States need more flexibility from health care reform, says Arkansas governor

As the Senate begins to write its own health care reform bill, it’s finding some crucial differences of opinion over the legislation passed by the House to replace the Affordable Care Act. As part of our conversations about what’s at stake for those closest to the problem, Lisa Desjardins speaks with Arkansas Gov. Asa Hutchinson about what he’s looking for to fix health care in his state.

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    We turn now to another health care story, this one the ongoing political battle to replace Obamacare.

    The U.S. Senate is beginning to write its own reform bill, and discovering there are some big differences of opinion over what Republicans passed in the House.

    Earlier this month, we spoke with Democratic Governor John Hickenlooper of Colorado about efforts to replace the Affordable Care Act.

    Today, we hear from a Republican. And our Lisa Desjardins has that.


    As part of our ongoing look at what's at stake in health care for those closest to the problem, we're now joined by Asa Hutchinson, the Republican governor from Arkansas.

    Our viewers will recall that Arkansas was, of course, one of the states to expand Medicaid under Obamacare.

    Governor Hutchinson, thank you for joining us.

    Now, you're in an interesting position. You have opposed the Affordable Care Act, but also you and your predecessor, as we just said, supported the expansion. And because of those things, we have seen uninsurance rates in your state get slashed in half under the Affordable Care Act.

    What do you think of the Affordable Care Act right now? Does it need full repeal?


    Well, we need to change what we have. It doesn't work completely.

    For example, we wanted to reform the Medicaid expansion in Arkansas with a simple work requirement, just lick we have on the SNAP program, but under Obamacare, the previous administration wouldn't give us that requirement.

    We needed to control the cost more. We're unable to do that whenever it's mandatory that you cover everybody up to 138 percent of the federal poverty level. And so we're trying to concentrate limited resources in Arkansas. We don't have the flexibility we need under the current program.

    So, yes, I supported a change in it, and I applaud the House for starting the debate with passing a repeal and a replacement. But we need to obviously do more, and I'm looking for the Senate to — they're starting over. They're drafting it. I hope they listen to the governors to provide the flexibility that's needed, and I hope they take some ideas from Arkansas as to some of the good things we have done in terms of reform, controlling costs, but also expanding health care coverage.


    One of the items of flexibility that House Republicans would give you is the ability to waive out of some things like essential benefits or a cap on the costs for people who have preexisting conditions.

    Are those things that you would want to waive out of?


    Not necessarily, but we have got to be able to have the flexibility and options for the state.

    And, for example, on the health care benefits, I think the state should be able to give more flexibility in terms of coverage. Not everybody wants every essential health benefit. They might want to have different options and a menu of options that suit their particular needs.

    Let's give the states the option to enhance coverage, to make sure there's health care options that are out there, but also the ability to control costs. And so we want to look at a menu of options. We take two options right now in terms of reform.

    We want to be able to reduce it from 138 percent of the federal poverty level down to the poverty level, so we can concentrate our limited resources on those that need it the most, shift more to the exchange, where they will have support and coverage, but it will be a cost-saving measure, both for the state and the federal government.

    These are types of reforms and flexibility that will make sense. The work requirement is important to encourage people to have the training they need to move up the employment ladder, to make more money, but, at the same time, have some support for health care. These are the reforms we want to put into place.


    Governor, House Republicans would offer you more flexibility, as you say, but they would also cut some of the Medicaid funding you get from the government, and it seems they are increasing uncertainty.

    Insurers need to set their rates for the next year, and they aren't sure if they are going to get the subsidies that the president and Congress control. What does that uncertainty feel like, and are you worried about funding cuts?


    Yes, that's one of the big faults of the House bill is that it's a cost shift to the states.

    We have to absorb more of the cost to maintain the same level of coverage. We don't need that cost shift to the states. We need to continue a good federal-state partnership. So, I'm looking to the Senate to rewrite that portion of it, so the flexibility is good, but you cannot accompany that with a massive cost shift to the states that would leave more and more uninsured, because the states cannot absorb that kind of a burden.

    But the flexibility is an important part of it to be able to manage it.

    Two points. Under Obamacare, they underestimated the number that was going to go on Medicaid. Too many went on Medicaid. They overestimated those that would go on the exchange, and there are too few on the exchange. We want to reverse that.

    And under Arkansas' plan, you're going to restrict those that are on the Medicaid portion of it, shift more to the exchange, and that's the original design that makes it more cost-effective for the states.


    I see.

    Governor Asa Hutchinson, Republican of Arkansas, thank you so much for joining us.


    Great to be with you.

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