{"id":7937,"date":"2017-09-21T20:57:30","date_gmt":"2017-09-21T20:57:30","guid":{"rendered":"http:\/\/arknews.org\/?p=7937"},"modified":"2017-09-21T20:58:02","modified_gmt":"2017-09-21T20:58:02","slug":"in-backing-obamacare-repeal-bill-governor-would-trade-billions-of-dollars-for-more-state-flexibility","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2017\/09\/21\/in-backing-obamacare-repeal-bill-governor-would-trade-billions-of-dollars-for-more-state-flexibility\/","title":{"rendered":"In backing Obamacare repeal bill, governor would trade billions of dollars for more state flexibility"},"content":{"rendered":"
\"\"
Governor Hutchinson (file photo)<\/figcaption><\/figure>\n

 <\/p>\n

On Sept. 19, Governor Hutchinson endorsed the so-called Graham-Cassidy health care bill and urged the U.S. Senate to approve the partisan legislation before a Sept. 30 deadline makes its passage effectively impossible. The governor called the bill \u2014 sponsored by Sen. Lindsey Graham (R-South Carolina) and Sen. Bill Cassidy (R-Louisiana) \u2014 the nation\u2019s \u201clast, best chance to repeal the Affordable Care Act.\u201d <\/span><\/p>\n

Although Hutchinson is a Republican and campaigned against the ACA, or Obamacare, his support for the latest repeal effort was not a foregone conclusion. He opposed legislation earlier this year that would have pared back federal Medicaid spending and unwound other parts of the ACA. <\/span>The governor said in July<\/span><\/a> that one such bill, the Better Care Reconciliation Act, would \u201cshift costs to the states, and that leaves states like Arkansas with few choices.\u201d Arkansas, unlike most Southern states, chose to expand its Medicaid program under a funding stream made available by the ACA, thereby extending health care coverage to some 300,000 low-income adults and drastically reducing its uninsured rate.<\/span><\/p>\n

Hutchinson said Tuesday that the Graham-Cassidy bill was different. \u201cIt does not represent a significant cost-shift to the states,\u201d he said. The proposal would \u201ctake the heart out of the ACA\u201d while not harming Arkansas in the process, he added later. \u201cWe\u2019ve looked at these numbers carefully, our whole team, and I\u2019m satisfied that there\u2019s not a retrenchment on the federal participation in the health care system here in Arkansas.\u201d<\/span><\/p>\n

Yet several health care experts said Graham-Cassidy would slash projected federal funds to Arkansas. The Center for Budget and Policy Priorities, a liberal-leaning think tank in Washington, D.C., <\/span>estimated the state would see a $1.1 billion reduction in federal funding in 2026<\/span><\/a> when compared to the money Arkansas would expect to receive that year under existing law. That\u2019s partly because the bill would trim overall spending, but also because it would reallocate money between the states in a way that would penalize Arkansas, according to Judy Solomon, the CBPP\u2019s vice president for health policy.<\/span><\/p>\n

\u201cThere\u2019s a redistribution of the funds from states that have taken up the Medicaid expansion, like Arkansas, to states that haven\u2019t,\u201d Solomon said. \u201cFor the most part, the states that are winners [under Graham-Cassidy] are states that did not expand Medicaid. The states that are losers are states that did. \u2026 You\u2019re starting at a lower point than you would under current law, and then you\u2019re redistributing from states like Arkansas to states like Alabama and Mississippi and Texas.\u201d<\/span><\/p>\n

Those three states are among the 19 that refused to expand Medicaid under the ACA. If Graham-Cassidy becomes law, the CBPP estimates that Alabama will see a federal funding increase of $1.7 billion, Mississippi $1.4 billion and Texas $8.2 billion, the same year that Arkansas will see a $1.1 billion reduction.<\/span><\/p>\n

Avalere Health, a D.C.-based consulting firm, released <\/span>an analysis of Graham-Cassidy<\/span><\/a> Sept. 20 that concluded Arkansas stands to lose out on $6 billion in federal funding over the period between 2020 and 2026 if the bill passes.<\/span> The Kaiser Family Foundation, a health care nonprofit based in California, <\/span>published a report<\/span><\/a> Sept. 21 that projected Arkansas\u2019s loss to be $2.2 billion for the same period. Though the analyses differ by a significant margin, both show that states that rejected Medicaid expansion would benefit at the expense of those that accepted it. Alabama, Mississippi and Texas would see their share of federal funds rise by $3.4 billion, $5.3 billion and $28.4 billion, respectively, from 2020 to 2026, the Kaiser Family Foundation report indicated.<\/span><\/p>\n

On Tuesday, Hutchinson chose a different comparison. \u201cIt should be noted that 37 percent of all the federal funds in the Affordable Care Act go to four states: California, New York, Massachusetts and Maryland,\u201d he said. \u201cI don\u2019t think anyone in middle America would see that as a fair distribution of funds. And so what the Graham-Cassidy bill does, it not only repeals the individual mandate and the employer mandate ... but it also block-grants to states the federal funds that are currently utilized, [and] it does it in a way that is more equitably distributed and does not represent a cost-shift to the states. \u2026 The block grants to the states will keep up with the health care inflation rate.\u201d<\/span><\/p>\n

Graham-Cassidy would transform the American health care system by instituting major spending cuts and giving states much broader authority to structure and administer programs independent of federal oversight. It would end the Medicaid expansion in 2020, along with the ACA\u2019s premium tax credits and cost-sharing reductions, which are funding mechanisms that help low-to-moderate income people buy insurance plans on the individual marketplace. All of that money would instead be distributed to all 50 states in the form of block grants, the amount of which would be based on a complex funding formula partly dependent on a state\u2019s poverty rate. B<\/span>ut the bill does not fund the block grants beyond 2026, meaning the money would disappear entirely if Congress did not act to renew it at that time. The Kaiser Family Foundation report said that would result in an additional $3.1 billion removed from Arkansas in 2027 alone. Graham-Cassidy would also change funding for traditional Medicaid to a per-capita funding model that would limit spending on children covered by ARKids, disabled people and the elderly.<\/span><\/p>\n

In addition to overhauling Medicaid, Graham-Cassidy would undo the ACA mandate that individuals be insured and that employers provide insurance to their workers. States could opt out of consumer-protection regulations that the ACA imposed on the insurance industry, including requirements that insurance cover certain \u201cessential\u201d benefits \u2014 such as mental health, substance abuse or maternity care \u2014 which were intended to prevent the sale of substandard, bare-bones health plans. States could also waive the ACA\u2019s prohibition against insurers charging more to customers with pre-existing medical conditions.<\/span><\/p>\n

The Congressional Budget Office has yet to issue an estimate on the bill\u2019s projected impact to the uninsured rate or the federal deficit. A preliminary CBO score on Graham-Cassidy may be available by early next week. But Senate Republicans are racing to pass the legislation before Sept. 30, which is when the window expires for the chamber to approve an ACA repeal bill with just 50 votes using the budget reconciliation process. Republicans control the Senate 52-48. Most Republican senators seem to be on board with the proposal, including Arkansas Sens. John Boozman and Tom Cotton, but several key Republican lawmakers who voted \u201cno\u201d on an earlier repeal effort have yet to announce a public position, including Sen. Susan Collins of Maine, Sen. Lisa Murkowski of Alaska and Sen. John McCain of Arizona. Sen. Rand Paul of Kentucky has said he\u2019ll oppose the Graham-Cassidy measure because it doesn\u2019t go far enough in repealing Obamacare. <\/span><\/p>\n

Marquita Little, health policy director at Arkansas Advocates for Children and Families, said the bill \u201chas many of the same dangerous features as previous proposals, although repackaged in a new way. It would result in deep cuts to Medicaid funding. It would result in, we think, tens of thousands of Arkansans losing coverage. It would result in cost increases, and it would remove a lot of important consumer protections, such as those for pre-existing conditions.\u201d<\/span><\/p>\n

Asked whether Graham-Cassidy constituted a cost shift to Arkansas, Little said, \u201cWe think it absolutely is. And we\u2019re all patiently waiting for the CBO analysis to know what the impact really will be. \u2026 There is definitely going to be a scenario where states are operating with significantly fewer funds, and so there\u2019s just no way around the idea that it doesn\u2019t create a cost shift to the states and require states to make changes.<\/span><\/p>\n

\u201cSome folks might interpret that to mean, \u2018It\u2019s not an automatic cost shift because the states get flexibility in determining how they use funds\u2019 and maybe that money is freed up in other ways \u2026 but we are opening the door to having to make dangerous changes to what we cover [and] who we cover in order to operate in the environment where we have fewer federal dollars.\u201d<\/span><\/p>\n

Bo Ryall, president and CEO of the Arkansas Hospital Association, said his organization has \u201ca lot of unanswered questions\u201d about Graham-Cassidy. \u201cThe numbers I\u2019ve seen show that there would be less money going to the states, and Arkansas in particular would see less funding under this formula from 2020 to 2026. ... We\u2019re concerned about that cost shift.\u201d Hospitals have seen their uncompensated care numbers fall dramatically in recent years as Arkansans have gained insurance under the ACA, and Ryall said that policies that cause people to lose insurance would fall on rural hospitals particularly hard. (The AHA is a financial donor to the Arkansas Nonprofit News Network\u2019s health coverage.)<\/span><\/p>\n

Hutchinson said on Tuesday that allowing states the flexibility to spend federal health care money how they choose would allow them to defray a possible rise in hospitals\u2019 uncompensated care. \u201cWhen you get rid of the individual mandate and give people freedom of choice, some are going to decide not to have [insurance], and so there will be some uptick in uncompensated care,\u201d he acknowledged. \u201cBut what the block grant does is allow us the flexibility to arrange our own system, so that we can cover [insurance] on the front end, but if there\u2019s some that slip through and wind up in the hospital in the uncompensated care category, then we can cover that.\u201d<\/span><\/p>\n

But under the block grant funding model, the state would have to balance uncompensated care costs with every other health care need. That would inevitably mean tradeoffs about what the state paid for and what it didn\u2019t. \u201cWe\u2019d have to see the numbers, and then if there\u2019s enough money there,\u201d Ryall said. \u201cWe\u2019re suspect about there being enough money in the pot to do that.\u201d<\/span><\/p>\n

On Tuesday, Hutchinson said that reports of Arkansas losing hundreds of millions of federal health care dollars under Graham-Cassidy are \u201cjust not so. \u2026<\/span> If you look at the entire nation, the Graham-Cassidy bill between now and 2026 will fund 95 percent of what is currently funded under the ACA.\u201d<\/span> Asked to clarify later, J.R. Davis, a spokesperson for the governor, wrote in an email that \u201cfederal spending will grow at a slower rate under Graham-Cassidy than under current law. But federal spending on Medicaid in 2026 is already lower under the latest CBO baseline than it projected the previous year. No one views the lower spending level as a loss of federal funds.<\/span> Graham-Cassidy sets a budget. This is the fiscal discipline that is long overdue in Washington. It is a realistic budget that is achievable.\u201d<\/span><\/p>\n

The major difference between the governor\u2019s analysis and those performed by groups like the Kaiser Family Foundation is that they are using different points of reference. Kaiser compared what states will receive in 2026 if the ACA is left intact to what states will receive in 2026 if Graham-Cassidy becomes law. The governor appears to be comparing what states receive now, in 2017, to what states will receive in 2026 if Graham-Cassidy becomes law. Spending on Medicaid, and health care in general, has been growing for decades, and the ACA envisions growth in spending that would keep pace with beneficiaries\u2019 needs. In contrast, Graham-Cassidy would establish strict limits on spending.<\/span><\/p>\n

The governor said that the proposal represented \u201cour only chance\u201d to repeal Obamacare. If it fails to pass, he said, \u201cthe Affordable Care Act is here in perpetuity, and it\u2019s built into the fabric of our health care system, and I don\u2019t see it changing.\u201d <\/span><\/p>\n

Despite others\u2019 concerns about spending cuts, Hutchinson projected confidence that giving Arkansas more control over its health care system would allow the state to drive down costs and create savings in innovative ways. He told reporters on Sept. 19 that Graham-Cassidy \u201crepeals as much of the ACA as it can under the reconciliation [process] \u2026 and then it allows states to make decisions beyond that. We can reject more of it, we can retain parts of it, we can come up with our own formulation as to what our health care system should be like in Arkansas \u2014 or any individual state.\u201d <\/span><\/p>\n

Solomon, of the Center for Budget and Policy Priorities, was not so optimistic. \u201cThe problem is that the funding is going to fall short,\u201d she said. \u201cIt\u2019s not going to be enough, particularly if you think about anything happening that increases the need for coverage. A recession. A natural disaster. The money is fixed \u2014 a fixed allotment that starts off not being enough, and anything that increases the need would make it less likely [to be enough.]\u201d<\/span><\/p>\n

\u201cThere\u2019s a proof point here that hasn\u2019t been met: Show me how you would do that. Show me how you would take what you\u2019re getting and how you would build yourself a program. \u2026 That\u2019s why it\u2019s very hard for me to understand how states that have had successful [Medicaid] expansions \u2014 and Arkansas has been very successful \u2014 think that this can be a substitute.\u201d<\/span><\/p>\n

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

On Sept. 19, Governor Hutchinson endorsed the so-called Graham-Cassidy health care bill and urged the U.S. Senate to approve the partisan legislation before a Sept. 30 deadline makes its passage effectively impossible. The governor called the bill \u2014 sponsored by Sen. Lindsey Graham (R-South Carolina) and Sen. Bill Cassidy (R-Louisiana) \u2014 the nation\u2019s \u201clast, best chance to repeal the Affordable Care Act.\u201d<\/p>\n","protected":false},"author":2,"featured_media":2637,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[],"class_list":["post-7937","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care"],"yoast_head":"\nIn backing Obamacare repeal bill, governor would trade billions of dollars for more state flexibility - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2017\/09\/21\/in-backing-obamacare-repeal-bill-governor-would-trade-billions-of-dollars-for-more-state-flexibility\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"In backing Obamacare repeal bill, governor would trade billions of dollars for more state flexibility - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"On Sept. 19, Governor Hutchinson endorsed the so-called Graham-Cassidy health care bill and urged the U.S. Senate to approve the partisan legislation before a Sept. 30 deadline makes its passage effectively impossible. 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