Arkansas Medicaid Expansion: It Makes Cents

More than 130,000 Arkansans benefiting from the state’s decision to accept Medicaid expansion work in industries that are the foundation of the state’s economy. Those on the state’s Private Option work in jobs ranging from sales and food service to construction and health care, according to a study released today by Families USA.

“By expanding access to coverage, we are ensuring we have a strong, healthy workforce in Arkansas,” said Rich Huddleston director of Arkansas Advocates for Children and Families (AACF). “We are supporting our friends and neighbors who work in industries that are critical to the Arkansas economy, like food services and health care.”

Without Medicaid expansion, many of these people would have fallen through the cracks in the health care system – making too much for traditional Medicaid, but too little to qualify for subsidies on the insurance marketplace, said Ron Pollack, executive director of Families USA.

Fifty eight percent of the state’s residents who benefit from Arkansas’s Medicaid expansion, which went into effect last year, work in sectors critical to the Arkansas economy.

“This study shows Medicaid expansion is a success story in Arkansas,” Pollack said. “The people it helps have tough jobs in industries that traditionally don’t provide health insurance. Now after a hard day’s work, they can sleep with the peace of mind that health insurance provides – knowing that a sudden accident or illness won’t wipe out their savings and dreams for the future.”

According to the study, following is the breakdown of occupations of those more than 130,000 Arkansans who benefit from Medicaid expansion:

• 20,000 in food service, working as fast food workers, waiters and cooks.
• 17,000 in sales, working as retail salespeople, cashiers and clerks.
• 15,000 in construction jobs, including carpenters, painters and laborers.
• 13,000 in production, including team assemblers, machinists and welders.
• 12,000 in cleaning and maintenance, including janitors and landscapers and housekeepers.
• 12,000 in office and administrative support, including bookkeepers, receptionists and stock clerks.
• 11,000 in transportation as truck drivers, freight laborers and bus drivers.
• 6,000 in health care support, including nursing assistants, orderlies and home health aides.
• 6,000 in personal care, including barbers, child care workers, hairdressers and personal care aides.
• An additional 20,000 work in a variety of other jobs.

Under the Private Option in Arkansas, which went into effect in 2014, states can offer Medicaid coverage to residents with incomes up to 138 percent of the federal poverty level, which is $27,720 for a family of three. For the first three years, the federal government pays 100 percent of the costs. Starting in 2017, states will begin paying a small portion of the costs, which will be capped at 10 percent in 2020.

Rewa Harris-Sparks of Fayetteville works hard for her family. She still cannot afford health insurance. Thanks to the Private Option, she’s covered.

“I do have a job. I work very hard every day,” Rewa says in the video. “Although I do work at the church, it’s hard to afford insurance. The private option has been a blessing for us. If I knew the Private Option was going away I would be terrified for myself and my family.”

Her story:

Rewa is not alone. See our other #KeepARCoverage stories here.

The state general revenue budget is often fluid. To arrive at a forecast, you look at long-term trends, national trends, local economic conditions … those calculations will tell you within some degree of certainty how much the state budget will grow.

From that projection, state leaders look at who needs what. In other words, how will we spend that growth? Do we need more books in our libraries? More kind-hearted souls to shepherd the children in foster care? Do we need academic interventions to keep all kids on the path to learning? Additional money to ensure that we have the best science, math, and reading teachers in the state? After answering these and thousands of other similar questions, the fluidity of the budget solidifies into something like that mixture (a non-Newtonian fluid) you can make with cornstarch and water (science at work!). (There is still a chance that things will change.)

And, that’s where we find ourselves now: facing a huge change that could have long-lasting, negative impacts for all Arkansans.

If the General Assembly does not fund the appropriation for the newly minted “Arkansas Works” in the fiscal session that is starting tomorrow, Arkansas’s general revenue budget will be facing a minimum of $143M in cuts to General Revenue. Yesterday Speaker Gillam released his view of what those cuts could look like. It’s not pretty.

In education, the cuts will be harmful for teachers and, more importantly, harmful to our kiddos.

The cuts proposed include the following:

1. $5M from our state’s quality pre-K program
2. $9M from our nationally board certified teachers
3. $1.69M from a program to help 11th- and 12th -graders succeed after high school
4. $2M from coordinated school health
5. $3M from our math, science, and literacy specialists in K-12 schools
6. $4.8M from higher education

Let’s break this down a bit.

We will be cutting funding to programs that make our children better off at every level of their education, starting with our littlest learners. Our Arkansas Better Chance program is one of the most highly-rated programs in the country, but as with all things, when the cost of crayons goes up, so too does the need for increased financial support. Not only does this $5M cut take away $5M in funding that hasn’t been increased in eight years, but it also appears that the “one-time money” set-aside for pre-K in this biennium won’t be repeated, so in essence, this is an annual cut of $6.5M. What this means is that we will be forced to serve fewer children or we will reduce quality; a two-edged sword, as we know that the quality of the program is what makes pre-K gains long-lasting.

The slashes here include cuts to our most highly qualified teachers, those who have gone through the rigorous National Board Certification process. These teachers are recognized statewide for their amazing passion in the classroom and contributions to their students’ educations. Cutting this important part of their salaries when our teachers are already woefully underpaid can only lead us toward fewer quality teachers staying in the profession. Further negatively impacting teacher quality are cuts to math, science, and literacy specialists who provide professional development statewide to our math, science, and literacy teachers. At a time when we should be increasing the computer-savvy of our kids, not to mention their ability to read on grade level by third grade, this is a cut we cannot afford.

We can’t forget the cuts to coordinated school health, which rather than being funding for coordination is actually funding for the 27 health clinics located on school campuses throughout the state. All of these clinics rely on this state funding. These amazing places provide well-child visits at school, saving parents multiple trips to and from school and the doctor as well as time off work. They keep our kids healthy and are right there to help when a child is sick.

There is a rather cryptic line in the Speaker’s list of education cuts. It simply says “At-Risk.” This euphemism really stands for a program that targets 11th- and 12th- graders who are at risk of remediation after high school. The nearly $2M used to help these students during the summer months can help save money down the road. When students take non-credit-bearing remediation courses in college, they drain students’ resources and often lead to them dropping out of college, which in turn has ripple effects into the overall economy.

Those high-tech jobs that we hope to grow in Arkansas depend on a skilled and educated workforce. Continuing a trend of under-funding our higher education institutions is not the way to get there.

Our only option is clear. If we truly care about the future of the state and the education of all of our kids, we have to fund “Arkansas Works.”

-By Kathryn Hazelett, Education Policy Director @AACF

Note: This is the first in a series of AACF blog posts related to the Arkansas Budget crisis.  

A new report shows that Arkansas continues to stand out amid other southern states with one of the lowest rates of uninsured people. According to U.S. Census data released today, only 9.5 percent of Arkansans were uninsured in 2015. This great success is due to the state continuing to provide affordable coverage to low-income adults that are eligible for the Medicaid expansion program. Additionally, many families were able to get help paying for their coverage on the insurance marketplace. For two years now, Arkansas has benefited from health care reform, and especially Medicaid expansion, which helped reduce the number of families without health insurance in 2015.

This annual report from the U.S. Census Bureau was released today and provides data health coverage in the nation. The report shows that the insured rate decreased by 1.3 percent between 2014 and 2015. This means that around 29 million more people became insured. According to the report this increase was seen across private and public insurance coverage.  Medicaid enrollment was only second to employer-based insurance.

Additionally, the data shows that adults were more than twice as likely to be uninsured as children in 2015. Like Arkansas, many states have been successful at enrolling even more children in coverage now that their caregivers have new coverage options. In Arkansas, over 80 percent of children who obtained coverage since the implementation of Medicaid expansion were eligible for ARKids First. These findings highlight the importance of the Medicaid program. Medicaid is a cornerstone of health care in this country for people who are struggling just to make ends meet, and since we expanded eligibility to help more people, the health care system is stronger than ever in Arkansas.

You can also check out our blog post on poverty data, some of which was released today.

Note: This is the second post in a four-part blog series on new poverty and health Census data. Stay tuned for several updates this Thursday, when even more data will be released. 

Today, Arkansas Advocates for Children and Families is releasing a health insurance toolkit and website to help Arkansans get the care they need and navigate the complex health care system.

Last summer, we held focus groups with in-person assisters, who help enroll people in coverage, about how to improve health outreach and enrollment. The results of these groups highlighted consumers’ need for more information about their health insurance and how to use it, including information about how to select a plan, find a doctor, and understand out-of-pocket costs.

Just in time for open enrollment – which begins November 1 – “Healthy for Life: A Guide to Using Your Health Insurance” will be available for consumers. This toolkit will help in-person assisters equip every family they enroll with the knowledge they need to get the most out of their coverage.

The toolkit includes a health insurance guide and a workbook that can be downloaded separately. The guide provides information on how to use your insurance in five steps. The steps will walk you through tasks like finding a doctor and getting preventative care. The health insurance workbook can be used to record important information about your health. Download a copy of the toolkit on the guide’s companion website here.

In 2014, the state legislature made history by passing a law to create the Health Care Independence Program (soon to become Arkansas Works). Since creating this program, over 250,000 Arkansans now have access to affordable comprehensive coverage, many for the very first time. This insurance guide will help us move even closer to every Arkansas child and adult receiving high-quality care and living a healthy, productive life. You can read more about how expanded coverage is helping Arkansas families, businesses, and the economy in our fact sheet.

When ARKids First (Arkansas’s state-funded health insurance program for uninsured kids) was passed in March 1997, nearly a quarter of Arkansas children were uninsured. Fast forward almost 20 years, and our uninsured child rate is below 5%!

In celebration of the 20th anniversary of ARKids First and our amazing, historical progress, we’re collecting stories from adults who were enrolled in ARKids First in the 1990s and 2000s. If you have a positive personal story about how ARKids First made a big impact in your life, we want to hear from you!

We’ll feature some of the stories in a special video series that will be released throughout the year beginning in March, the month when then-Governor Mike Huckabee signed ARKids First into law.

Tell us your story here.

Questions? Email us here.

Special thanks to our Anniversary-Year Sponsor Arkansas Children’s Hospital! 

This was a fairly lively week at the State Capitol. In case you missed it, here are some of the highlights and a few things to look out for next week:

FAMILY ECONOMIC SECURITY: On Thursday, Governor Asa Hutchinson signed Senate Bill 125 into law (now Act 182) that expands access to paid maternity leave for Arkansas state employees. This is a monumental change that puts Arkansas ahead of most other states–especially those in our region–in providing access to paid maternity leave. Read more about it in our new blog post.

UNEMPLOYMENT INSURANCE: A bill that would reduce the time and total cash amount of unemployment insurance moved one step closer to becoming law this week by passing on the House floor. The bill (HB1405) doubles down on cuts to unemployment insurance that legislators already voted for in the previous session.

HEALTH: This week, SB355 was filed, which would end the state’s expanded coverage program for low-income adults. While the bill requires enrollees to be transferred to traditional Medicaid after July 1, 2017, the program will end altogether on December 31, 2018. Currently, about 300,000 Arkansans receive coverage through this program.

COMING UP NEXT WEEK

JUVENILE JUSTICE: SB294 will be presented as a “special order of business” at the Senate Judiciary Committee at 10 a.m. on Wednesday, Feb. 22, in Room 171 at the Arkansas State Capitol. SB294 is important because it will eliminate life without parole as a sentencing option for minors and create a more age-appropriate sentencing standard in compliance with the United States Constitution for minors who commit serious crimes. This bill adheres to recent U.S. Supreme Court rulings which recognize that youthfulness both lessens a juvenile’s moral culpability and enhances the prospect that, as a youth matures into an adult and neurological development occurs, these individuals can become contributing members of society. Listen to a podcast we recently aired on Life Without Parole here.

ARKANSAS CAMPAIGN FOR GRADE-LEVEL READING DAY: Wednesday, Feb. 22 is the Arkansas Campaign for Grade-Level Reading (AR-GLR) Day at the Capitol. The day will begin with a legislative breakfast at 7:30 a.m. at Capitol Hill Apartments and will include opportunities to advocate for policies that benefit all Arkansas children, including support for expanded quality pre-K programs, after-school and summer programs, and more. The event will conclude with legislators reading to pre-K students at the Capitol. Join AACF, AR-GLR and other partners for this special event! Register here.

See below for a look at all the bills we’re tracking so far. Keep an eye on our blog for the latest news and updates. And follow us on Facebook and Twitter for additional thoughts and analysis. Sign up to receive weekly legislative alerts here.

• Budget
• Child Care and Early Education
• Child Welfare
• Economic Self-Sufficiency
• Education
• Health
• Immigration
• Juvenile Justice
• Taxes

Today, lawmakers voted to make more changes to Arkansas Works, the state’s Medicaid expansion program that provides coverage for over 300,000 Arkansans, during a special session.

With few consumer protections and details on the implementation of these policy changes, this legislation gives the state legislative approval to make four changes to Arkansas Works: lower the income eligibility, implement a work requirement, end mandatory enrollment in subsidized employer-sponsored plans, and give the state responsibility to use its system (rather than the federal portal) to determine eligibility.

If implemented in January 2018 as planned, we know that these changes will immediately result in 60,000 people losing coverage in Arkansas Works and impose new barriers to staying covered, which we detailed in an earlier post. Supporters of the bill argue that these changes will save the state money, despite anticipating it will also cause premiums to increase by about 2 percent.

Although state lawmakers have approved the changes, the Department of Human Services (DHS) must now seek federal approval. In the past, federal regulations have prevented the state from imposing restrictions like a work requirement as a condition of eligibility for Medicaid. However, with the promise of increased flexibility under the new administration, these federal guardrails are much more flexible and lenient when it comes to enforcing consumer protections.

Since the legislation left out details like the development of an outreach plan or when enrollees will be notified of the changes, state agency officials have stated more specifics will be determined as they develop the rules and seek federal approval. While we have an overall concern that the policy changes will result in many Arkansans losing coverage, the following polices could help make the transition better for the people enrolled:

1. DHS and insurance carriers should auto-enroll beneficiaries who are no longer eligible for Arkansas Work in a QHP (marketplace plan) unless they opt out. Enrollees should be informed of premiums and new cost-sharing requirements, like higher co-pays and deductibles.
2. DHS should cover any increased premium and cost-sharing for a six-month transition period for enrollees who become ineligible, or offer this as an incentive available for meeting certain healthy behavior requirements.
3. DHS or the insurance carriers should develop an outreach plan that includes plain-language notices (at an appropriate reading level) informing enrollees about changes to their coverage at least 90 days prior to implementing the policy change.
4. The state should work with and refer enrollees to navigators and community organizations to educate enrollees about their coverage options and assist them with enrollment.
5. DHS should evaluate the impact of these policy changes and collect data on the number of people who became ineligible for Arkansas Works; the number of former enrollees who applied for a QHP or other coverage; the number of enrollees who successfully paid a premium and enrolled in coverage; and the number of former enrollees who did not sign up for coverage. This data should be collected and reported quarterly.

These recommended polices will at the very least create public transparency so we are aware of the effects of these changes on families. They will also ensure people are given adequate help to successfully transition to other coverage options. With many working families now at risk of losing their coverage and facing the burden of more out of pocket costs, Arkansas has taken a risky step in the wrong direction, especially with the uncertain future of health care at the federal level.

You can find more information about the changes to Arkansas Works and the resulting coverage barriers here. Other media outlets have also reported on the special session.

The passage of the American Health Care Act (AHCA) by the U.S. House of Representatives will have a devastating impact on health care for Arkansas children and families. Congress rushed this through before getting an independent analysis from the nonpartisan Congressional Budget Office. That means that our nation’s leaders and their constituents have no idea how much worse the new version of the AHCA is than the previous version and how many more people will lose coverage. At a minimum, we know that the bill devastates Medicaid, cutting more than $800 billion over 10 years and resulting in at least 24 million more uninsured people within a decade. It will put many of our most vulnerable Americans at risk, including children, people with disabilities, and pregnant women.

The AHCA also places a cap on federal funding for Medicaid, blowing a hole in state budgets. This move doesn’t do anything to reduce health care costs for our state; it only shifts the costs and leaves state and local taxpayers to foot the bill. This arbitrary cap on Medicaid will put over 450,000 of Arkansas’s children in harm’s way.

Additionally, this measure opens the door for insurers to deny coverage for pre-existing conditions, putting kids with asthma, diabetes, heart defects, and other conditions at risk. The recent addition of $8 billion to fund high-risk pools doesn’t come close to covering the cost of care for these kids and other people suffering from pre-existing conditions. Even with these additional funds, the AHCA still falls short for people with pre-existing conditions by leaving at least 6.4 million children and adults without additional support to protect them from premium hikes and benefit reductions. The bill even turns back the clock to a time when insurers could deny coverage for life-saving treatments by imposing annual and lifetime caps.

We call on our Senators to stand up for Arkansas’s children, seniors, people with disabilities, pregnant women, families, and those with pre-existing conditions who will be paying a dangerous price if this ill-conceived bill becomes law.

Finally, our state health care system will take another painful hit. The AHCA rolls back the Medicaid expansion that has improved financial stability for many Arkansas families. About 300,000 adults in lower income groups are currently enrolled in Arkansas Works, the state’s Medicaid expansion program, which would effectively end by 2020 if the AHCA becomes law.

Also, just one day before the disappointing federal vote on the AHCA, lawmakers in Arkansas voted to cut Arkansas Works health care for 60,000 people who are working but are still unable to afford coverage. State leaders say they will able to transition them to coverage on the Marketplace, but the future of the Marketplace is uncertain. As a result of the AHCA, many families will already pay more out-of-pocket costs for these health plans, plus face more costly changes to tax credits and cost-sharing reductions that help lower the costs of these plans. It should also be noted that Arkansas has managed to keep premium increases at a minimum compared to other states because of our unique Medicaid expansion program that put more people into the insurance Marketplace and drove down costs.

Arkansans stand to lose big if lawmakers continue down the current path with dangerous cuts to critical health coverage programs, especially Medicaid. The impact will be felt far and wide because the federal law threatens to destabilize the entire health care system in our state.

Each legislative session brings its own bag of mixed goods, and the Regular Session of the 91st General Assembly was no different. While we were concerned about the constant push for legislation that punishes poor people, there were definitely some wins for families this year. The session began with an aggressive push by Governor Asa Hutchinson for a $50 million low-income tax cut. Although AACF advocated for the creation of a state Earned Income Tax Credit as the cheaper and more effective way to provide tax relief for low-income working families, we applaud the Governor for his plan, which was the first tax cut in recent history to specifically target low-income Arkansans.

Other wins included paid maternity leave for state employees; Medicaid expansion approved for another year; a school discipline law designed to keep our youngest kids in the classroom; passage of the Fair Sentencing of Minors Act, which prohibits sentencing youth to life without parole; and an additional $3 million in the budget for our Arkansas Better Chance pre-K program.

