Questions and concerns about healthcare dominated the discussion during an informal public event with Rep. Steve Womack and Rep. Bruce Westerman at the Alma Senior Center on Monday.

About 70 area residents with varying political affiliations attended Coffee With a Congressman to hear from Womack and Westerman, who represent Districts 3 and 4 respectively.

Most of the event centered around questions regarding healthcare and the recent passage by the House of Representatives of the American Health Care Act.

Mona Harper, an Alma resident and Air Force veteran, was the first to voice concerns about the AHCA. She became emotional when calling herself a representative for homemakers, caregivers and small business owners.

“(I’m) very, very concerned how you two will help protect the seniors and the preexisting conditions,” Harper said. “Your vote that you took did not show me that protection… Are you going to protect us?”

Harper, who is 60, noted that for her age group under the AHCA passed by the House, she could be paying as much as five times as much as younger adults for her insurance coverage.

Under the Affordable Care Act passed under President Barack Obama, also known as Obamacare, insurers are prevented from charging more than three times as much.

Womack answered that the AHCA is the “first stab at a solution to healthcare.”

“It is a starting point - it is not the finished product,” Womack said. “We are going to do everything we can to protect people with preexisting conditions and we have a plan that we think will bring down the overall cost of healthcare insurance.”

Possible solutions mentioned by Womack and Westerman included Medicaid block grants, work requirements for the able-bodied and invisible risk pools for people with preexisting conditions.

Womack blamed “open-ended entitlement programs” for taking the lions share of taxpayer money and preventing funding from going to other programs “that are critical to people with preexisting conditions,” such as health research.

Jennifer Hansen, a resident in Womack’s district, acknowledged that the ACA was a law that needed improvement, but questioned how the AHCA was doing that.

“You’re now asking people 64 years old to pay up to five times what the youngest people pay, but they’ll only get two times the tax credit,” Hansen said.

Hansen also mentioned the MacArthur amendment to the AHCA, which would allow states to apply for waivers to some requirements in the law such as what must be covered by insurers.

“The MacArthur amendment actually lets states waive or erase a general understanding that most Americans thought was something we could rely on of what healthcare coverage is,” Hansen said. “So now each state, depending upon how they lean, gets to decide what they’ll cover.”

Hansen also pointed out that under the AHCA, insurers could restrict coverage for policy holders who let their insurance lapse for 63 days or longer.

“There is no preexisting security in what you voted for,” Hansen said. “There is no reduced cost of insurance in what you voted for. And there definitely is no very clear understanding and you cannot guarantee to us today that the average ailment and medical condition that most of the people in this room will experience because of our age … will be covered.”

Rather than defending the parts of the AHCA mentioned by Hansen, Womack said he passed legislation that he thought was better than what is currently in place.

“There probably hasn’t been a bill, substantive legislation, that has worked its way through Congress where every single thing on the bill I agreed with. I can’t think of one,” Womack said. “But I’m in a spot as a legislative person to take something that is better than what we have now and give it an opportunity to see the light of day. In my strongest opinion, what I voted for last Thursday is better than Obamacare.”

His statement was booed by some in the audience, but Womack reiterated a claim that the ACA has driven up deductibles and made it difficult for people to afford insurance.

“What we have simply said is, this program - the Affordable Care Act - is being crushed under its own weight and it is a matter of time before most states won’t have but one insurance company on the exchange, if they have that,” Womack said.

Hansen called the AHCA a tax cut for the wealthy because the bill does away with items such as a tax on people with high incomes and limits on flexible spending accounts, both of which had been put in place under the ACA.

Westerman pointed to younger adults, who he said are unable to afford insurance because of lowered rates for older people under the ACA.

“They’re choosing to pay the penalty because they’re not able to afford the insurance,” Westerman said.

James Kohut, who named himself as a physician in Fort Smith, asked the congressmen why they did not work to improve the ACA rather than repeal and replace it.

“Flawed though it was, it did result in a dramatic increase in the number of Arkansas citizens who were able to get insurance,” Kohut said.

Kohut referred to comments made earlier by Womack about the necessity of the process by which laws are passed regarding his own concern about how swiftly the AHCA was approved by the House.

“It had a year of hearings, it had a CBO score, it had a summit with its opponents - and you may argue that it was not passed in a bipartisan way, but the process was open to commentary and open to the nonpartisan CBO scoring,” Kohut said. “The bill that you passed, your vote, had none of that. There were no hearings on this bill, the CBO scoring has not yet been released … I can’t imagine that process is defensible if you’re passing a bill that affects one-sixth of the economy, the healthcare of millions of Americans including a huge number of Arkansas citizens and you haven’t given it the process it deserves.”

Westerman noted that the original bill had a CBO scoring, but Kohut countered that that score indicated 25 million people will lose insurance under the AHCA and that premiums would rise.

“If you’re standing by the CBO scoring of the original bill, that looks to me like a disaster for most Americans who rely on healthcare,” Kohut said.

“The CBO score originally said it would lower costs,” Westerman said.

“If you boot 24 million people off of healthcare, you will in fact lower costs,” Kohut said.

Westerman clarified that the CBO used a baseline in the original score assumed an additional 7 million people with insurance under the ACA.

“Another 5 to 10 million people that they said would lose healthcare are 5 to 10 million people that are being forced to buy healthcare or pay a penalty right now,” Westerman said.

Kohut claimed that the idea that the ACA is a major contributor to rising deductibles is incorrect.

“If you look at the rise of premiums in healthcare, premiums have been rising for 30 years - with or without Obamacare,” Kohut said. “People conflate all the problems of healthcare to Obamacare, and that’s not true. Obamacare is a marginal extension of insurance to people who were dreadfully under insured.”

Cost reductions, Kohut said, will likely be paid for by people who were previously covered under the ACA with a reduction in their health coverage.

“What I would say that Congress needs to do is fix Obamacare,” Kohut said. “Wholesale slashing of healthcare expenditures while you cut the taxes on rich people that paid for it is not the way to do it.”

Womack asked Kohut asked what Congress could do to “fix Obamacare.”

“What can we do to stop the flagrant increase in deductibles and, in many cases, the flagrant increases in premiums for a large percentage of our population that liked their healthcare plan and lost it?” Womack asked.

“First of all, make the insurance mandate meaningful,” Kohut said, “so that insurance works - and the way that insurance works is that everybody gets insurance so that when you get sick, you’re covered. You don’t just wait until you’re sick to buy insurance.”

Kohut also suggested implementing a competitive national insurance marketplace, and mandating what insurance companies cover.

“Let’s abandon pride,” Kohut said. “Just say we have this system, there are a lot of great Republican ideas for introducing market forces that could make it much better. Let’s do that; forget Trumpcare. It’s going to hurt a lot of people.”

Womack and Westerman both said they were not in favor of using governmental authority to force Americans to buy health insurance.

Other topics discussed at the meeting included the future of local infrastructure projects and a legislative bill that would allow veterans to collect full retirement pay and disability compensation from Veterans Affairs simultaneously.