In June 2016, Arkansas requested HHS approval to operate a state-based exchange that uses HealthCare.gov, the federal enrollment platform, and the change took effect starting in 2017. The state already used HealthCare.gov as a partnership exchange for individuals, so the change had little impact on the way Arkansans enroll. However, the state now has its own call center and board of directors for the state-run exchange.
For 2018, total enrollment in private plans through the Arkansas exchange reached 68,100, which was about 2 percent lower than it had been the year before.
Currently, Arkansas fares poorly in national health rankings. Yet, it is arguably among the nation’s ACA success stories, with an uninsured rate that was reduced by half from 2013 to 2016. Although the Trump Administration and Republicans in Congress vowed to repeal the ACA, the law remains intact as of 2018, with the exception of the individual mandate, which will be eliminated starting in 2019 (the GOP tax bill repealed it in late 2017, but that repeal doesn’t take effect until 2019).
A big part of Arkansas’ success in reducing the uninsured rate is due to the state’s expansion of Medicaid, under the Arkansas Works program. As of January 2018, there were about 285,000 people enrolled in Arkansas Works, and Medicaid enrollment in the state has increased by 63 percent since 2013. But Arkansas obtained permission in March 2018 to implement a work requirement for Arkansas Works, effective in June 2018, which will likely result in a reduction in the number of people covered by the program. In the same waiver approval, however, CMS rejected the state’s proposal to reduce the income cap for Medicaid eligibility from 138 percent of the poverty level to 100 percent of the poverty level. That measure would have resulted in far more people losing access to Arkansas Works, but CMS did not let the state implement it.
Arkansas health ratings
Arkansas was ranked 49th on the Scorecard on State Health System Performance 2015, which compared the 50 states and the District of Columbia. On the 2017 edition of the Scorecard, Arkansas moved up one spot, to 48th. The score is based on measures within five categories: Access, Prevention and Treatment, Avoidable Hospital Use and Costs, Healthy Lives, and Equity. Arkansas’ best ranking was for Prevention & Treatment, with 40th place. But for both Healthy Lives and Equity, the state came in 48th.
Arkansas ranked 51st in the nation—the absolute worst—in terms of the percentage of non-elderly adults whose out-of-pocket costs for medical care are considered unaffordable based on their income. But the state ranked 12th for the percentage of adults with a usual source of health care, a metric that’s associated with better health outcomes.
See the Arkansas scorecard for rankings on individual measures.
America’s Health Rankings, most recently published in 2017, also puts Arkansas at 48th, which was the same ranking they assigned the state in 2015. Although Arkansas is very near the bottom of the rankings, the report notes that Arkansas fared considerably better than Louisiana and Mississippi, which occupy spots 49 and 50. 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.
2018 health insurance carriers and rates
The following health insurance carriers are offering 2018 plans through the Arkansas exchange:
- Arkansas Blue Cross Blue Shield (USAble Mutual)
- Celtic Insurance Company (Ambetter)
- QualChoice: 23.68 percent increase
- QCA Health Plan
UnitedHealthcare exited the Arkansas exchange at the end of 2016. The impact was relatively small, however, as only about 550 people in Arkansas were enrolled in the company’s exchange plans in 2016. All of the insurers that offered plans in the Arkansas exchange in 2017 continued to do so in 2018.
How has Obamacare helped Arkansas?
The implementation of the Affordable Care Act had a significant impact on Arkansas’ estimated uninsured rate, with the percentage of uninsured residents dropping by half in the first three years of ACA implementation.
According to US Census data, Arkansas had an uninsured rate of 16 percent in 2013. That number fell to 7.9 by 2016, which was more than a 50 percent reduction. 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-run health insurance exchange using the federal enrollment platform (HealthCare.gov) 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.
But enrollment dropped slightly in 2017, and again in 2018, when enrollment in private plans through the Arkansas exchange reached 68,100.
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 in March 2010 (both had voted for it in December 2009, however). Lincoln lost her re-election bid in 2010. Pryor was defeated by Tom Cotton in 2014; Cotton has repeatedly supported repeal of the ACA. Arkansas’ second Senator, Republican John Boozman, also opposes 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. Current Senator, John Boozman was in the House of Representatives when the ACA was being debated, and he voted against it.
The current House of Representatives delegation from Arkansas is also entirely Republican. So while Arkansas had two Democratic senators when the ACA was being crafted, and three of their four Representatives were Democrats, they now have a congressional delegation that is entirely Republican, and entirely opposed to the ACA.
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 began offering coverage during the 2017 open enrollment period, although Gov. Asa Hutchinson had previously questioned whether the state should move ahead with its plans, after the Supreme Court’s 2015 decision in King v. Burwell that ensured that subsidies would continue to be available in states that use the federally-run exchange. As of September 24, 2015, the state’s progress toward creating a state-run exchange was “on pause,” according to Gov. Hutchinson, but it soon got back on track, and the state-run exchange was up and running in time for the November 2016 start of the open enrollment period for 2017 coverage.
Arkansas first to implement 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.
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. Governor 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 wanted to make some changes to the program, including a switch to requiring modest premiums for enrollees with incomes between 100 percent and 138 percent of the poverty level.
The initial waiver that was approved by CMS allowed Arkansas to implement their Private Option (called the Arkansas Health Care Independence Program) for three years, through the end of 2016. At that point, an extension was approved, and the name of the program was changed to Arkansas Works. Under the waiver extension for Arkansas Works, the state was allowed to begin charging premiums for enrollees with income above the poverty level, and also implemented a premium assistance program for some Medicaid-eligible enrollees who have access to employer-sponsored insurance.
In mid-2017, Hutchinson submitted an amendment to the Arkansas Works waiver. It was mostly approved in March 2018, although CMS rejected the provision that would have lowered the Medicaid eligibility cap from 138 percent of the poverty levelt to 100 percent of the poverty level. But CMS did approve a work requirement for Arkansas Works, which can be implemented as soon as June 2018. This was not surprising, as CMS approved work requirement waivers for Kentucky and Indiana in early 2018 (work requirements for Medicaid had been a non-starter under the Obama Administration, but the Trump Administration had made it clear that they would consider them; several states have proposed work requirements or are considering doing so).
The waiver amendment for Arkansas Works proposed four primary changes:
- A work requirement to maintain Medicaid eligibility, which was approved.
- Eligibility for Medicaid capped at 100 percent of the poverty level (and people with income between 101 percent and 138 percent of the poverty level would be transitioned to regular plans in the exchange, instead of the exchange plans funded by Arkansas Works; this would reduce state spending to zero for these individuals, as the full cost would be shifted to the federal government for premium subsidies, and to the individual enrollee for additional premiums and cost-sharing). This was rejected by CMS.
- Elimination of the Arkansas Works premium assistance program for employer-sponsored insurance. This was approved, as the program had been rarely used and is being discontinued.
- A waiver of retroactive eligibility. This was mostly approved, but CMS is imposing a 30-day retroactive coverage provision for Arkansas Works. People who enroll in Medicaid will be eligible for coverage backdated to an effective date 30 days before the application date. That’s in contrast with the normal three-month retroactive coverage window, and CMS noted that they’ll be watching to see shortening the retroactive coverage window makes people more likely to maintain their coverage year-round.
From 2013 through November 2017, total enrollment in Arkansas Medicaid/CHIP grew 63 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. 21 percent of the state’s Medicare enrollees have Medicare Advantage plans instead of traditional plans. Nationwide, 33 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
Scroll to the bottom of the page for a summary of recent healthcare-related legislation in Arkansas.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.