Unfortunately, lawmakers did not fund the Positive Youth Development Grant Program Act. The law passed in 2011 and is designed to provide funding for quality after-school and summer programs. It has never been funded, but just $5 million would get these programs off the ground. However, legislators decided to set aside funds for a competitive grant program to allow districts to apply for funds for after-school, pre-K and tutoring programs. This is progress, but we hope lawmakers will fund the Positive Youth Development program in the next session so that non-school district programs will also have access to grant funds for quality after-school and summer programs.

Read more about the session’s highs and lows in our most recent Kids at the Capitol.

The federal health bill that the House recently passed, the American Health Care Act (AHCA), would be particularly harmful to Arkansas’s rural communities, according to a new report released today by the Washington, DC-based Center on Budget and Policy Priorities (CBPP). With debate now underway in the Senate, Senators Tom Cotton and John Boozman can prevent the bill’s harmful cuts and other changes from ultimately becoming law.

Rural communities in Arkansas already face a lot of challenges, like high poverty rates and poor health outcomes. Policymakers in Washington should not make life harder for these families by passing a bill that will end the Medicaid expansion, make insurance coverage unaffordable, take away protections for people with pre-existing health conditions, and limit the Medicaid program that covers children, seniors, and people with disabilities.

The House bill would also effectively end Arkansas Works, the state’s Medicaid expansion program for lower income adults, which provides health coverage for about 300,000 Arkansans. In expansion states like Arkansas, a much larger share of enrollees live in rural areas than metropolitan. In fact, roughly 47 percent of Arkansas Works enrollees who have gained coverage live in rural communities.

The bill would also dramatically cut and radically restructure the entire Medicaid program through a per capita cap or block grant, putting coverage for seniors, people with disabilities, and children at risk across the state. Arkansas’s state budget relies heavily on federal Medicaid funding. About 64 percent of federal funding in the state budget comes from federal Medicaid dollars. Medicaid plays an even more important role in our rural communities, and these cuts would threaten access to care in these areas and harm rural hospitals.

In addition, the bill would replace the ACA’s premium tax credit and cost-sharing protections with an inadequate tax credit that would make coverage unaffordable for many rural families in Arkansas. Forty percent of Arkansans who buy their coverage in the ACA marketplace are from rural communities. The House bill would raise total costs for state Marketplace consumers by an average of $871. Combined with other costs, like co-pays, Arkansans can expect an out-0f-pocket increase of almost $1,900.

The House bill also removes key protections that the ACA put in place nationwide to let people with pre-existing conditions get affordable coverage that provides the health services they need. These protections are especially critical to people in rural communities, who are more likely to have disabilities or die as a result of a chronic disease. We’ve made major progress increasing access to affordable coverage and much-needed care in rural communities in Arkansas. We can’t afford to reverse this progress. Arkansas Senators should oppose any bill that ends Medicaid expansion, caps or cuts Medicaid, or makes coverage less affordable.

Read CBPP’s full report here.

A new report from the Georgetown University Center for Children and Families and the University of North Carolina Rural Health Research Program shows children and adults in small towns and rural areas in Arkansas rely on Medicaid and ARKids First, the health coverage program for children, more than those in urban areas (referred to as metro areas within the report). The impact is particularly powerful in Arkansas because more than a third of the population lives outside of urban areas.

The report finds that 61 percent of children in rural areas and small towns in Arkansas receive health coverage through Medicaid and ARKids First, compared to 46 percent in urban areas. For adults, 21 percent in non-metro areas are covered by Medicaid, compared to 16 percent in metro areas.

The report also found that Arkansas Works, the state’s Medicaid expansion program, is having a greater positive impact on small towns and rural areas in Arkansas. Across the state, the rate of uninsured adults in these areas decreased significantly from 2009 to 2015. Arkansas ranks eighth in the nation for decline in the uninsured rate among adults in small towns and rural areas. We also saw drops in the rate of insured children in these same parts of the state because children are more likely to be covered when their parents have coverage (called the welcome-mat effect).

When children and families have access to coverage, it strengthens the whole community. In addition to getting children and families the access to health coverage that they need, families have fewer emergency room visits, and hospitals have reductions in uncompensated care. This highlights the important role of Medicaid in rural Arkansas communities as a link to critical care, an important support to local health care professionals, and ultimately, a job creator.

Because Medicaid provides critical access to life-saving treatment and protection from rising health care costs for many children and families living in small towns across the state, cuts to Medicaid would take those protections away from many and reduce their financial stability and overall ability to get much-needed care.

Find more information about the federal proposal to repeal the Affordable Care Act and cut Medicaid funding in our recent blogs on the recently pass House bill and the Congressional Budget Office analysis.

Read the full Georgetown CCF report and view interactive maps showing a county-by-county breakdown of health care coverage here.

Find the Arkansas Times’ coverage of this report here and read about how one small-town Arkansas hospital, Baxter Regional in Mountain Home, has thrived under the ACA.

