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.
Health insurance carriers
Five carriers will be be offering individual health plans for 2016 in the Arkansas exchange:
- Arkansas Blue Cross Blue Shield
- Celtic Insurance Company (Ambetter)
- QualChoice, and QCA Health Plan (both owned by QualChoice Holdings – QualChoice offers POS plans; QHC Health Plan offers PPO plans)
- UnitedHealthcare of Arkansas (new to the exchange for 2016; initially UHC will only sell plans in central Arkansas, but they’re planning to expand in 2017)
There is also one individual carrier that only sells plans outside the exchange:
- Coventry Health and Life
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 2014, 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 is planning to begin offering coverage during the 2017 open enrollment period, although Governor Asa Hutchinson has questioned whether the state should move ahead with its plans for a state-run exchange, especially now that the Supreme Court’s decision in King v. Burwell means that subsidies are safe in the federally-facilitated marketplace.
How did the ACA help Arkansas?
The implementation of the Affordable Care Act had a significant impact on Arkansas’ estimated uninsured rate, with the state having the highest percentage point drop in the country. 22.5 percent of Arkansas residents were uninsured in 2013, and that had fallen to just 9.1 percent by the first half of 2015 – a 60 percent decrease. 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, 65,684 people – about 26 percent of the estimated eligible market in the state – enrolled in private health plans through HealthCare.gov during the second open enrollment period. By June 30, effectuated enrollment in private plans through the Arkansas exchange stood at 51,436 people (attrition is a normal part of the individual market, particularly outside of open enrollment, when opportunities to enroll are limited).
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, there are questions about whether Arkansas will continue to offer expanded Medicaid, and whether any changes will be made to the current program. 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. Legislative opponents of Medicaid expansion have concerns about costs as well as political objections to the program, given its association with “Obamacare.”
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, initially did not commit to a position on Medicaid expansion. In August 2015, Hutchinson expressed his support for continued Medicaid expansion in Arkansas, but noted that he wants to make some changes to the current program, including a switch to requiring modest premiums for enrollees with incomes between 100 percent and 138 percent of the poverty level. The changes that Hutchinson has proposed would require new or renewed waivers from CMS.
From 2013 through June 2015, total Medicaid/CHIP enrollment in Arkansas grew 47 percent, from 556,851 people, to 820,769. Some of the new enrollees were already eligible under the previous guidelines but didn’t enroll until after 2013. But the majority of new enrollees are newly-eligible under the expanded guidelines.
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: