Gov. Asa Hutchinson
today made the argument for continuing the private option (with conservative tweaks) and said that there was no inconsistency between opposing Obamacare and supporting his plan. He said he aimed to "debunk" the theory that backing his plan was supporting Obamacare.
Hutchinson met with the press at the Capitol at 1 p.m. to lay out his political argument for continuing to accept billions in federal money and keeping the health care coverage expansion in place. The governor negotiated with the feds earlier this month on conservative tweaks to the policy. He's calling the revised version of the PO "Arkansas Works." He's expected to announce the details of his agreement with the feds at tomorrow's meeting of the Health Reform Legislative Task Force.
Hutchinson was flanked by key legislators (many of them currently under heavy political attack from conservative advocacy groups for their support of the governor's health care plan). The govenor said that he was there to "debunk" the argument from both liberal and conservative critics that backing the governor's "Arkansas Works" plan (or Medicaid expansion in the states generally) amounts to supporting Obamacare. “That is not so,” he said. “We need to debunk that argument…because there is no truth to it.”
Whatever its name — Medicaid expansion, the private option, or Arkansas Works — the coverage expansion relies on federal funds available as part of the national health care law, or Obamacare. But Hutchinson said that his opposition to that law did not change his responsibility to seek the best outcome for that state as long as that law is on the books. The best policy for the state, he said, was to continue the Medicaid expansion.
Hutchinson said that he campaigned against the ACA because he opposes the individual mandate and the employer mandate, which he said were an affront to freedom. He said that the mandates were “unconscionable and a federal intrusion.” He continues to oppose the ACA today, he said. However, he said that "we have to live in the real world." The Supreme Court kept those "unconscionable" mandates in place, he said, and there wasn't anything state lawmakers could do about that. But the Court punted the Medicaid expansion question to states. Some wondered whether the health care law would collapse, Hutchinson said (or whether states would band together and reject expansion). Instead, 31 states and the District of Columbia have expanded Medicaid and Obamacare has not collapsed.
“It’s important in Arkansas that we make decisions that are right for Arkansas,” he said. Hutchinson said that Obamacare was decided in Washington. None of the legislators with him "voted for Obamacare" or "ever supported the ACA" he said. Instead, they are trying to "pick up the pieces and make the right decisions for this state."
He complained about critics trying to “link someone who supports reform of Medicaid in Arkansas, who supports an Arkansas Works initiative, as somehow supporting Obamacare. Nothing could be further from the truth.”
He said that the Obamacare attacks that he and his legislative allies were receiving were “the worst of politics.” He said that they too were frustrated by federal intrusion on state prerogatives in terms of health care.
"But we should not punish Arkansans simply because we are frustrated with Washington," he said. “We can’t punish Arkansans by denying health care coverage, by denying Medicaid reform."
He said, "I hope that Washington replaces Obamacare but until then we would only be punishing Arkansas to turn down federal money that 30+ states are accepting."
Hutchinson then made his core pitch:
It is perfectly consistent, it is perfectly conservative and logical to oppose Obamacare as a federal policy and yet to accept federal dollars under the Medicaid program in Arkansas. It is a logical position, it is an Arkansas-oriented position, and it does not embrace the federal policy that is the framework of Obamacare.
Hutchinson argued for continuing to accept Medicaid expansion dollars for three reasons:
. Hutchinson said that it would be unfair to punish poor Arkansans while middle-income Arkansans continued to have Obamacare subsidies available. He said that no one is suggesting the state should give back the federal money that helps subsidize middle class residents buying insurance on the Obamacare exchange. He said it would be inconsistent to punish the poorest residents in the state by turning down federal money and leaving them in a coverage gap.
2) Access to health care
. The uninsured rate in Arkansas has been cut in half since the enactment of the private option, which covers 250,000 Arkansas. Hutchinson said that the private option has improved health care access and outcomes and “that is a positive thing.”
3) The budget
. Finally, he noted the impact on the state budget: ending the PO would lead to a gap of more than $100 million in the state budget, he said. "To balance the budget without those Medicaid expansion dollars, we would have immediate $100 million budget deficit in our state budget—and that is on the conservative side," he said.
Hutchinson said that filling that hole would lead to painful cuts or tax increases, as well as scrapping his highway plan. “You would have to cut a lot in education, you would have to cut across the board in our agencies, you have to end the highway program I’ve initiated, or you’ve got to raise taxes. That’s the reality of it. You’re going to endanger public safety, you’re going to jeopardize our commitment to education with that kind of $100-million+ gap in our budget if we reject the Medicaid expansion dollars.”
The governor continued: “We should not be asked to turn down federal money because we want to make a political point and that is all that would be. These legislators are here because they’re willing to make the right decision for Arkansas. To listen and to be realistic in terms of our budget and how we can reform Medicaid. That’s all I can ask of a good legislator. I have confidence they’ll come to the right decision. Any other decision will kill our highway program, education, and endanger public safety.”
The private option will need 75 percent support in both houses of the legislature in order to continue. Most expect that the feds will approve most of the governor's requested changes. Nevertheless, the governor faces an uphill climb to get supermajority support in the legislature.
“If we do not work to get the truth out to Arkansas voters, than we’re not going to make that three fourths vote margin because legislators listen to the voters,” Hutchinson said. “But I have confidence that if we debunk the erroneous arguments that are out there, if we get the truth out, and there’s a good understanding of the impact on our state budget, then absolutely we’re going to get the three fourths vote, we’re going to get the support we need to have our budget balanced, we’re going to have a good state highway program, and Medicaid reform."
Hutchinson said that he still supports repealing and replacing the ACA. He said that the smartest approach for Arkansas is to take the federal Medicaid dollars now — if a GOP president is elected next year and changes the policy, Arkansas should make a decision at that time based on "the lay of the land" if federal policy is different. “We’re making our decisions now based on what’s best for Arkansas based on federal policy as it exists today,” he said.
Hutchinson continued to insist that voting for "Arkansas Works" amounted to "ending the private option."
Interesting moment at the end of the presser: KUAR's Jacob Kaufman asked Hutchinson about the governor's professed hopes for a repeal-and-replace of Obamacare. Kaufman asked whether Hutchinson would like to see coverage for the Medicaid expansion population continue under a new "replace" plan passed in a hypothetical Republican administration. Somewhat to my surprise, Hutchinson immediately said, "yes." He said that he would like to see some version of the coverage expansion continue but would like to see a shift to block grant funding.
You can watch a livestream of the press conference via KATV
here. Benji is at the Capitol and will have a report from the scene shortly.
Support for special health care reporting made possible by the Arkansas Public Policy Panel.