ROBERT SIEGEL, HOST:
Asa Hutchinson is the governor of Arkansas. He's a Republican, and he joins us now from Little Rock to give us his reaction to the proposed replacement for the Affordable Care Act.
Welcome to the program once again.
ASA HUTCHINSON: Hi, Robert. Great to be with you.
SIEGEL: And what failings of the ACA, Obamacare, did you see in Arkansas, and is does bill fix them?
HUTCHINSON: Well, the concern of the Affordable Care Act is that, first of all, there's a long-term cost that we're concerned about here in the state of Arkansas in terms of budget. But also, in the Medicaid expansion, our numbers were much greater than what was anticipated at the beginning. And we didn't have the flexibility that we needed under the Affordable Care Act. And so I'm delighted with the direction that we're moving, even though the outcome is uncertain at this point.
SIEGEL: How big a share, by the way, of Arkansans are on Medicaid?
HUTCHINSON: Well, I mean, we have our traditional Medicaid. But if you just look at the Medicaid expansion, it was estimated that we'd have 250,000 on the Medicaid expansion. And we currently have 331,000.
The big thing, though, is that we want to be able to put in a work requirement in which would operate similar to the work requirement in a SNAP program. You're talking about healthy individuals that are capable of working that might need training, that might need opportunities. And we want to be able to have that to be a part of the Medicaid expansion program. And that's why we call it Arkansas Works. And so we need additional waivers and flexibility to accomplish that. And we believe we can get that under the new approach that Congress is taking and this administration.
SIEGEL: But in this case, it's not just people who are - who are not working who would qualify for Medicaid. It's people who - who make up to 138 percent of the poverty line. Are there enough higher-paying jobs that people could qualify for through a program like that that would permit them to contribute to their health insurance costs?
HUTCHINSON: Well, the answer is yes. We have a 3.9 percent unemployment rate in Arkansas. And usually, the problem is not the availability of jobs as much as it is you have to have better training for the workers.
SIEGEL: The Affordable Care Act, Obamacare, was a very, very big, unwieldy piece of legislation with lots of different parts and different systems that - some of which work better than others. Should we assume that a Republican bill will be likewise, that the problem is just so big that we're not going to have a very simple, clean machine to fix health care?
HUTCHINSON: Well, there certainly is challenges to it. And the way you avoid bumps in the road in terms of changes is to give the states the greatest amount of flexibility and control. If you give us that kind of flexibility, then we'll be able to have a smoother transition. But if we have to have constant review, approval and submissions to Washington for every change that we make, then it makes it cumbersome and people get caught in the system.
The big difference between the approach that we want to take and what the Obama administration took under the Affordable Care Act is that they viewed it as a permanent entitlement. And we want to be able to see this as temporary assistance as people move up the job ladder and get more pay as time goes on. But not everybody fits in that category.
SIEGEL: Does that check out? That is, don't we inevitably have low-income people in America who really can't afford health insurance as it's been marketed prior to the ACA?
HUTCHINSON: That's true. There will be some that don't have the capacity to move up further, but there will be many others that will move up that ladder of success and will - through their training program, through job opportunities, will move out of it. And we've already seen that. The whole goal is that they are here on this assistance, and then they'll move on to the exchange or have the middle-class subsidy. And that will be available. But they will be participating in it. So it's a shared responsibility, what we want to move to.
SIEGEL: So in a word, your reaction to what's been proposed this week sounds - you're relatively positive about this.
HUTCHINSON: I'm positive about it as a good start. It accomplishes many of the objectives that I think are important, but it's not perfect yet. And the governors are going to be continuing to submit our ideas and evaluate the proposal and be a part of the debate. And it's not going to be a quick resolution, even though this is a good start.
SIEGEL: Governor Asa Hutchinson of Arkansas, thanks for talking with us today.
HUTCHINSON: Great to be with you. Thank you. Transcript provided by NPR, Copyright NPR.