The Delta Grassroots Caucus (DGC) is a broad coalition of grassroots leaders in the eight-state Delta region. DGC is also a founding partner of the Economic Equality Caucus,
which advocates for economic equality across the USA.

Gov. Hutchinson & Health Care Speakers; & Need to Preserve Health Care Law Mandate

Posted on November 30, 2017 at 03:16 PM

This is the 3rd in a series of reports on Oct. 19-20 Delta Caucus in Little Rock.

Gov. Asa Hutchinson, Bo Ryall, CEO of the Arkansas Hospitals Association, and Billy McFarland of Judson College in the Alabama Black Belt gave thoughtful, highly informative presentations on health care the Oct. 20 session of the Delta Caucus at the Clinton Library in Little Rock.

With Congress debating important changes in the Affordable Care Act that are included in the latest version of the tax cut bill, we are summarizing the great presentations made at the recent Clinton Library session of the Delta Caucus by Gov. Hutchinson, the Arkansas Hospitals Association CEO Bo Ryall, and Billy McFarland of Judson College-currently in the process of establishing a new rural hospital in the heart of the Alabama Black Belt.

It is vital for all our partners to follow this debate and express their views to your representatives in Congress, as well as at the state level.

These reports are in-depth and we do not expect anyone to read all of it, but please scroll down to those parts listed in the Table of Contents that are most important for you.







I. Comment the Flurry of Health Care Changes being considered for inclusion in the tax bill now being debated in Washington, DC

As Bo Ryall said in his presentation, there are so many new and constantly changing developments on the health care front that you need to check your E-mail and Twitter accounts every 10 minutes to make sure you’re not out of date. We will note some of the key pending developments, but the substance of the health care presentations at the Oct. 20 Delta Caucus session is still fundamentally valid.

While there is a broad range of positions on this subject, the key conclusion is that we want to preserve the basic gains of health insurance coverage from the Affordable Care Act-including the modified version of it in Arkansas and other states-while making improvements and adjustments in it. Repealing it without a viable alternative in place would be a huge mistake.

For the conference as a whole, we had Gov. Hutchinson, Rep. Crawford, US Sen. John Boozman speaking by video, Rep. French Hill, Alternate Federal Co-Chairman Peter Kinder of the Delta Regional Authority, Chelsea Clinton speaking about the domestic USA programs of the Bill, Hillary and Chelsea Clinton Foundation, Dean Todd Shields of the J. William Fulbright College of Arts and Sciences at the University of Arkansas, Fayetteville, and grassroots advocates on job creation, health care, education, and women and minority issues.

A total of 131 people attended parts or all of the conference.

Series of proposals being debated in Washington, DC regarding health care: Regarding the current health care debate, the substance of the presentations made at the recent Delta Caucus conference are still valid. Right now there is a vital debate in Congress on the future of the Affordable Care Act. While there is a broad range of views on this subject, most Delta Caucus partners would strongly support preserving the gains made by and improving the Affordable Care Act-including the Arkansas Works Medicaid expansion program that has led to 300,000 Arkansans having health insurance-rather than taking any action to gut the ACA.

In the current tax bill there is consideration regarding a provision that would gut the health care law requirement that most Americans have health insurance or pay a penalty. The Congressional Budget Office analysis revealed that this would leave 13 million Americans uninsured by 2027.

It would be greatly preferable to improve, modify but preserve the Affordable Care Act rather than throwing many people off of the program. We urge all our partners to contact your Members of Congress and urge removal of this provision from the tax bill.

Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) promoted an ACA stabilization bill in an effort to lessen the impact of repealing the health law’s requirement that all individuals buy health insurance- But unfortunately the Congressional Budget Office reported on Nov. 29 that the stabilization bill would have no impact on its estimate of the large number of Americans who will be left uninsured if the tax bill retains the provision eliminating the ACA requirement that Americans have health insurance or pay a penalty.

The CBO estimates that repealing the mandate would leave 13 million Americans uninsured by 2027, and for the shorter term, 4 million people would lose health coverage bin 2019.

The Delta Caucus encourages pragmatic, bipartisan efforts that are being made in the Senate by Sen. Lamar Alexander (R-TN), Sen. Susan Collins (R-Maine), Sen. Ben Nelson (D-FL), and others to come up with a compromise that would avoid destroying the gains made by the ACA while trying to make improvements in it. We continue to support those efforts for a reasonable compromise.

There is considerable confusion about the health care provisions in the tax bill-please think about this-a tax bill is supposed to deal with taxes, NOT a massive change in health care law. The provision is wrong and threatens to gut the Affordable Care Act, which would have ominous consequences eventually for the Arkansas Works program in Arkansas and gains from the ACA in other Delta states.

Whatever your viewpoint on this, we would ask that you contact your US senators and representatives in all 8 states and weigh in on this tremendously important issue.

II. Presentation of Bo Ryall, CEO, Arkansas Hospitals Association (AHA) on the Arkansas Works program:

Bo Ryall said that President Trump’s decision not to make the cost sharing reduction payments to insurance companies had an immediate impact in Arkansas.

Blue Cross/Blue Shield had previously applied for new insurance premiums on the marketplace with a 7.8% increase, but after the President’s decision they expanded that to 14.2%.

Ryall said that prior to the President’s decision, in Arkansas most insurers came in with increases under double digits, and “we felt like we had a stable market.” By not making the cost sharing reduction payments, these increases almost doubled in the case of Blue Cross/Blue Shield and more than doubled for two other insurers.

Ryall supported the bipartisan compromise of Sen. Lamar Alexander and Sen. Patty Murray that would give states greater flexibility to preserve subsidies for low-income people and provide cost sharing reduction payments.

There are many proposals being discussed in Washington, DC and the Delta Caucus continues to urge all our partners to contact their representatives in the House and Senate and ask for a compromise that would preserve the basic gains of the ACA.

Arkansas Works success-307,000 people now receiving health insurance who did not have it before: The AHA CEO said that the Arkansas Works program is the Arkansas version of Medicaid expansion, originally called the Private Option, has clearly been a great success, leading to 307,000 people in the state who are now receiving health insurance that previously did not have insurance.

The reduction in the number of uninsured in Arkansas has decreased from 21% to 9%, the second best improvement in the entire country after Kentucky.

It is great to see two of the Greater Delta Region states in Arkansas and Kentucky (the west Kentucky Delta is an integral part of the region) leading the nation in the reduction in the number of uninsured people.

Preventive services: Ryall said Arkansas Works has allowed people to receive preventive services that they did not receive in the past. By having an insurance card, they can get appointments with a physician so they can get services provided at an earlier date before it becomes an emergency, rather than showing up in emergency rooms for expensive care after the problems had become much worse.

Regarding hospital finances, Ryall said that is crucial for many small hospitals in rural areas that are barely surviving or losing money. Arkansas Works has led to a reduction in uncompensated care for hospitals of $149 million.

Those reductions in costs are very helpful for small rural hospitals that are anchors for the community not only in health care but also in providing good jobs for local areas.

Arkansas Works has come in under budget and is fiscally sound: Ryall emphasized that Arkansas Works has come in under budget, has met all the budget caps set by the federal government and has net budget neutrality. There has been incorrect talk that Arkansas Works costa a lot of money and is over budget, but he stressed that those allegations are simply not true.

In addition to the changes being debated at the federal level, there have also been changes at the state government level that the federal government has not yet approved.

One important change-if approved-would be a reduction in eligibility for Arkansas Works from 138% of the federal poverty level to 100% of the federal poverty level. The Arkansas Department of Human Services estimates that this will have an impact on about 60,000 people in Arkansas beginning next year.

This group of people will transition from the Arkansas Works program to the marketplace. Ryall emphasized that it’s very important to have a stable marketplace and they are not immediately taking away insurance from 60,000 people in January, 2018. The Dept. of Human Services will do the transfers on a rolling basis of about 5,000 per month.

Ryall asked for Delta Caucus partners to help get the word out about this change. Insurers, hospitals, health care providers will be working on informing people about this transition. For this group of people they will still be eligible for subsidized plans on the marketplace, “so we need your help in encouraging people to sign up for these.”

In citing the impact of this transition in a number of Arkansas Delta counties,

–in Craighead County 2,300 people will be moving from Arkansas Works to subsidized plans;

–In Mississippi County the number is 1,000;

–In Crittenden County, 1,200;

–In Jefferson County, 1,500;

–In Phillips County, 532;

–In Desha County, 315.

Ryall stressed that it is crucial to get the word out that these people’s insurance will continue, but it will be different and will cost them a little more.

Work requirement-an important change is a work requirement. All the specifics are not yet known, but one concern is that it should not be too burdensome for people to prove that they have a job. Not everyone has access to computers and the Internet or transportation to get their information in, so Ryall called for a process that will be easy to implement and not a burden on working people.

Concerns about incorrect perceptions about health care, due to all the changes and proposals for changes being debated at both federal and state levels. There is a concern that some people may have erroneously concluded that repeal and replace of the ACA did in fact take place (which of course is not true) and that there are no longer opportunities for Arkansas Works. The supporters of Arkansas Works have gone to bat for the program and have preserved it for many years now, and we intend to do so this time as well.

In an updated communication between the Delta Caucus and Bo Ryall on Nov. 29, he said that some people may not be aware that the provision in the tax bill discussed above would remove the mandate that most Americans have insurance or pay a penalty.

There is some confusion because this is a tax bill, but it contains a provision regarding health care that the CBO indicates would cost 13 million people their health insurance by 2027, as noted above.

Please call your US senators and representatives and urge them to remove this provision from the tax bill.

The open enrollment period this year is much shorter than in the past-only from Nov. 1 to December 15.

The federal government is also not putting the advertising dollars about the program as it did in the past or spending money on navigators that helped enroll people in insurance. This is not out there in full force as it was in the past. Despite these obstacles, Ryall stressed that “we need to spread the word that health care is still available through

Arkansas definitely still has insurance options and is fully covered across the state. This is in contrast to some other states where some counties are not covered.

Surveys have indicated that many of the remaining uninsured people believe they can’t afford coverage, but they have not explored their options. Thus, we need to encourage everybody to go to and explore their options, because there are different plans through Arkansas Works or subsidized plans that could be helpful.

Ryall closed by saying how important health care is to assure that we have a healthy, productive workforce, and we need our hospitals to continue and prosper so that they can provide essential health care as well as good jobs for the economy.

Ryall congratulated Billy McFarland of Judson College on the unusual and great accomplishment of establishing a new rural hospital.

III. Billy McFarland, Special Assistant to the President of Judson College, Marion, Alabama-on Judson’s establishment of a new rural hospital in the heart of the Alabama Black Belt.

The Alabama Black Belt is not geographically in the Mississippi River Delta region, but this area is historically, culturally, economically and demographically quite similar to the Delta region so we join forces with our colleagues there to advocate for the community and economic development of the eight-state region as a whole.

Billy McFarland is a long-time senior adviser to the Delta Grassroots Caucus. For the past year and a half he has been working with a coalition to establish a new rural hospital in Marion, Alabama in Perry County-one of the poorest counties in America.

McFarland said that many people seem to think that rural hospitals are going by the wayside and they can’t be viable, but as his group researched the hospital project they discovered that rural hospitals are vital not only for the health care they provide their constituents but they can also be an economic engine for development like a college or a business.

McFarland said the Marion hospital will utilize the the Critical Access Hospitals program of the Center of Medicare and Medicaid Services (CMA) of the US Dept. of Health and Human Services. This designation for certain rural hospitals was created by Congress in 1997 in response to hospital closures in the 1980s and early 1990s.

McFarland said that unlike Prospective Payment System (PPS), the Critical Access Hospitals provide 101% reimbursement, and that enables them to maintain a solid cash flow and to remain profitable. There is one other similar hospital in Alabama three counties over, and the Marion/Judson College hospital will use their management team as a model.

The Judson project is partnering with an organization that operates seven hospitals in Mississippi and one in Alabama. The Delta Caucus looks forward to the progress of this excellent effort to increase health care opportunities in the heart of the Alabama Black Belt.

On a broader subject, Delta Caucus Director Lee Powell said that Billy McFarland has a longstanding record of working in a pragmatic, bipartisan way with leaders from both parties.

Billy is a moderate Republican and has relationships with Alabama leaders of both parties, including Republican US Senator Richard Shelby and Democratic US Representative Terri Sewell. (He is currently a candidate for the state legislature in Alabama.)

McFarland said that he has worked in rural Alabama for 10 years now, previously as Vice President of the University of West Alabama and now at Judson College, and he believes it is crucial to support a bipartisan compromise on health care such as that of Sen. Alexander and Sen. Murray.

McFarland emphasized that based on his experience in Alabama we need to keep bipartisan compromise proposals in health care in place to help these people rather than a “repeal and replace” approach. He commended Sen. Alexander and other moderate voices who want to improve the ACA while keeping programs in place for health care and reduction in poverty in our region.