The American Health Care Act, the health care bill passed by the House of Representatives in May and currently under consideration by the Senate, would shift more than $350 million in yearly costs to Arkansas by 2023, according to a report by the non-partisan Center on Budget and Policy Priorities (CBPP). This would put the health insurance of the 300,000 Arkansans who currently receive coverage through Arkansas Works, the state’s Medicaid expansion program, at risk. Additionally, it would place a serious strain on our state budget.

The House health bill would reduce federal Medicaid payments to the states for expansion enrollees starting in 2020, shifting almost $200 million in yearly costs to Arkansas that year and growing to more than $350 million by 2023. The state would have to make up the difference if the federal government does not keep its commitment to provide the same level of funding that’s currently in the law.  This would more than double the cost of Arkansas Works to our state.

Arkansas would almost certainly be unable to absorb these additional costs; even if every tax cut that has been passed under Governor Hutchinson’s administration were reversed, we would be less than halfway toward filling the gap in revenue necessary to maintain Arkansas Works.

As the Senate considers changes to the House bill, some have claimed that phasing in this shift in costs to the states over a longer period of time could help avoid these harms. But state legislation that created the program known as Arkansas Works includes a provision that requires the program to end within 120 days from the date that federal Medicaid payments fall below the levels agreed to in the Affordable Care Act. The ultimate impact would therefore be the same for Arkansans, regardless of whether these cuts come in 2020 or 2023.

Arkansas Works has garnered bipartisan support because it has saved the state hundreds of millions of dollars while simultaneously cutting the uninsurance rate among adults. We urge our senators to reject any health bill that ends the Arkansas Works program, and instead work to strengthen and improve the Medicaid program that many children and their families rely on to get the care they need, but cannot afford otherwise.

Read the full report from CBPP here.

Note: This blog is second in a series of posts covering the findings in the 2017 Annie E. Casey Foundation Kids Count Data Book. 

According to the annual Kids Count Data Book from the Annie E. Casey Foundation, Arkansas remains in 46^th place for child health rankings, when compared to other states. Although the state has continued to reduce the rate of uninsured children, progress has been slow in other important areas of child health, like child deaths and low birth-weight babies.

This year, the Data Book highlights the gains in the state covering even more children. Since 2010, the already-low rates for children without health insurance dropped to five percent. In addition to the great success of the ARKids First program, which provides a steady source of affordable, comprehensive coverage for many children, the “welcome mat effect” resulted in even more children enrolling in coverage. The “welcome mat effect” describes the increase in Arkansas children that were signed up for coverage when their parents and caregivers enrolled in newly available coverage options through the Affordable Care Act.

Although there has been a percentage point decrease in teens who abuse alcohol and drugs over a four-year period, the number of low birth-weight babies born in the state and child and teen deaths has remained the same or increased. This data highlights the need to focus on both access to health coverage and health care services.

Moving up the ranks from 46^th place to number one will require more targeted efforts to address child health beyond access to coverage. Getting children enrolled in coverage is just the first step in ensuring they have the care they need to grow and thrive. The next steps must include getting children critical preventive care, like screenings that help identify any health issues early, and ensuring women of child-bearing age also have access to important health care services and education.

However, the greatest threat to the coverage gains we’ve made and the overall health of Arkansas kids is the federal debate on health reform. The recently passed House bill proposes slashing $3 billion from the state Medicaid program over the next decade. This would put the health of millions of kids at risk and force the state to serve fewer people, cut provider payments, or reduce benefits. For more information on the devastating impact of reversing expanded coverage for children and their families, check out this AACF fact sheet.

Read our first 2017 Kids Count Data Book blog post here.

Following the special session on health care that happened in May, Arkansas is now preparing to make changes to Arkansas Works, the state’s Medicaid expansion or affordable coverage program for low-income adults. This includes changing the eligibility requirements and removing 60,000 Arkansans from the coverage program. You can read more about changes to Arkansas Works in an earlier blog summarizing the new policies that lawmakers approved.

Before these changes can be rolled out, the state must receive federal approval. Recently, the Department of Human Services released the application that will be submitted for federal approval, along with an invitation for stakeholders to submit comments on the proposed changes.

Arkansas Advocates for Children and Families submitted comments that you can download here. In addition to highlighting the new barriers to coverage that will likely result from the changes, we make recommendations about how to improve consumer outreach and education and the importance of evaluating the impact of these new policies.

1. The bill leaves millions without health coverage. The non-partisan Congressional Budget Office (CBO) analysis of the Senate bill shows that 22 million more people would lose coverage over the next decade. This is a slight improvement from the 23 million people expected to lose coverage under the version of the bill passed by the House.
2. The bill makes deep cuts to the Medicaid program and strips coverage for kids, seniors, and people with disabilities. Today, states and the federal government share the costs of health care for enrollees. The Senate bill will cap federal funding and force states to make up the difference. These deep cuts to the Medicaid program, which get larger every year, will put the health of the most vulnerable Arkansans at risk. A recent estimate from the Urban Institute shows that the number of Medicaid enrollees in Arkansas would decrease by nearly 43 percent for enrollees under 65 years old.*
3. The bill will strain the state budget. The proposed cuts to the Medicaid program will only shift costs to the state. Recent estimates show that in Arkansas we would lose $300 billion dollars over the next decade.* This cost shift would create a large hole in the state budget, since Medicaid dollars account for over 64 percent of federal dollars in the Arkansas budget. We would have to raise taxes, cover fewer children and families, pay for fewer services, or cut payments to health care providers.
4. The bill ends the Arkansas Works program. Over 300,000 adults are enrolled in the state’s Arkansas Works program, which is the state’s Medicaid expansion program for individuals earning low incomes. The program is funded with Medicaid expansion dollars, which would eventually end, resulting in tens of thousands of Arkansans losing coverage, access to care, and financial security.
5. The bill increases premiums and out-of-pocket expenses for individuals, especially older Arkansans. The Senate bill increases the costs of care for many Arkansans because it slashes tax credits and other cost-sharing assistance that helps reduce the costs of health insurance purchased on the Marketplace. Older people would see especially large increases because the bill would allow insurance companies to charge more due to their age.
6. The bill endangers rural hospitals, health providers, and families. Children and families in largely rural states, like Arkansas, will be more at risk of losing coverage than families in urban areas. Over 60 percent of children in rural Arkansas rely on Medicaid to provide a consistent source of health coverage, and half of adults enrolled in Arkansas Works live in rural areas. Rural hospitals will also bear the financial burden of these proposed cuts because they are more likely to serve more low-income, elderly, and chronically ill Arkansans.
7. The bill removes critical consumer protections that guarantee coverage for basic services. By allowing states to cut basic health services and other important treatment like mental health and substance use treatment or maternity care, Arkansans will be left to pay more for less care.  This will leave people with pre-existing conditions without the care they need.
8. The bill gives tax breaks to the wealthiest on the backs of the lowest income Arkansans. The Senate bill maintains many of the tax breaks included the earlier version of the health bill passed by the House. The House bill provided big tax breaks for the wealthiest households — an estimated $33 billion for the 400 highest income earners. These tax breaks come close to the federal costs of Medicaid expansion in Arkansas, Nevada, West Virginia, and Alaska combined.
9. The bill would allow insurers to spend less on providing coverage and keep more profits. The ACA required insurance companies to spend a minimum amount of premiums collected on providing families with coverage. The Senate bill removes these federal regulations, which will allow a greater share to be diverted from covering families and used on administrative costs and profits. These requirements will vary by state, making it less appealing for insurers to offer coverage in states that decide to keep a minimum standard in place.
10. The bill does not address the rising costs of health care. Despite the sweeping changes the Senate bill will make to the health care system, it does not address the rising cost of health coverage and fails on the promise to provide cheaper care. Millions of children and families will pay higher costs and have less access to comprehensive care.

*This estimate is based on the House version of the federal health bill that passed in May 2017. State-specific analysis of the most recent bill released by the U.S. Senate is forthcoming. The Center on Budget and Policy Priorities has a tracker online that compares each version of the reform bills introduced in Congress.

The U.S. Senate’s health care bill would be devastating to rural Arkansas – not just to the health of its citizens but to its economy, as well. Research on the House-passed Affordable Care Act (ACA) replacement showed that it could result in 42 percent of Arkansas Medicaid enrollees younger than 65 being dropped from coverage. The Senate bill goes further, calling for even steeper cuts to Medicaid. It would effectively end Arkansas Works, the state’s Medicaid expansion program for adults with low incomes. These cuts would hit rural Arkansas the hardest because of the large number of children, older adults, and families who rely on the program to provide a consistent, affordable source of coverage. Medicaid makes up 64% of federal funds to Arkansas, much of which flows into rural areas. The bill threatens to undermine the many positive impacts that the Affordable Care Act has had in rural communities, including:

1. In Arkansas, 61 percent of children in rural areas have Medicaid-funded health coverage. The program provides them critical access to life-saving treatment and the preventive care they need to thrive and become healthy, productive adults. Cuts to Medicaid would reduce the financial stability of rural families and decrease their ability to get much-needed care for their children.
2. Arkansas Works expanded coverage to more than 300,000 Arkansans, almost half living in rural areas. The Senate bill would effectively end Arkansas Works by phasing out the federal funding available for the expansion population. Nationally, Medicaid expansion has caused a greater increase in coverage in rural areas than in urban areas. In fact, Arkansas ranks 8th in the nation for the decline in the uninsured rate among adults in small towns and rural areas.
3. Arkansas Works has saved our rural hospitals. Families with health care coverage have fewer emergency room visits, and hospitals have reductions in uncompensated care. Rural hospitals’ uncompensated care costs in Medicaid expansion states plummeted by 43 percent compared to 16 percent in states that did not expand Medicaid, because Medicaid covered more of their patients.
4. The ACA put in place important consumer protections that help rural communities. Under the ACA, health plans on the individual marketplace are required to cover key services, known as Essential Health Benefits, such as mental health treatment, prescription drug coverage, and maternity care. These services were often excluded before the passage of the ACA, and the Senate bill would allow states to waive these protections. Rural populations tend to be older and sicker than urban populations, so they could be disproportionately harmed by any changes to this essential coverage.
5. The ACA has helped keep coverage affordable and accessible for rural families, especially because residents in rural areas tend to be older and to have lower incomes. The Senate bill would allow insurance companies to offer skimpier plans with much higher out-of-pocket costs. Insurers would be allowed to charge the elderly five times as much as someone who is younger. The bill also reduces the premium tax credits and repeals subsidies that help make health care affordable for low-income people.

