Gover­nors on watch

State braces for im­pact from health care law changes

Northwest Arkansas Democrat-Gazette - - EDITORIAL PAGE - Brenda Blagg Brenda Blagg is a free­lance colum­nist and long­time jour­nal­ist in North­west Arkansas. Email her at bren­da­jblagg@gmail.com.

Arkansas Gov. Asa Hutchin­son has popped up in a cou­ple of na­tional re­ports lately,

ex­press­ing con­cerns about health care leg­is­la­tion and its po­ten­tial im­pact on this state.

Some of the at­ten­tion stems from com­ments he made to re­porters in the state Capi­tol last week, when he sug­gested changes in on­go­ing ef­forts to re­peal and re­place the fed­eral Af­ford­able Care Act, or Oba­macare.

Hutchin­son is one of many gover­nors, Repub­li­can and Demo­crat, who are weigh­ing in on the health care de­bate. They are closer to the peo­ple whose lives may be im­pacted by changes in the fed­eral law and are try­ing to in­flu­ence how new law is writ­ten.

Repub­li­can gover­nors, like Hutchin­son, may have the best chance to do so, as­sum­ing they are com­mu­ni­cat­ing with the Repub­li­cans who con­trol the Congress.

The de­bate is presently front and cen­ter in the U.S. Se­nate, which is on a brief hol­i­day re­cess but will soon re­turn to this task.

Se­na­tors are home now, pre­sum­ably hear­ing from con­stituents.

To be sure, a state’s gov­er­nor is a pow­er­ful con­stituent and this state’s gov­er­nor re­port­edly is talk­ing to U.S. Sens. John Booz­man and Tom Cot­ton, al­though nei­ther Arkansas sen­a­tor has been par­tic­u­larly forth­com­ing on the health care law lately.

For his part, Hutchin­son said last week the big prob­lem with what the Se­nate has been dis­cussing is that it shifts costs to the states.

“And that leaves states with few choices,” Hutchin­son said.

He was talk­ing about the threat­ened phase down in fed­eral match­ing funds for Med­i­caid ex­pan­sion, which might go as low as 70 per­cent in 2024, if the Se­nate bill isn’t sig­nif­i­cantly al­tered.

That would leave Arkansas to come up with 30 per­cent of the cost of ex­pan­sion, much more than had been an­tic­i­pated un­der Oba­macare, which was sup­posed to max out at 10 per­cent in 2020.

That’s par­tic­u­larly trou­ble­some in Arkansas be­cause the state Leg­is­la­ture put a pro­vi­sion into its Med­i­caid ex­pan­sion law that re­quires the pro­gram to end if there is a change in the fed­eral match­ing rate.

Wary law­mak­ers wanted that pro­tec­tion against cost in­creases that are out of their con­trol.

So here we are, un­cer­tain about where any of this is go­ing but sure to see suf­fer­ing if it isn’t re­solved to pre­serve Med­i­caid, both the tra­di­tional pro­gram and the ex­pan­sion in poor states like this one.

All in all, about 950,000 peo­ple are en­rolled in Arkansas’ Med­i­caid pro­gram, ac­cord­ing to state of­fi­cials.

“When the re­im­burse­ment rate is re­duced, then the state has got dif­fi­cult choices to make,” Hutchin­son said last week. “It ei­ther has to re­duce the ex­panded Med­i­caid cov­er­age or we have to cut costs in the tra­di­tional Med­i­caid pro­gram, and that in­cludes chil­dren, el­derly and peo­ple with dis­abil­i­ties, or it could be a com­bi­na­tion of cuts to both, or we could in­crease taxes,” Hutchin­son said last week.

“We are not rais­ing taxes,” he added. Even if the gov­er­nor were will­ing to con­sider such a thing, the Repub­li­can-con­trolled Leg­is­la­ture prob­a­bly wouldn’t be. So the state will get what it gets and deal with it as best it can.

Arkansas is al­ready propos­ing changes to its ex­ist­ing ex­pan­sion pro­gram, called Arkansas Works, and last week sub­mit­ted them to the Trump ad­min­is­tra­tion.

They in­clude a limit on el­i­gi­bil­ity for adults that is ex­pected to re­move 60,000 en­rollees from a pro­gram that now pro­vides health cov­er­age to roughly 300,000 Arkansans. Changes also would im­pose work re­quire­ments for able-bod­ied in­di­vid­u­als.

Oba­macare — and the sev­eral Arkansas in­car­na­tions — had ex­panded Med­i­caid el­i­gi­bil­ity to per­sons earn­ing up to 138 per­cent of the fed­eral poverty rate. The state’s pro­posed changes roll that el­i­gi­bil­ity back to 100 per­cent of the poverty rate.

The state main­tains that peo­ple af­fected by the waiver will still have ac­cess to health in­surance.

That re­ally de­pends on how you de­fine “ac­cess” and how you gauge af­ford­abil­ity.

And it all ties back to how the Trump ad­min­is­tra­tion re­ceives this waiver re­quest and how the Congress — the Se­nate and the House — re­solve the larger health care de­bate.

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