Thursday, January 22, 2015

Gov. Asa Hutchinson asks legislature to fund Arkansas private option for Medicaid expansion through end of 2016

Posted By on Thu, Jan 22, 2015 at 10:33 AM

click to enlarge _nkw7095_800.jpg

Gov. Asa Hutchinson
announced this morning at UAMS that  he will ask the legislature to fund the private option through the end of 2016. He will create a task force to come up with a new plan for 2017 and beyond.

Hutchinson said that the new plan should cover the beneficiaries currently covered by the private option, but be more sustainable in terms of cost. Note that a new set of "waivers on steroids" will become available in 2017, so it is in fact possible that the state could have much more flexibility to craft conservative (or ostensibly conservative) twists on its Medicaid program. Those waivers could potentially impact much more than the Medicaid expansion population, which fits with Hutchinson's references to the health care system as a whole, of which the private option is a small portion (see that pie chart above). 

Also worth noting that the private option — the state's unique version of Medicaid expansion, funded by the Affordable Care Act — is fully federally funded through the end of 2016. (The state has to chip in 5 percent in 2017, gradually rising to 10 percent in 2020 and beyond.)

Hutchinson is communicating with the feds about encouraging employment and promoting prevention and healthy behaviors. However, he said that he is asking the legislature to fund the private option "as is" through the end of 2016 — so he will not necessarily be seeking additional waivers. The task force, which will report to the legislature, would make recommendations for changes in 2017. Hutchinson was vague so far on who would be included, but mentioned Arkansas Surgeon General Greg Bledsoe

While this is big news, the private option will still need supermajorites in the legislature to survive, and that won't be an easy task. Will Hutchinson's pitch be enough to bring some anti-PO Republicans aboard? We'll see. I'll follow up with another post including some reactions from lawmakers to today's speech. 


Gov. Asa Hutchinson is set to (finally) announce his position on the private option this morning at UAMS. See here for all the background. Most are predicting a continuation of some version of the private option with additional "conservative reform" ideas attached. Plus probably some more studying of the issue. (Blue ribbon commission? Punting things a year down the road?) 

One thing is certain: there will be pie charts. I'll update this post once there's news to report. 

THV11 is live streaming here

I'll add some real-time livebbog notes below (and feel free to chime in via comments if you're watching the stream).


UAMS Chancellor Dr. Dan Rahn introducing Hutchinson. Says "we're all in this together," and expresses appreciation for Hutchinson's work on the issue thus far. 

Hutchinson re-telling the history of the Affordable Care Act. He has a pie chart. Lots of antsy/drowsy audience members. Hutchinson reiterates his opposition to Obamacare. "But guess what? I lost that debate."

"Arkansas was the center point of the debate over Medicaid expansion," Hutchinson said. He said that Medicaid expansion was transformed by the private option. Calls it "innovative." But he says it divided the state politically (notes two of his nephews, both Republicans, were on opposite sides). Plans to talk about benefits and costs of the private option. 

"I know you came here today to hear one simple statement," he says. Sounds like hedging!

Says PO backers should be applauded for innovative "market-based" reforms. States are the laboratory of democracy.  But he adds that opponents of PO "wise to ask about costs." 

Mentions benefits of PO: more than 200,000 people gaining coverage, huge drops in uninsurance rate, uncompensated care, help to rural hospitals. Helping the state budget. 

Hutchinson: "Long-term costs and solutions in terms of funding remain legitimate questions."

"The human side tugs at our heart strings and is rightfully part of the debate." Hutchinson telling a personal story of someone helped by the PO. These stories, state-of-the-union style, certainly sounds like someone giving a speech to continue the coverage expansion in some form. 

Hutchinson says goal is "affordable, competitive" program based on conservative, market-basd principles. 

Asa Hutchinson sharing demographic info on PO: Forty percent of enrollees show no income. Seventy percent worked at one time. Hutchinson seems to be setting up additional waivers around work/work-training encouragement or incentivizing (requirements not allowed by feds). 

Hutchinson: "Principles that should frame debate for the future: one is work and responsibility." And "incentives for preventive care." And: "emphasize role of private sector and charity care." 

Hutchinson says we need more "reliability and predictability" about the PO year to year. Keep hospitals from facing a "cliff" of the legislature taking PO away. Good point.

Hutchinson telling another heartwarming story.  

"As governor I wil ask the legislature to take the following action: to fund the private option through this fiscal year and through end of 2016. Secondly I ask the legislature to create health reform task force to make recommendations for the future. Purpose is to find alternative health care model." He's aiming to create an affordable alternative to PO by 2017 that covers everyone. Hmm, well, we'll see. 

Timing here is important: 1332 waivers become available in 2017. The state really will have MUCH more flexibility at that point. 

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