IV. Gov. Asa Hutchinson’s presentation on health care

Caucus Director praised Gov. Hutchinson’s leadership on job creation projects in the Delta, education improvements in the public schools, trade, and in particular said that the Arkansas Works program has done more to help people in the east Arkansas Delta than any other initiative, and “it would not have happened without Gov. Hutchinson’s leadership.”

Gov. Hutchinson cites success of Arkansas Works: The governor said that Arkansas has succeeded in maintaining the Arkansas Works program, which is greatly needed in the Delta and the entire state, has helped rural hospitals, expanded health care access in the Delta, and the budget is being carefully managed to pay for it and make it sustainable for the long term.

Hutchinson said he has asked the Trump administration for a waiver so that instead of Arkansas Works premium assistance going to people at 138% of the federal poverty level, it will be reduced to 100% of the federal poverty level in order to concentrate our limited resources from the state perspective to help people who need help the most.

As Bo Ryall had discussed, if Arkansas gets the waiver, then about 60,000 people will move from Arkansas Works Medicaid expansion over to the exchange, with a limited number of people every month rolling off of the Arkansas Works to the exchange to get their health insurance. Under Arkansas Works, people at 138% of the federal poverty level contribute 2% of their income toward their premium, and that’s exactly what is expected on the exchange.

Gov. Hutchinson said “If we can move them smoothly to the exchange there will be a continuity of their health insurance. The idea is not to say, ‘You’re cut off from health insurance.’ The idea is to move them to the exchange, move them up the economic ladder, and concentrate our resources on those that need help the most.” It’s crucial to understand that as Arkansas moves on to the new phase next year.

In response to a question, the governor said he supports the bipartisan compromise supported by Sen. Alexander and others from both parties.

The governor emphasized that he has always held the view that the ACA needs to be replaced with something that is sustainable over the long term, but has never advocated repealing the health care law without knowing where we are going next. He said the Alexander bill (discussed above) fixes a problem that would hurt people if it were not fixed; it’s a good temporary solution until we have a long-term solution in place.

V. Gov. Hutchinson’s presentation on education, job creation in the Delta, agriculture and trade

Gov. Hutchinson’s education improvements: The governor said that education is crucial for the Delta, and that Arkansas can’t be successful unless all regions are successful including the Delta. Hutchinson grew up in the hill country, but he said that “even a hill country guy can fall in love with the Delta, with its beauty, its future, its history and its great opportunities.”

Hutchinson said that the Delta has been a major focus of his, and that whenever policies are discussed he always asks, “How does this impact the rural schools and the rural communities? Are we leaving anybody behind?” He said he had grown up in a rural school, and “they are really the fabric of Arkansas.”

Arkansas’ success in computer science education: The governor’s first initiative in education was to put computer coding in every high school. Arkansas was the first state to mandate this, and placed $5 million to re-train teachers. The state placed standards in the lower grades for computer science education.

As a result, Arkansas rose to the top of the nation in computer science education. Google, MicroSoft, Facebook, and Wired magazine have recognized Arkansas as setting the example for the nation in this field.

The governor said the state wanted to make sure these efforts worked in rural schools. Grants were provided to re-train teachers, and then teachers who were able to get certified in teaching computer science were given a $2,000 stipend as an incentive to encourage these efforts. The governor has traveled to 50 high schools in the state to promote computer coding.

Access to high-speed broadband in the public schools: The federal government set a standard that in order to meet the educational needs of the future, every school has to have access to 100 kilobytes of information on broadband per student per second. When Hutchinson became governor the state was not anywhere close to this level.

Arkansas made it a state “backbone” to provide that Internet access. Arkansas is doubling the speed the federal government said is needed: instead of 100 kilobytes per second per student, the state is putting in 200 kilobytes per second, per student. So Arkansas doubled the national standard.

Arkansas is in the top tier of states that have high-speed broadband access to all the public schools in the state.

Delta Caucus senior partners pointed out that it is great for Arkansas to be among the nation’s leaders in computer science, high-speed broadband access, as well as in reducing the numbers of people who don’t have health insurance, along with Kentucky. Arkansas and other Delta states unfortunately rank at or near the bottom in food insecurity, poverty and other key indicators, but Arkansans can also take great pride in leading the nation in these key education and health care initiatives.

Job creation, agriculture, farm trade to Latin America, and economic development: The governor said that for the Delta, agriculture will always be crucial. He has made trips to promote the state’s economic development to Cuba as part of his efforts to support opening up farm trade to Cuba that would provide major markets for the Delta region’s rice, poultry and other agricultural products.

