Governors were in Washington last week and a prime topic was the future of the Affordable Care Act and, of particular interest in Arkansas, continuing federal support for the expansion of Medicaid under Obamacare.

Arkansas is in the middle of the scrum because it’s had a highly successful Medicaid expansion that has brought tens of millions of federal dollars to Arkansas — an economic and state budget boon on top of the enefit of better health coverage for some 300,000 Arkansans.


Arkansas angles:

* MAKE THEM WORK: The New York Times front page article focuses on Arkansas in an examination of the push by Gov. Asa Hutchinson and others to add a work requirement to Medicaid. This was resisted by the Obama administration, though it’s an idea with popular political support. The theory is that medical coverage discourages people from seeking work.


That might be true, but the issue is complicated as the Times article illustrates through many personal stories in Arkansas. The Times writes about the people who’d be left behind by such a rule. The article notes that many on Medicaid already DO work, but because of lack of opportunities or continuing health problems, can’t work the minimum that might be required to qualify. Some could work, but it also might be detrimental to health to do so.

The outline of a new replacement plan, presented to House members last week, shows just how far some Republican leaders hope to go in overhauling a program that has grown under the Affordable Care Act to insure one in five Americans, including more than half of the roughly 20 million people who have gained coverage under the health law.

It would give each state a fixed amount of money for each Medicaid beneficiary, instead of paying a large share of whatever it costs to cover everyone who qualifies. And it would substantially reduce the amount that the federal government pays to help cover the Medicaid expansion in Arkansas and 30 other states, a change that would most likely result in many people losing coverage.

It’s easy to say people should work. But it’s not always easy for people without transportation to get to available jobs, for example. And how do you define able-bodied?


Hutchinson is quoted as saying a limited work experiment on food stamps seems to have “worked,” if a decline in recipients is a measure. Undoubtedly, rules on Medicaid can “work,” too. But at what cost?

* THE COST OF CHANGES: A Bloomberg article on the governors’ meetings in Washington says millions could lose coverage under the changes envisioned by Republicas in Congress. The estimate says a drop of perhaps 30 percent in states that expanded Medicaid. That could mean a crippling blow to tens of thousands of Arkansans.

The article had this scenario which happens to sound a lot like Arkansas:

In a hypothetical state that did expand Medicaid coverage and had 300,000 enrollees in the individual market, the number would drop to 210,000.

…The expansion state could see further losses in Medicaid, where another 115,000 would probably lose eligibility, without being able to find an affordable replacement plan.”

The presentation also revealed that a hypothetical state that expanded Medicaid could lose 24 percent of federal dollars spent on the program over five years, requiring $6.2 billion to make up the gap. The scenario would require Congress to repeal the expansion and implement a per-person funding mechanism. A hypothetical state that didn’t expand the program could lose 6 percent in federal spending.

The presentation is based on a plan by Republican leaders to eliminate income-based subsidies under Obamacare that help people afford insurance and replace them with age-based tax credits.

This would be a success in the eyes of many Republicans, of course, because it would mean a huge cut in federal spending. If the government stops paying, Arkansas will have to rethink, Hutchinson acknowledged in the Times interview. He’s among those hopeful of block grant continued funding, but if the grant is less than now received, freedom to spend it as states wish still will mean many fewer people served


Doubt my statement about what’s considered a success? Here’s the Republican chair of a key subcommittee quoted as saying it would be a “good thing” if a lot of people lost coverage.