Gov. Asa Hutchinson (R) said Wednesday that a health care special session could occur “within 10 days” before the scheduled April 13 fiscal session, with his legislative package ready about two weeks before that in mid-March.
Hutchinson made his comments to reporters after addressing the Health Reform Legislative Task Force, the group of legislators who are considering changes to the state’s Medicaid program and the private option.
Hutchinson reported to legislators about his meeting Feb. 1 with U.S. Department of Health and Human Services Secretary Sylvia Burwell about changes he wants to make to the private option, which is the program that uses federal dollars to purchase private health insurance for Arkansans with incomes up to 138% of the federal poverty level.
Hutchinson is seeking waivers from the federal government to change the private option to a new version he is calling “Arkansas Works.” The program would have to be approved in the special session by a majority vote and then funded in the fiscal session by a three-fourths majority. Hutchinson told reporters he would not worry about finding a three-fourths majority in the special session.
“I think you’ll have a totally different standard, so whenever you need a majority vote, you hope for a majority vote in the authorizing session, and then we’ll increase that in the regular session,” he said.
Prior to his address to legislators, Hutchinson turned in his chair at the testimony table, looked at the standing room only capacity crowd, and said, “Wow.” He then reported on his Feb. 1 meeting with Burwell while outlining his Arkansas Works proposal.
Arkansas Works would differ from the private option in four ways.
First, it would require adults with access to insurance through their employer to take advantage of that benefit rather than stay on the program. The state would provide assistance in paying the premiums.
Second, the state would mandate that able-bodied individuals with no income be referred to job training and job search programs. Hutchinson said Burwell had encouraged him to work with the U.S. Department of Labor in this regard, and he is expected a call from Secretary of Labor Thomas Perez soon.
Third, Arkansas Works would require enrollees with incomes above 100% of the federal poverty line to pay premiums of up to $19 per month, with those who fail to pay incurring a debt to the state.
Finally, Arkansas Works is meant to enhance program integrity by eliminating a current provision where medical costs can be covered 90 days prior to enrollment. Instead, costs would be covered only upon enrollment. Also, the state would have the ability to end the program with 30 days’ notice to the federal government.
The private option has been controversial since it was created. It provides insurance for 200,000 Arkansans, has reduced the state’s uninsured population, and has reduced the amount of uncompensated care provided by hospitals. However, detractors say it is an unsustainable expansion of Obamacare.
Hutchinson presented a letter sent to him by Burwell after their meeting that he said showed she accepts the framework of his proposals while the details are worked out. In it, Burwell wrote, “You outlined a number of specific changes in support of these goals, and many are quite innovative. In some cases, they also push the bounds of what is allowable under federal Medicaid law and raise concerns about potential adverse impacts on beneficiaries. However, I am hopeful that we can work together to find acceptable approaches to reforms in each of our focus areas.”
Hutchinson said he and the Obama administration have significant differences over Medicaid expansion. Referring to his meeting with Burwell, he said, “I see it as a means of moving up the economic ladder,” he said. “This administration sees it as a permanent status. And so we butted heads. We had a difference of opinion. At the same time, she has some roots in West Virginia and Arkansas. She’s a very practical lady, very cordial lady, and we both realize the differences of opinion and the limitations on each of our positions.”
As he has in the past, Hutchinson reiterated his opposition to Obamacare, which he emphasized is a federal program over which state officials have no control. He said he favored the federal government providing flexible block grants to states.
“Where we are right now, I did not create,” he said.
Hutchinson defended the program by saying that, as a result of the Affordable Care Act creating Obamacare, Medicare funds have been reduced, the infrastructure for helping lower-income Arkansans has been dismantled, and employer-based insurance has declined. He said the state cannot leave 200,000 Arkansans without a recourse for health insurance.
He said continuing the program is the right thing to do because middle-income Arkansans are subsidized when purchasing insurance off the federal government’s insurance exchange, so the state should be fair to lower-income residents; because this is the best option under current federal health care policy; and because the state would face a $100 million budget deficit without it.
“As powerful and determined as we are, we cannot change federal health care policy by simply being stubborn,” he said.
Hutchinson has faced criticism from opponents who say Arkansas Works differs little from the private option. He said his seeking a waiver proved his idea represents a change.
“There’s a reason you have to ask for a waiver. That is because it’s a change from existing law and requirements,” he said.