Gov. Asa Hutchinson made a tiny bit of news as I interviewed him Monday for a forthcoming Talk Business and Politics magazine article on the broad canvas of the new Trumpian and wholly Republicanized frontier in Arkansas.
He said he’d travel to meet next week with President-elect Donald Trump’s transition team to convey his wishes on repealing and replacing Obamacare.
He said — as he had said before — that he would ask for Medicaid block grants to the states, which, as far as he’s concerned for Arkansas, would include money for basic Medicaid plus the current private-option Medicaid expansion population.
He said he’d recommend that these block grants — meaning finite amounts of money — come with autonomous state flexibility and control. For Arkansas private-option recipients, Hutchinson envisions that benefits would require work or work-training, new levels of cost-sharing by enrollees and other elements he is not ready to talk about.
What it comes down to is that Hutchinson wants to continue Medicaid expansion, but in a different form. Most of the rest of Obamacare — the exchanges, the individual mandate — can and should become history as far as he’s concerned. But he leans toward something like tax credits for health-insurance expenses for low-middle-class persons and families losing federally subsidized insurance on the exchanges.
“I think we’ll go to block grants for Medicaid, but the issue for Congress could be the amount to the states,” the governor said. “Some states presumably will get less than others,” he said, meaning those, all Republican-led, that have chosen not to expand Medicaid to cover residents falling within 138 percent of the federal poverty line. “And that might be a source of contention,” he said.
His point seemed to be that, if we go to a system of Medicaid block grants with the running of them left wholly to the states, some states might argue for equitable amounts of money even for those that hadn’t previously expanded Medicaid.
It sounds like a political problem more than a legitimate fairness problem. States choosing not to expand Medicaid are getting less already, by their own preference. They don’t warrant a federal windfall now for turning down federal money before.
At any rate, Hutchinson’s position seems solid enough, if a tad convenient.
He likes the Medicaid expansion money because he wants the tax cuts it affords. And he would prefer not to jerk health insurance from more than 300,000 poor people. But he believes the private-option population has grown too large because people are not transitioning to jobs with the regularity he finds desirable, indeed essential.
Thus he likes the conservative notion of converting Medicaid from an open-ended federal matching program to a finite block-grant amount. He likes including money for the expansion population in that grant. He likes giving the state the authority to run everything more restrictively.
The political debate is whether it’s fair to poor people to make conditional their access to human services paid for mostly by federal money but left totally to state whims. But there aren’t enough Democrats left in Arkansas to have much of argument.
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers’ Hall of Fame in 2014. Email him at [email protected]. Read his @johnbrummett Twitter feed.