LITTLE ROCK, Ark. — Arkansas Gov. Asa Hutchinson is embracing the latest effort from fellow Republicans in Washington to repeal former President Barack Obama’s health overhaul, saying it would give the state the flexibility he’s long said he wants for Medicaid and other parts of the health care system. But, if it overcomes last-minute obstacles in the Senate, the plan could offer even more uncertainty for the thousands of people in the GOP state who have health coverage through the health overhaul.

After raising concerns about past health care repeal efforts that foundered in the U.S. Senate, Hutchinson endorsed the latest proposal to replace much of the law with block grants to states. It would also cut and reshape Medicaid and allows insurance rules that protect people with pre-existing conditions to be loosened through state waivers. It would also get rid of unpopular mandates for people to carry insurance or face penalties

“I see this bill as the best and last opportunity to repeal the Affordable Care Act, which is the wrong direction for America,” Hutchinson told reporters at the state Capitol last week. “I also see this as covering the major points that I’ve advocated for during the last six months.”

Hutchinson’s support came days before the bill was dealt a potentially fatal setback, with Republican U.S. Sen. John McCain saying he won’t vote for the measure. The bill gives Hutchinson a chance to publicly solidify his opposition to the health care law and counter any criticism from the right over his support for keeping the state’s hybrid Medicaid expansion, which covers more than 300,000 people. But it also could Hutchinson a chance to put his own mark on the state’s health care system.

It’s an imprint that Hutchinson has already sought with a proposal to remove 60,000 people from the expansion by lowering its eligibility cap, moving them on to the insurance marketplace, and imposing a work requirement on other enrollees. Under the hybrid program, Arkansas uses Medicaid funds to purchase private insurance for low-income residents. Arkansas is awaiting federal approval for the new limits on the program.

The biggest unknown, if the repeal effort succeeds, is what Arkansas’ new health plan would look like. Hutchinson has said the state would have until March 31, 2019 to work with providers, insurance carriers and others to craft its application for a block grant. Hutchinson left open the possibility that some of those funds could be used to address concerns about the rise in uncompensated care costs if the insurance mandate is eliminated.

“We can come up with our own formulation as to what our health care system should be like in Arkansas or any individual state,” Hutchinson said.

Both of the state’s Republican U.S. senators have said they plan to vote for the latest repeal effort. But Democrats, who had aligned with Hutchinson on efforts to keep the hybrid expansion, are railing against the governor for backing an effort they said would be devastating for the state.

“The governor’s past leadership on this issue only underscores how disappointing it is that he is willing to embroil himself in such a desperate, extremely-partisan legislative Hail Mary that would end Medicaid expansion in Arkansas as we know it,” state Rep. Michael John Gray, who chairs the state Democratic Party, said in a statement after Hutchinson announced his support.

The bill also faces pushback from health care groups who say it would result in more people losing health insurance coverage. Washington-based Avalere Health estimated the state would lose $6 billion in federal health care funding over seven years under the legislation. Hutchinson has argued that the federal funding under the plan is sufficient, and notes it won’t require Arkansas to pay a state match for the expanded coverage.

Hutchinson said he thinks Arkansas is in a good position whether the repeal effort succeeds or not. But he says the coming week could determine where the state will have to live with a law he and other top Republicans have run against since it was enacted.

“If this doesn’t pass, I think the Affordable Care Act is here in perpetuity. It’s built into the fabric of our health care system and I don’t see it changing,” he said. “So this is our last chance.”


Andrew DeMillo has covered Arkansas government and politics for The Associated Press since 2005. Follow him on Twitter at www.twitter.com/ademillo

An AP News Analysis