JONESBORO - Legislators have begun a close examination of the Arkansas Works Program after Gov. Asa Hutchinson proposed changes to the state's Medicaid program earlier this month.
Rep. Dan Sullivan, R-Jonesboro, said Thursday he and other state legislators have begun reviewing the proposed changes to the Arkansas Works Program that include capping the eligible participants of the program to those who make a wage equal to or less than the federal poverty level. Previously, anyone making 138 percent of the federal poverty level could apply for the program.
The difference would boot about 62,000 Arkansans from the subsidized program and into the private insurance marketplace. Many of those, a worksheet from the governor's office points out, are eligible for other federally subsidized private coverage. Any changes to the Arkansas Works Program would have to be approved through legislation on the state level - something legislators have already discussed doing in a special session later this year.
"It's a big deal for the area, because on the current path, [Arkansas Works] is unsustainable," Sullivan said. "Right now we are at a 95 to 5 match, where the state pays 5 percent and the federal government pays 95 percent. But over time, match percentages are set to shift. And we have expanded so much that we have about 320,000 people on the program, and if we assume more liability on the state level, we can't afford to pay it."
According to the Arkansas Center for Health Improvement, the program's original intent was to offer health care coverage to about 250,000 low-income Arkansans. By the year 2020, the match was scheduled to reach 10 percent for the state, with 90 percent coming from the federal government.
With an increase in participants and a shift of payments onto the state, some legislators worried it would take money from other costly programs like education or roads.
"It's a double hit," Sullivan said. "One, it would cost more in tax money, and Arkansas would have to pay more. And it would take more of our budget to pay for it, which means we would have to cut into other services we provide like roads or education. We'll have to pay for insurance first. Secondly, it would impact people's health benefits. We'll have to reduce services provided in the program, and we'll have to cut somewhere."
Sen. David Wallace said he had yet to make up his mind on the governor's proposal, but said he looks forward to studying it more before a special session is called. He said he'll continue to work with his constituent's interest in mind, whichever side he takes on the issue. Rep. Johnny Rye, R-Trumann, did not return a call for comment before press time.
Sullivan said a lot of moving factors will need to be considered by state legislators in the special session.
"I've been participating with several of the legislators in weekly meetings and conference calls to look at what I've been describing to move Arkansas in a direction that is sustainable for us," Sullivan said. "I think the governor has some good ideas here, and the points he is making have validity. I'm focused on putting a program together that puts Arkansas in the right direction and moving forward. Finding out exactly how we'll do that will come in the legislative session, so again I like his ideas, but how far we move and how quickly we move and what we move is all to be determined."
Statewide pressure to reduce the amount the state spends on health care has been reflective of the national effort to repeal and replace the Affordable Care Act, also known as Obamacare. Through Obamacare, the uninsured rate of Arkansans has declined rapidly since 2014, the Georgetown Health Policy Institute estimates.
Regional hospitals like Lawrence Memorial estimate a complete repeal of Obamacare would be costly. Junior Briner, the chief operating officer of Lawrence Memorial Hospital, previously told The Sun that an offer on tax credits - as proposed by the failed legislation that would have repealed Obamacare, would not have been effective.
"If they completely repealed it, it would affect us by over a million dollars a year," Briner said. "No we're not in favor of a repeal. We weren't opposed to the new workforce that the governor put in last year, but when they start redoing this thing, when you start giving people tax credits, that doesn't mean they're going to pay their bills."
Of greatest concern for many of the 62,000 Arkansans that fall outside of the 100 percent parameter of the governor's proposed plan, many feel they've been cut out of a program they were previously provided. A shift to a national policy means less local care and more standardized care from private insurance providers.
"Now the people in that window - we aren't dropping them off, just shifting them over to a federal plan," Sullivan said. "I don't know all the details about the switch yet, but I do know they'll be on a qualified health plan, where they will receive tax credits and cost-sharing reductions. So, they'll get subsidies."