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Governors Also Have A Stake In Health Care Overhaul


Here's a quick update on Senate health care measures. The latest Republican plan to replace the Affordable Care Act is dead for lack of votes. An alternative, to just repeal without replacing, also appears dead for lack of votes. President Trump says he's willing to do nothing.


PRESIDENT DONALD TRUMP: Let Obamacare fail. It'll be a lot easier. And I think we're probably in that position, where we'll just let Obamacare fail. We're not going to own it. I'm not going to own it. I can tell you that Republicans are not going to own it.

INSKEEP: Whatever happens will be felt in the states, including Arkansas, where Asa Hutchinson is the Republican governor. Governor, welcome back to the program.

ASA HUTCHINSON: It's always good to be with you.

INSKEEP: Is it OK to let Obamacare fail?

HUTCHINSON: Well, that's not what we need to have. Whenever you look at the long-term health of our delivery system in Arkansas and the nation, this is too expensive of a program. Medicaid continues to grow and expand and be costly. And so you've got to look at the long-term cost of it and health of it. And then you have the issue of access to health insurance, with many of the carriers pulling out of various states.

In Arkansas, we're more fortunate because we have our expanded Medicaid dollars actually buying insurance on the individual - on the marketplace. Therefore, our premium costs are more controlled, and we have carriers still participating and competing in that marketplace. So there are some things that we've done right in Arkansas. But even with that, our expanded population was estimated to be 250,000 people, and it's grown to 330,000.

INSKEEP: Three hundred and thirty-thousand, so that's people who took insurance thanks to the Medicaid expansion, which was part of Obamacare. I'm wondering if we're getting at the dilemma for Republicans here, Governor, because you've got a Republican state. It voted for President Trump. It also has many, many hundreds of thousands of people who have benefited from Obamacare - the very program - the very law that Republicans in Congress have pledged to replace with something better, but they can't think of what that is.

HUTCHINSON: Well, it is a problem because, one, we've said we need to repeal Obamacare. And that was the right position because it was not sustainable long term. But we've tried to adjust in Arkansas. We've tried to accomplish reform. We tried to keep it cost effective. And under the current system, we're doing the best that we can. But we know that, long term, it's going to cost the state more money if you don't have a control on the cost.

And if we can't really return more flexibility to states, we can't accomplish the reform that's necessary. Now, if nothing happens in Washington, we're going to continue reform in Arkansas. Next year, we're going to be reducing that unexpected large number down by reducing the eligibility rate from - as we get a waiver from Washington. We also want...

INSKEEP: Oh, you're going to tighten eligibility to get Medicaid? That's what you're saying?

HUTCHINSON: We're tightening eligibility in the sense of reducing the income level, so we concentrate on those that need it the most. And that's what's marshalling resources about. I think that's what they were trying to do in the Senate. But it fell apart because it's a complicated subject in trying to be fair about it. But that's what we have to do, is marshal our federal and state resources to make it a safety net and not a permanent entitlement program when you come to those that are able-bodied.

INSKEEP: Governor, if I can, in a few seconds, would you urge Republicans now to work with Democrats to just fix Obamacare, which seems to be something politically within reach, rather than continuing to try to repeal it?

HUTCHINSON: Well, I think you have to - no, wait, come back. I'm first for repealing Obamacare, but you still have to have where you're going after that. And so - and that's the challenge with Democrats. They won't come on if you have to - if you're going to say you repeal it. But you've got to have a bipartisan solution here because you don't have the votes to repeal. If you don't have the votes to - with the new Senate plan and to reform it, then you've got to start saying, there's things we can agree upon. Let's move forward with those. And so I think you need to catch your breath. I think you need to figure out what we can agree upon and get passed because what we have right now is a problem.

INSKEEP: Governor Hutchinson, it's always a pleasure talking with you. Thanks very much.

HUTCHINSON: All right, thank you. Good to be with you.

INSKEEP: Asa Hutchinson is the Republican governor of Arkansas. Transcript provided by NPR, Copyright NPR.