In his travel to Cuba, China, and Europe, the governor said he not only recruits industry buty also raises the issue of agricultural trade. He expressed delight that China has opened its doors to rice from Arkansas, which is the leading rice producing state in America and produces about half of the nation’s rice each year.

Mexico as a major purchaser of Delta rice: and The governor traveled to Mexico and discussed trade, investment and educational exchanges with that vital economic partner of the US. He emphasized that Mexico is the leading purchaser of rice from the USA, and if you look at NAFTA and the current re-negotiation efforts, it is very important to remember that since NAFTA was enacted Arkansas has had a positive trade balance with Mexico-“we sell them more than we buy from them.”

The governor traveled to Queretaro, Mexico, where Arkansas State University is the first American university with a campus based in Mexico whose degrees are recognized in the USA. Among other activities, the ASU Mexican campus teaches English to Mexican students. The Hispanic population in Arkansas and the Delta is growing rapidly so the many trade, investment and educational ties will only become more important every year.

Hutchinson pointed out that a good illustration of the flow of commerce is that in the aeronautical industry Mexicans buy parts from Arkansas that they work on in a sub-assembly fashion, and then send the parts back to the US for final assembly into airplanes. That’s an example of the back and forth Arkansas has with Mexico, with Arkansas having a positive trade balance with our neighbor to the south.

Delta Caucus senior partners would like to highlight the reality that Gov. Hutchinson has stated the facts about Arkansas’ positive trade experience with Mexico after the enactment of NAFTA. This refutes the erroneous notion that NAFTA has somehow been harmful to the Delta region, when on balance it has been a plus.

The reality that too many Arkansas companies re-located to Mexico in earlier years is based upon the fact that Mexican workers will work for much lower pay than American workers will, and that fact would exist even if NAFTA had never been passed. Mexico also has fewer environmental and other government regulations that some companies see as a plus, although a longer term view would be that environmental and labor regulations are positive in the long run for all concerned.

Many plants in the Delta that moved to Mexico for cheaper labor subsequently moved to China or other places with even cheaper labor and even less government safeguard regulations. That had nothing to do with NAFTA.

We are all in favor of improving NAFTA and making sure trade is fair. But the fact is that Mexico and Canada are the most important trading bloc the USA has, and the wage differential between the US and Mexico would exist if NAFTA had never been passed.

On another subject related to Arkansas and Delta ties to Latin America, Gov. Hutchinson welcomed a group of seven members of the National Assembly of Ecuador to the Delta conference, along with three people affiliated with the US State Department and Toni Carr, executive director of Global Ties Arkansas, an organization that brings international visitors to the state.

Gov. Hutchinson said he has been to Ecuador, and told the national legislators that “you have a lovely country and thank you for joining us today.”

Delta Caucus senior partners expressed the hope that expanded trade and investment ties could be made between the Delta and the nation of Ecuador.

Manufacturing jobs: The governor pointed out two major job creation projects that are not quite in the Delta itself but are close enough for many people in the region to be hired and commute there. One was a biproducts mill in Arkadelphia, slightly to the west of the Delta in which a Chinese company will invest about $1 billion utilizing timber resources.

In central Arkansas, a Chinese garment company that manufactures 90% of its products for Adidas will re-locate there, and they will hire 400 people, some of whom will be from the east central Arkansas Delta.

“But I wanted a success in the heart of the Delta,” the governor said. Arkansas has attracted a major Chinese company–Shandong Ruyi Technology Group–to re-locate in Forrest City in the heart of the Delta at the old Sanyo facility that had been abandoned for 10 years.

This garment manufacturer sells high-end products to sell in Europe and all over the globe.

They will set up a cotton processing facility in the Forrest City area that will invest $410 million, create 800 jobs, and buy 800,000 bales of cotton every year.

The jobs reportedly will pay $15 an hour or more.

To give an idea of the huge size of this project, in 2016 in Arkansas the state produced only 820,000 bales of cotton, so the new plant’s purchases will equal a year’s production of cotton.

Arkansas is the fifth largest producer of cotton in the USA.

Mayor Larry Bryant of Forrest City was at the conference and thanked the governor for this project that will have a major impact on the area’s economy.

The governor replied that “Arkansas is part of the global economy and the Forrest City project illustrates it. When you’re looking for vast acreage, the Delta’s got a lot of flat land, an interstate going through the heart of it, and the Mississippi River. So the opportunities are immense.”