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.
Commentary on 07/05/2017