When 2017 open enrollment began on November 1, Arkansans may have noticed some relatively subtle changes to their state’s exchange. For starters, UnitedHealthcare no longer offers individual health plans through Arkansas’ exchange – the carrier makes its departure at the end of 2016. The exchange itself will also be a little different.
In June 2016, Arkansas requested HHS approval to operate a state-based exchange that uses HealthCare.gov, the federal enrollment platform. As the state currently has a partnership exchange for individuals and has used HealthCare.gov in the past, the change is likely to have little impact on the way Arkansans enroll. However, the Arkansas Health Insurance Marketplace has awarded a one-year contract to the Arkansas Foundation for Medical Care, which will provide call center service for the exchange, something consumers may notice.
Currently, Arkansas fares poorly in national health rankings. Yet, it is arguably the nation’s biggest ACA success story with the greatest reduction in uninsured residents. With the Trump administration taking office in 2017 and promising to repeal Obamacare, change is likely on the horizon for health insurance in Arkansas. We have addressed some common concerns here.
Arkansas health ratings
Arkansas is ranked 49th on the Scorecard on State Health System Performance 2015, which compares the 50 states and the District of Columbia. The score is based on measures within five categories: Access, Prevention and Treatment, Avoidable Hospital Use and Costs, Healthy Lives, and Equity. Arkansas ranked last in Equity, 28th for Avoidable Hospital Use & Costs, and in the bottom 10 for the other categories.
Although the state ranked a relatively poor 36th for uninsured adults, it ranked a much higher 13th for uninsured children. Coverage has not seemed to translate into care, however, as the state ranked 40th for the number of children with a medical and dental preventive care visit in the past year. See the Arkansas scorecard for rankings on individual measures. Arkansas was ranked 50th in the 2014 evaluation.
America’s Health Rankings, most recently published in 2015, puts Arkansas at 48th – another one-place improvement from the year prior. Compared with others in the ranking, Arkansas has a relatively low disparity in health status and relatively high public health funding, and it faces significant challenges when it comes to access to dentists and primary care physicians, childhood and adolescent immunization rates, and lack of insurance.
The 2016 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. The Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin compiled this detailed evaluation. This analysis found the physician to patient ratio was 1,540:1 overall in Arkansas, ranging from 870:1 to 10,350:1. The nation’s top-performers had a ratio of 1,040:1.
2017 health insurance carriers and rates
- Arkansas Blue Cross Blue Shield (USAble Mutual): 9.7 percent increase (initially proposed 14.7 percent)
- Celtic Insurance Company (Ambetter): 4.2 percent increase (initially proposed 8.52 percent)
- QualChoice: 23.68 percent increase: 11.1 percent increase (initially proposed 23.68 percent)
- QCA Health Plan: 11.3 percent increase (initially proposed 23.8 percent)
UnitedHealthcare will exit the Arkansas exchange at the end of 2016. The impact will be relatively small; however, as only about 550 people in Arkansas are enrolled in the company’s exchange plans and will have to find a new plan for 2017.
How has Obamacare helped 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.
Arkansas had an uninsured rate of 22.5 percent in 2013. That number fell to 9.6 percent by late 2015 – nearly 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.
Arkansas has a state-partnership health insurance exchange and expanded Medicaid under the ACA.
Enrollment in qualified health plans
Nearly 74,000 Arkansans signed up for exchange plans during the 2016 open enrollment period; about 27,250 of them were new to the exchange. 88 percent of those enrolled in plans through Arkansas’ exchange receive premium subsidies, the same amount as in 2015.
Arkansas and the Affordable Care Act
Arkansas Sens. 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.
Reps. Robert Berry, Vic Snyder, and 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. As of now, the state-run exchange plans to begin offering coverage during the 2017 open enrollment period, although Gov. Asa Hutchinson has questioned whether the state should move ahead with its plans, especially now that the Supreme Court’s decision in King v. Burwell means that subsidies are safe in the federally-facilitated marketplace. As of September 24, 2015, the state’s progress toward creating a state-run exchange is “on pause,” according to Gov. Hutchinson.
Arkansas first to propose Private Option for Medicaid
Arkansas was the first state to receive federal approval for Medicaid expansion through the Private Option. The approach uses federal Medicaid money to subsidize the purchase of QHPs 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 2016, total enrollment in Arkansas Medicaid/CHIP grew 54 percent. 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. Medicaid enrollment lasts year-round, and these numbers continue to fluctuate.
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 with an effective date of January 1, 2014, through Arkansas’ health insurance exchange.
Arkansas Medicare enrollment
As of July 2015, Arkansas Medicare enrollment had reached 594,596, nearly 20 percent of the state’s population. Seventeen percent of the U.S. population is enrolled in Medicare. Arkansas is among the states with the highest percentage of Medicare recipients who qualify due to a disability: 23 percent. The other 77 percent of Arkansas Medicare beneficiaries qualify based on age alone.
Arkansas Medicare beneficiaries who want to gain some additional benefits may select a Medicare Advantage plan instead of original Medicare. Nineteen percent of the state’s Medicare enrollees have Medicare Advantage plans instead of traditional plans. Nationwide, 31 percent of enrollees have Medicare Advantage.
Medicare Part D plans are also an option for those who want to add stand-alone prescription drug coverage to their traditional Medicare coverage. Half of all Arkansas Medicare recipients (51 percent) are enrolled in Part D plans compared with 45 percent of all Medicare recipients.
Health reform legislation in Arkansas
State legislative action regarding healthcare reform in Arkansas includes:
- Gov. Hutchinson plans to continue creating an Arkansas-specific version of Medicaid expansion, and certain aspects of his plan will require new or renewed CMS waivers. Among other plans, his vision includes a premium requirement of no more than 2 percent of income for beneficiaries with household incomes between 100 and 138 percent of the federal poverty level. During the 2016 legislative session, state lawmakers will consider the extension of Medicaid expansion.
A round-up of other Arkansas state legislation related to health reform: