- Associated Press - Saturday, July 1, 2017

LITTLE ROCK, Ark. (AP) - Asa Hutchinson didn’t have a say in the 2010 federal health care overhaul that expanded insurance coverage to thousands in his state, and he won’t have a vote on the stalled efforts to repeal and replace that law. But the future of his agenda as Arkansas’ governor hinges on what Congress does to follow through on a promise he and other Republicans have made to repeal a law they’ve long opposed.

That explains the balancing act Hutchinson is attempting as he urges changes to a Senate health care bill that he’s not ready to endorse or denounce as it faces an uncertain future in Washington. Hutchinson, who touted his opposition to the health care law in his successful 2014 bid for governor, says the Senate bill is moving in the right direction but is making it clear he’s concerned about the millions of dollars in additional costs the state could face under the current legislation.

“We’re not saying, ‘Do nothing.’ We’re saying we need to do better and we need to have a better result from the debate in Washington,” Hutchinson told reporters last week.

Much of Hutchinson’s two and a half years in office have been focused on efforts to keep the state’s hybrid Medicaid expansion, which uses federal funds to purchase private insurance for low-income residents, and add new limits that have won over Republicans who had vowed to kill the health law that enabled the program.

Hutchinson stopped short of saying whether he opposes the GOP Senate bill that’s stalled, but says changes are needed to avoid shifting too much in costs to the state. The tweaks he’s proposing include exempting the aged, blind and disabled on the state’s traditional Medicaid program from the legislation’s plan to cap federal spending on the program.



He’s also calling on the Senate to allow states that have expanded Medicaid to continue the program as a block grant, a move that he says would allow them to negotiate a federal match rate higher than the lowered one spelled out in the GOP legislation. Otherwise, he said, Arkansas can’t come up with the $200 million in additional funding that would be needed each year to keep its hybrid expansion.

Hutchinson’s proposals highlight the tough position he and other Republicans in the state who have spent the past several years railing against the law they call “Obamacare” are in as they ponder a future without it in place. More than 300,000 people are covered by the state’s hybrid expansion, which uses Medicaid funds to purchase private insurance for low-income workers. The program’s been hailed by health advocates who say it’s helped lower the state’s uninsured rate and cut hospitals’ uncompensated care costs.

Hutchinson managed to avoid the protracted fight in the Legislature over the program’s future earlier this year, winning support for its reauthorization despite uncertainty about the health overhaul’s possible repeal. That uncertainty still looms over Arkansas as the state heads into the new fiscal year this week. Questions about the expansion’s future as well as new limits on Medicaid funding could dominate future legislative sessions, especially as lawmakers discuss future cuts to the state’s tax code.

Hutchinson’s plea for changes came the day before he formally submitted the state’s request to impose new limits on its hybrid expansion. The new limits would move 60,000 people off the program by lowering the eligibility cap and would also impose a work requirement on some participants.

“The changes we are seeking will build on these successes and increase the sustainability of the Arkansas Works program,” Hutchinson wrote in the letter submitting the state’s request.

The coming days could determine whether that program will exist at all.

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Andrew DeMillo has covered Arkansas government and politics for The Associated Press since 2005. Follow him on Twitter at www.twitter.com/ademillo

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