The Arkansas Department of Human Services sent out a press release (pdf) that is quite amazing. Arkansas is one of the few southern states not to outright reject the Medicaid expansion. They applied for and gained approval for an alternative to strict Medicaid expansion. Instead, they are taking the federal Medicaid money and using it to give people vouchers to buy a “private option” health care plan.
A total of 155,567 of the estimated 225,000 Arkansans who qualify for health insurance through the Private Option had applied and been determined eligible as of March 31, surpassing expectations of the level of acceptance in the program’s first year.
An analysis of demographic information of those in the Private Option showed that most – 82 percent– had incomes too low to qualify for insurance through the Health Insurance Marketplace.
“We now know that an overwhelming majority of Arkansans in the program would have likely gone without health insurance had the Legislature not passed the Private Option,” said John Selig, director of the Arkansas Department of Human Services. “Clearly there was a real need in a lot of these families.”
The Private Option, signed into law last April, allows the state to use federal Medicaid funding to pay the private health insurance premiums for those making up to 138 percent of the federal poverty level, or about $16,105 for a household of one. Arkansas was the first state in the country to place people in private plans rather than expand the traditional Medicaid program.
About 70% of eligible Arkansans took advantage of the subsidies. This is a category of person that is getting shafted in the rest of the Deep South and even here in Pennsylvania. They made too much to qualify for Medicaid under the old formula and too little to qualify for subsidies on the health exchanges. Caught in this donut hole, they aren’t receiving assistance in getting health insurance in much of the country. Yet, the Arkansas legislature found a solution they could live with, and we can see the result.
Over 155,000 people are getting coverage, which is almost as big as the margin former Sen. Blanche Lincoln lost by in the 2010 election. If you’re in the donut hole and living in Mississippi or Tennessee or Texas, you can look at Arkansas and wonder why your own legislators are putting you at needless risk of bankruptcy, or worse.
We now have several “experiments” in state health care–Vermont’s single payer, Arkansas’s private option, California’s whatever the heck it is, straight up Obamacare as enacted, Obamacare minus Medicaid expansion.
I’m not sure you can say that the sample populations for trial were drawn randomly but some savvy statisticians might find a way to do studies that tease out the dependent data.
The question is whether policy changes will move so fast as to not allow firm conclusions or whether policy stalemate will result in unequivocal identification of what can provide universal coverage at lowest cost and best results.
My bet is still on treating health care as a part of infrastructure with a national, not a state risk pool. (Ultimately a worldwide risk pool.) The details are in payment, auditing, and improvement of diagnostic and treatment protocols and provider judgement.
TarheelDem, I just want to tell you again how much I appreciate your participation here and how much I value your comments.
It will be interesting to see what Arkansas’ legislature does next year when it reconvenes. Much will hinge on how the Governor’s race and the legislative races turn out – if the Dems manage to recapture the state’s House (which is a realistic possibility) and keeps the Governor’s mansion, the Private Option will probably be safe. Otherwise, hard to say, although it will be difficult (although not impossible) to find the necessary legislators to kick 155,000 people off their newly obtained coverage.
Never underestimate the spite vote. If I have crap insurance, and you have no insurance at all, all of a sudden I don’t have crap insurance.
The GOP aim is to turn everything, from education, to employment, to health care, to retirement, into a positional good, offering less — which is still better than nothing — and pocketing the difference.
For the few who have enough money what we used to consider barely adequate will still be available.
Down the road as the ACA diminishes the Medicaid expansion contribution, Arkansas will be in a position, as a State, of telling it’s constituents that it’s cutting back the dollars. Will the State then expand its own contribution?
I doubt if the federal contribution will actually diminish. Like the “doc fix”, it made the budget numbers look good and allows both sides to engage in campaign-oriented histrionics before it is inexorably “postponed” every year.
The economic development of kentucky and arkansas will be interesting to watch over the next few years. All those people not bankrupting themselves has got to make some kind of difference. Is there enough of an economy in those states to take advantage of it?
The decision-makers of Southern States’ Chambers of Commerce have to decide at some point that allowing lack of access to health insurance and health care to continue is bad for business. Sick, impoverished people don’t have the ability to patronize your businesses.
The portions of our nation’s economy which have been swallowed up by megacorporations, many of them international conglomerates, could give a rat’s ass about Georgia’s economy, though. You may be a local franchisee in Atlanta for McDonalds’, or a manager for the Wal-Mart in Athens, but your home in town doesn’t mean that you are able to able to run your business or lobby policymakers in ways which are in the best interest of the community at large, or even in the long-term interest of your own business.
If/when a community can’t support your business, that’s not a problem for McDonalds’ or Wal-Mart unless and until it affects their stock prices. And, of course, those megacorps are able to use their massive market share and purchasing power to drive down the cost of their goods in ways that mom-and-pop businesses cannot, thus assuring that in many impoverished communities, the megacorps will be the last businesses standing, unhealthily milking every dime out of poor people who have no other realistic choices.
All of this is a series of problems which must be solved. We haven’t even touched on the immorality of denying people health care, but that’s in here too. To me, the best way to begin that difficult problem-solving is to engage in caring for our neighbors in a sincere way, creating fewer community members of competence who would be willing to sell out their neighbors for the megacorp, and electing leaders who stop doing the megacorp’s bidding.
I don’t care if these are many barriers to our work. We must become successful at solving these problems anyway.
The AR “private option” is a true hybrid of the ACA expanded Medicaid and ACA subsidized private insurance. It is less of a step away from current Medicaid programs than the general public might be aware of:
It’s several tests (or experiments) mushed together. One is the proposition that a larger pool of private health insurance purchasers will reduce the total health care costs for that pool of people. Not too different from the S-Chip flexibility:
S-Chip in some states is a public option and in some a private option:
The other three test propositions are 1) Medicaid payment fees don’t reduce program costs and 2) administrative costs for private insurers are competitive with public programs 3) co-pays and deductibles reduce total medical care costs. All mushed together, the data will give plenty of fodder for arguments between liberals and conservatives.
Why is the average annual Medicaid cost/beneficiary twice as much in Nebraska as in California?
re: neb vs ca: CA has an insurance commissioner with some actual power?
Does Medicaid fall within the jurisdiction of state insurance commissioners? Off the top of my head would say no, but I could be wrong.
Age demographics don’t seem to be the answer either as CA and NB are similar. Shouldn’t be the cost of living either as Medicaid reimbursement rates are capped.
When you bring up vote totals remember the losses Dems took after medicare in the 60s. Success with policies might not matter for voters.