Gov. Asa Hutchinson on Thursday outlined several changes he said he would like to see made to the Senate bill that seeks to repeal and replace the Affordable Care Act.

LITTLE ROCK — Gov. Asa Hutchinson on Thursday outlined several changes he said he would like to see made to the Senate bill that seeks to repeal and replace the Affordable Care Act.
Hutchinson said the bill — which the Senate has delayed voting on so it can be reworked in an effort to shore up support — could cost Arkansas about $500 million a year, by a conservative estimate, and force the state to reduce or end its hybrid Medicaid expansion program, which has provided government-subsidized private health insurance to more than 300,000 low-income Arkansans.
The governor stopped short of saying he opposes the bill in its current form.
“People ask me, ‘Do you support the Senate bill or do you not support the Senate bill?’ That’s really not a fair question because it’s changing day by day,” he said.
Hutchinson said he believes the bill in its current form would do “some good things,” including reducing the national deficit and providing more flexibility to states. The current system is “not sustainable,” he said.
“The big problem is that the Senate bill does continue to shift costs to the states, and that leaves states like Arkansas with few choices,” he said.
The bill would phase down federal matching funds for Medicaid expansion starting in 2021. By 2020 the federal government’s share of the cost of Medicaid expansion will be 90 percent, but the bill would lower the federal government’s portion to 85 percent in 2021, 80 percent in 2022, 75 percent in 2023, and then to states’ regular Medicaid matching rates — which in Arkansas is 70 percent — in 2024.
“That is a dramatic shift of federal participation in the Medicaid program,” Hutchinson said. “When the reimbursement rate is reduced, than the state has got difficult choices to make. It either has to reduce the expanded Medicaid coverage or we have to cut costs in the traditional Medicaid program, and that includes children, elderly and people with disabilities, or it could be a combination of cuts to both, or we could increase taxes.”
Hutchinson stressed that “we are not raising taxes.”
Arkansas’ Medicaid expansion program contains a trigger written into it by the state Legislature that requires the program to end if there is any change to the federal matching rate that was established under the Affordable Care Act. Hutchinson said he believes that trigger would take effect when the rate is actually reduced and not when a bill to reduce the matching rate becomes law, so the state would have a few years to prepare.
Hutchinson outlined four changes he would like to see:
• Exempting the aged, blind and disabled from a per capita cap on federal Medicaid funding contained in the Senate bill. Capping federal Medicaid money for these high-cost categories would represent a significant cost shift to the states, Hutchinson said.
• Allowing states to include their Medicaid expansion populations in the bill’s block-grant funding option, which the Senate bill currently would not allow.
• Redesigning the tax-credit subsidies in the bill to stabilize the individual market and make health-care coverage more affordable for low-income people. The bill currently offers no incentives for low-income people to move off of Medicaid, he said.
• Giving states more control over the Medicaid program under the per capita option. The bill currently provides only minimal new state authority, he said.
A reporter noted that there is public fear over the bill and asked Hutchinson whether he believed the congressional delegation should hold town hall meetings during the July recess to discuss it with constituents.
Hutchinson said that is up to the delegation, not him, to say, but he added that he believes the delegation is listening to constituents.
“I think they are very responsive,” he said.
Republican Sens. Tom Cotton and John Boozman have not said whether they support the bill in its current form.