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Arkansas health insurance

Arkansas ranked dead-last on health. Can Obamacare provide relief?

Arkansas is known as The Natural State for its beautiful waterways and abundant wildlife. However, the state’s scores on public health indicators aren’t so pretty. See how Arkansas compares to other states in terms of health status and consider if expanded health insurance coverage through the Affordable Care Act can play a role in boosting the state’s overall health.

Arkansas health ratings

Arkansas is ranked 50th on the Scorecard on State Health System Performance 2014, which compares the 50 states and the District of Columbia. The score is based on measures within four categories: access, prevention and treatment, avoidable hospital use and costs, and healthy lives. See the Arkansas Scorecard for rankings in the individual measures. Arkansas was ranked 49th in the 2013 evaluation.

America’s Health Rankings, most recently published in 2013, puts Arkansas at 49th. The low ranking arises from a high uninsured rate; high rates of obesity, smoking, and physical inactivity; limited availability of dentists; and low childhood immunization rates. Arkansas scored well for the low rate of binge drinking and limited health disparities across educational attainment levels.

The 2014 edition of Trust for America’s Health is another resource for reviewing a variety of public health indictors. See Key Health Data About Arkansas.

If the state-level evaluations don’t meet your needs, get county-by-county health rankings for Arkansas. This detailed evaluation was compiled by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

Arkansas and the Affordable Care Act

Arkansas Sen. Blanche Lincoln and Mark Pryor were two of only three Democratic senators who voted against the Affordable Care Act. Lincoln lost her re-election bid in 2010. Pryor was defeated by Tom Cotton in 2014; Cotton has repeatedly supported repeal of the ACA.

Rep. Robert Berry, Rep. Vic Snyder, and Rep. Mike Ross – all Democrats – voted in favor of the ACA in the House. All three have since left office. Republican Rep. John Boozman voted against the bill and now represents Arkansas in the U.S. Senate.

At the state level, a bill to establish a state-run exchange was considered during the 2011 legislative session but did not pass. The Arkansas Department of Insurance then shifted gears and received grant money in February 2012 to develop a partnership exchange.

In September 2014, the board of the Arkansas Health Insurance Marketplace, voted to transition to a state-run exchange. The state-run exchange will begin offering coverage during the 2017 open enrollment period.

How did the ACA help Arkansas?

The implementation of the Affordable Care Act had a significant impact on Arkansas’ estimated uninsured rate. The rate dropped 7.1 percent – falling from 20.87 percent pre-open enrollment to 13.77 percent post-open enrollment. Enrollment in qualified health plans (QHPs), qualifications for Medicaid or the Children’s Health Insurance Program (CHIP) under existing eligibility requirements, and Medicaid/CHIP qualifications under expanded eligibility rules all contributed to the drop.

Enrollment in QHPs

In Arkansas, 43,446 eligible individuals, or 19.1 percent of the estimated eligible market in the state, enrolled in a QHP during 2014 open enrollment.

Four insurers offered 71 policy options through the Arkansas marketplace during 2014 open enrollment: Arkansas Blue Cross and Blue Shield, QualChoice of Arkansas, NovaSys Health, and National Blue Cross Blue Shield Multi-state Plan.

Arkansas first to propose Private Option for Medicaid

Arkansas was the first state to receive federal approval to expand Medicaid through the Private Option. The approach uses federal Medicaid money to subsidize the purchase of QHP plans through the marketplace for individuals earning up to 138 percent of the federal poverty level. A number of other states have shown interest in and adopted the approach.

However, Arkansas may score another first by abandoning Medicaid expansion. Republicans took control of all state-level offices in the November 2014 elections and expanded their margins in both chambers of the state legislature. Reauthorization of Medicaid expansion, which is required annually, barely passed in 2014, and its questionable if the program will be renewed in 2015. Legislative opponents of Medicaid expansion have concerns about costs as well as political objections to the program, given its association with “Obamacare.”

Further, Medicaid expansion lost its advocate in the governor’s office. Former Gov. Mike Beebe, who worked with Republican legislative leaders to craft the Private Option, faced a term limit and left office in January 2015.  Asa Hutchinson, Beebe’s successor, has not committed to a position on Medicaid expansion. Hutchinson may take a stance by late January during a planned speech on health care topics.

Through December 2014, nearly 213,000 Arkansas residents have singed up for the Private Option.

Learn about Arkansas’ Medicaid and ARKids First (CHIP) programs.

Does Arkansas have a high-risk pool?

Before the ACA reformed the individual health insurance market, coverage was underwritten in almost all states, including Arkansas.  This meant that applicants’ medical histories were scrutinized before they could purchase coverage.  People with pre-existing conditions were often unable to purchase a plan in the private market, or could only get one that excluded pre-existing conditions.

The Arkansas Comprehensive Health Insurance Pool (CHIP) was created in 1996 to provide an alternative for people who were unable to purchase individual health insurance because of their medical history.

A major component of the ACA is the requirement that all policies be guaranteed issue starting in 2014.  Since there is no longer medical underwriting in the major medical individual market, the need for high risk pools has largely been eliminated.  CHIP ceased operations on December 31, 2014, as applicants were able to secure guaranteed issue coverage through the exchange with an effective date of January 1, 2014.

Health reform legislation in Arkansas

Here’s a summary of state legislative action regarding healthcare reform in Arkansas: