Brenda Blagg: Prognosis? Unknown

Direction of health care uncertain in U.S., state

Anyone who thinks they know where health care coverage is headed in this country or this state needs to think again.

Yes, it is the subject of the hour at all levels of government. The U.S. House of Representatives made the most noise, recently offering up a much-criticized replacement for the federal Affordable Care Act.

That law law, better known as Obamacare, remains in place for now. It has been under attack from the right ever since it was enacted in Obama's first term.

Last week's House action, celebrated by President Trump and House Republicans in the White House Rose Garden, was a first step toward its repeal. The finish line is far away.

Every signal from the U.S. Senate has been that the upper chamber won't be signing on to the House proposal but will instead craft its own approach to repeal and replace Obamacare.

Senators, while resolute in the goal to end Obmacare, aren't in as great a hurry. They'll take their time, displaying more sensitivity than their House colleagues to the adverse reaction from Americans to proposed cutbacks in access to affordable health care.

The Senate also has a challenge to find a plan that is acceptable to the slim two-vote margin Republicans hold in the upper chamber. It will take only a few defections to completely stall the effort.

Unlike the House, the Senate will also wait for the Congressional Budget Office to score the bill, or determine its costs and impact on the federal budget.

Right now, members of both chambers are back home, where some are brave enough to meet with constituents who are increasingly angry about the shifts being proposed in their health care.

Again, the members of Congress are getting an earful from people who understand only that millions of Americans could lose health care coverage, among them the sick and poor and elderly.

House members ought to be rethinking their quick passage and celebration of an Obamacare repeal that is so unpopular it is already spawning opposition for targeted House seats.

It is anyone's guess whether Senate Republicans can do any better. But they'll at least be more cautious in what they propose.

Meanwhile, against this federal backdrop with 24 million Americans potentially losing coverage, Arkansas lawmakers have voted to change the rules in this state, too.

At Gov. Asa Hutchinson's request, the Legislature endorsed a plan to remove about 60,000 from the state's Arkansas Works program.

That's the latest name of what was known as Arkansas' "private option" plan to buy health insurance for eligible citizens with money provided under Obamacare to expand Medicaid.

This newest wrinkle reduces eligibility from 138 percent to 100 percent of the federal poverty level, if the federal government approves Arkansas' request for a waiver from federal requirements. Roughly 60,000 of the 320,000 Arkansans in the Medicaid program fall in that income gap. They would lose Medicaid coverage.

Hutchinson maintains they can be covered by federally subsidized non-Medicaid plans, but others worry many who now have health coverage will go uncovered in the future and will again rely instead on hospital emergency rooms for urgent care.

Uncompensated care in the state's hospitals, particularly those in rural areas, had decreased with greater availability of Medicaid to qualifying Arkansans.

Hutchinson asked for the change in eligibility for Medicaid to address increasing costs to the state.

When Obamacare was initiated, the federal government paid the full cost of Medicaid expansion programs. This year, the state was required to pick up 5 percent of the cost. The state share will grow to 10 percent in 2020, increasing gradually in the intervening years.

While Arkansans know what the Legislature's intent is, they don't know yet how the federal government will respond to this latest waiver request.

Chances are probably good for approval, however, from the Trump administration. State officials hope to implement the change as early as Jan. 1, although no one knows exactly what will remain of Obamacare itself or what might be in the Trumpcare that could replace it.

Maybe the Senate will have addressed its changes to by then. Maybe not.

The same goes for the all-important conference committee that will be charged with resolving differences between the House and Senate versions.

The prospects aren't all that encouraging.

So what all these people affected by the changing laws, including a lot of poor people in Arkansas, are really left with is staggering uncertainty about their futures.

Commentary on 05/10/2017

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