.
Noted too: Hutchinson refused to talk taxes — either those to pay for his expanded vision of health coverage and the windfall for the wealthy envisioned in the pending bill.
Just yesterday, Arkansas Advocates for Children and Families gave some idea of the blow the Senate bill would deliver to rural health care.