In Washington the Republican-controlled Congress is speeding toward a repeal of the Affordable Care Act. While GOP leadership at the Arkansas state Capitol has said lawmakers should wait and see what happens, some conservative members of the legislature want action now.
State Rep. Kim Hammer (R-Benton) says waiting out the uncertainty is like being in a storm.
“It’s kind of like saying, ‘I see a tornado coming over the horizon. Let’s just stand here and wait and see which direction it’s going to turn,’" he said.
"I’d rather go ahead and build a safe house, you know, that we could all be standing in in case the tornado comes over us or the tornado turns away.”
Hammer is authoring a replacement bill that he hopes could become model legislation for the nation. It would limit Medicaid eligibility to able-bodied workers and cut others off the program.
“I think it also makes it difficult for the hardworking taxpayer to say, 'Why are we out there working two jobs when you’ve got somebody out there not working one job, but we’re paying for their insurance premiums?'”
Hammer’s plan would also increase incentives for employers to provide insurance.
The bill is unlikely to pass because state party leadership wants to wait for a federal framework. Rep. Charlie Collins (R-Fayetteville) says acting this legislative session would be foolish.
“So it would be like trying to play a sporting event before they’d written the rules. You could run around in circles, but you wouldn’t know if you’d made any progress or not,” said Collins.
With over 300,000 enrollees in its program, dubbed the Private Option and passed in 2013, Arkansas has seen the greatest percentage drop of uninsured people in the nation. The state has been projected to bring nearly half a billion federal dollars for Medicaid expansion over the next five years.
The program, which must be re-approved every year, has continued amid significant debate. Most state Republicans are now united by a desire to repeal the Affordable Care Act and reshape the Private Option, now "Arkansas Works," after a Republican rebranding. Sen. Missy Irvin (R-Mountain View) says she would be in favor of a plan that increases state authority.
“The way the Medicaid expansion has developed, we really don’t have a whole lot of control over the growth of those programs. And when you talk about the growth of the program, you’re talking about sustainability of a program,” said Irvin.
“So we can have the program, but we’ve got to do it in a way that’s budget friendly for our state,” she said.
Irvin and Collins support federal block grants that would fund Medicaid while capping expansion of the program. They would also establish more work requirements and asset-tests consistent with what they've called the “personal responsibility” of the beneficiaries. Collins believes free market models will be the antidote to entitlement programs that he says encourage laziness and waste. Affordable Care Act regulations have prevented these changes to date.
“Nobody is really under any kind of an obligation or a need to even think about what the cost is. Because the bills just get paid, and as long as the bills just get paid, why not just keep doing it?"
Irvin is championing the return of health savings accounts into which Arkansans would directly contribute. Personal illness-preventative decisions would be monitored and rewarded with public dollars through the savings accounts.
“We shouldn’t just say, 'here it is, go use it,'” she said.
Arkansas briefly experimented with a version of health savings accounts in 2015 and found they weren’t viable under the ACA.
Marquita Little, Health Policy Director for Arkansas Advocates for Children and Families, worries such measures would mean increased barriers to coverage for low-income people, even if they’re employed.
“So if it’s increasing a premium, if it’s making work a requirement in order to have insurance, if it’s changing that eligibility, if it’s doing much more frequent verifications of income rather than the current annual process, it all results in creating more barriers to coverage,” she said. “Making it more difficult to enroll or making it more difficult for people to keep their coverage.”
Senate Majority Leader Jim Hendren (R-Gravette) has suggested there will be a special session to resolve healthcare if the Affordable Care Act is repealed in Washington. Arkansas Governor Asa Hutchinson says he supports keeping Medicaid expansion.
The liberal-leaning Urban Policy Institute estimates 361,000 Arkansans will lose coverage if the Affordable Care Act is repealed without any replacement.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State News with Context.