1. What is the Graham-Cassidy Bill?

The Graham-Cassidy bill is a true replacement to the Affordable Care Act

(ACA or Obamacare) that, if passed, will provide states the flexibility through
block grant funding to innovate, identify efficiencies and find cost-savings
while maintaining coverage for their populations. It is our best and last
chance to repeal and replace the unsustainable ACA.

The Graham-Cassidy bill will repeal the individual and employer mandates
established under Obamacare and return the power to regulate insurance to
the states.

The Graham-Cassidy bill will also implement a more equitable approach to

federal health care funding for ALL states.

2. If the bill becomes law, will Arkansans with pre-existing conditions be

protected?

Absolutely. Throughout this debate, Governor Hutchinson has emphasized

his commitment to ensuring access to affordable coverage for all Arkansans,
including those with pre-existing conditions.

While Graham-Cassidy allows for a state to waive certain provisions under

the ACA, the statute clearly states that a Governor seeking such a waiver
would have to show an alternative plan to provide access to adequate and
affordable coverage for those with pre-existing conditions.

3. What would it mean for Arkansas?

If Graham-Cassidy passes: Arkansas Works would continue, as would the

reforms were working to implement (lowering the income threshold and
instituting work requirements) in the program. Between now and March 31,
2019, the date in which our block grant application would be due, the state
would begin working with our provider community, healthcare advocates, the
patient community, insurance carriers, and our state officials to design a plan
that works well for Arkansas. Its important that we get it rightand we will.
It will also allow us to continue to identify and achieve cost-savings we are
pursuing under current reform efforts. For example, the Governor and the
Healthcare Legislative Task Force, along with DHS, have developed a plan to
create $835 million in savings over a 5-year period. The State is well on its
way to that goal.
4. Will Arkansas lose federal funds under Graham-Cassidy?
 Graham-Cassidy puts federal spending on a budgeta realistic, manageable
and achievable budget. This sort of discipline is long overdue in Washington
and the states must be a partner in making our health care programs more
sustainable.

Federal spending will grow at a slower rate under Graham-Cassidy than

under current law, but we will have the flexibility needed to manage to the
new growth rates and we will no longer be required to pay a state match for
the Medicaid expansion population.

The level of funding that will be provided to Arkansas is sufficient, and we

already have experience successfully operating healthcare programs under
budget caps. In fact, our Arkansas Works program includes budget neutrality
caps, and the Childrens Health Insurance Program (CHIP) is based on capped
allotments. Graham-Cassidy has a similar structure.

Its important to note that the block grants under Graham-Cassidy represent
95% of the spending projections under current law (ACA) for private
insurance subsidies and Medicaid expansion, nationally. Therefore, we can
maintain high coverage levels under this plan.

5. Is there a state match under Graham-Cassidy like there is under the ACA?

There is no state match for Medicaid expansion required under the Graham-
Cassidy bill. Under Obamacare, Arkansas currently has a 5 percent match
($100 million) for this population that we pay to the federal government.
That match will increase to 10 percent ($200 million) a year in the coming
years under the current law.
Graham-Cassidy does not require a state match for the block grant funding
that will replace the ACAs expansion and private insurance subsidy system.
In Arkansas, this will free up more than one billion dollars in general
revenue between 2020 and 2026.
6. If this bill becomes law, will Arkansas proceed with current reform efforts to
the Arkansas Works program and the waiver request pending at the Federal
level?

The Graham-Cassidy block grants do not take effect until 2020. This means
Arkansas will proceed with the Arkansas Works waiver amendment as
planned, which includes lowering the income threshold for the program from
138 percent of the Federal Poverty Level (FPL) to 100 percent and instituting
work requirements.

Lowering the FPL to 100 percent will reduce enrollment in the Arkansas
Works program by approximately 60,000 Arkansans. Most of these
 individuals will then become eligible for federally subsidized coverage
through the individual marketplace, allowing the state to concentrate limited
resources on those who need it most. The block grant program would allow
us to continue a similar model beginning in 2020, if that is deemed to be the
best path forward for Arkansas.
7. If the individual mandate is repealed, will this destabilize the individual
marketplace? Wont premiums become more expensive faster if healthier
individuals flee the individual marketplace?

The best way to stabilize the market is to return control back to the states.
There is no such thing as a national health insurance market. Markets are
state and localcompetition for customers who decide for themselves what
coverage they want and at what price will lower premiums.

In many cases, the individual mandate has not been successful in convincing
healthy individuals to purchase insurance. The flexibility allowed under
Graham-Cassidy will result in a wider range of coverage options, which may
be a more effective way to motivate individuals to buy insurance.

Under the Graham-Cassidy block grants, states will have ultimate flexibility
to design an individual health insurance market that meets the needs of their
populations. For instance, they could provide direct financial assistance to
individuals to buy health insurance; direct payment to providers for health
care services; and/or assistance to insurance carriers to help stabilize
premiums. These mechanisms will also be helpful in ensuring market
participation and access to care.

8. How will funding for the aged and disable population be affected?

Under Graham-Cassidy, per capita caps will be applied to several different

Medicaid populations, including aged and disabled individuals. These caps
will be set based on several factors, including the cost of covering the various
populations in recent years. Additionally, the long-term growth rate for the
aged and disabled population will remain higher than the growth rate for
other populations, to account for the higher costs often required to provide
needed services to these individuals. In addition, Arkansas can utilize a
portion of its block grant funds for traditional Medicaid to fill any gaps, when
and where necessary.

9. Is block-granting health care funds to the states and letting them decide how to
use the money a good thing?

It is not only a good thing, but the right thing. The ACA proved, among other
 things, there is no national health insurance market. There are only state and
local markets. The ACA transferred authority over state health programs and
markets from the states to the federal government, causing significant
market disruption.
The federal government was never involved in regulating insurance until the
ACA and its role in the process in recent years has resulted in duplicative and
burdensome administrative requirements. The decisions about individual
mandates, mandated benefits, and all the other decisions the ACA moved to
Washington are best made at the state level by Governors who understand
the unique characteristics and needs of their states. Graham-Cassidy is about
putting authority and responsibility back together at the state level and that,
in itself, will help stabilize the markets.
10. Will states lose the block grant entirely after 2026?

No. Graham-Cassidy follows the CHIP model. As you may recall, when CHIP
was created, Congress only provided funding and authority for 7 years. In the
20-year history of CHIP, Congress has consistently reauthorized and
periodically increased funding for it. In fact, CHIP is up for reauthorization
now and there is a bipartisan effort to ensure the program continues.
There is no reason to believe future Congresses and Administrations will act
any differently in their approach this new block grant program, which will be
the basis of access to care for many Americans.
11. What is the Governors perspective in the healthcare debate?

Governor Hutchinson believes the Affordable Care Act is the wrong direction
for America. He has always supported its repeal, and his message has been
clear and consistent throughout this debate. The Governor believes it should
be repealed and replaced with something that works, is affordable, and
continues to provide access to healthcareall the while providing flexibility to
the states and a mechanism to better control costs.

Most importantly, the Governor has repeatedly stated that he will not support
a replacement bill that dramatically shifts costs to the states. Graham-Cassidy
meets these conditions and would enable Arkansas to develop an innovative
and sustainable path forward.