To read more of our analysis, download the complete one-pager. If you have questions, please feel free to contact us here.

The amended version of the Senate health bill, released July 13, maintains the same core features as previous versions of the legislation and would have essentially the same harmful impacts. It would still:

• End Medicaid expansion to low-income adults, including the Arkansas Works program which allowed 300,000 Arkansans to gain coverage;
• Cut Medicaid spending over time while giving tax breaks to corporations and the wealthy; and
• Increase out-of-pocket spending and raise premiums and deductibles, especially for low-income and older Arkansans.

Also, many of the proposed fixes are inadequate, and some of the provisions would make things worse.  For instance, the amended version of the Senate bill adds an additional $45 billion in funding for opioid treatment over the next decade. But the costs of covering treatment for opioid addiction in that time frame would be more than $200 billion. On top of this, even some conservative senators are concerned that creating a separate fund for addiction coverage could create barriers between addiction treatment and physical health care. These additional funds for opioid addiction would also be greatly outweighed by the bill’s deep Medicaid cuts and other fundamental changes to the Affordable Care Act that would cost millions of people their health care coverage and leave many opioid sufferers without the care they need to recover.

One of the biggest changes comes from the “Cruz Amendment” (an amendment introduced by Senator Ted Cruz). This amendment allows insurers to sell plans that do not comply with consumer protections put in place by the ACA, as long as they sell at least one plan that does comply. This means that insurers would only have to offer one plan that includes essential health benefits, where premiums would not vary based on health status. Other non-compliant plans could vary greatly by the health status of the individual and offer a skimpier benefits package.

This would remove consumer protections in every state and allow insurers to charge people with pre-existing conditions higher premiums, which a number of Senate Republicans have pledged not to do. In practice, healthier people would gravitate toward cheaper plans with fewer benefits, and people with pre-existing conditions would enroll in more robust plans, which are likely to have sky-rocketing premiums.

Bottom line: the latest Senate bill – like every version of this bill – would cause millions to lose coverage. While we are waiting a Congressional Budget Office score to detail the full impact of this bill, we know enough to know that it will put millions of Americans at risk, including the 367,000 Arkansans who would lose coverage or become uninsured.

Arkansas’s uninsured rate for children dropped to just 4 percent in 2016, a new record and a remarkable achievement for our state. This follows a trend in recent years, since the implementation of the Affordable Care Act, of uninsured rates dropping to historic lows for Arkansans of all ages.

Today, the US Census Bureau released state-level data on health insurance coverage. The report shows that options made available because of the Affordable Care Act (ACA), including Medicaid expansion, are working for millions of Americans. According to the new data, in 2016, the uninsured rate decreased for all Americans.

Arkansas continues to stand out among southern states because of Arkansas Works, the state’s Medicaid expansion program. Fewer than 8 percent of Arkansans lack health insurance, which means that the state has cut this rate in half between 2013 and 2016. As anticipated, states with Medicaid expansion programs, like Arkansas, have continued to see a greater decrease in the rates of uninsured adults (19-64 years old) in 2016.

Medicaid expansion, created by the ACA, has benefited a broad range of Americans. It has provided insurance to those who have traditionally been more likely to lack coverage, such as people of color, young adults, part-time workers, people with less education, and low-income parents. It does all of this while producing better health outcomes, saving some states money, and facilitating innovations in health care.

The percentage of children in Arkansas without health coverage had already reached an historic low—about 5 percent— in 2015. The rate dropped even more in 2016.  This is because more children got coverage through Medicaid and employer-based insurance last year.

It’s worth noting that Medicaid and the Children’s Health Insurance Program (the two programs together are known as ARKids First), remain the major source of coverage for more than half of the children in the state. More children have enrolled in coverage as their parents signed-up for their own plans under the ACA.

These data underscore the importance of the Medicaid program and the ACA, which have allowed more people to get the care they need to go to work, take care of their families, and be healthy, productive members of their community.  To date, every ACA repeal-and-replace proposal would have ended the expansion for low-income adults and put the coverage for up to 300,000 Arkansas at risk.  These proposals would also deeply cut and cap traditional Medicaid funding and threatened access for half of children in Arkansas.  Congress should continue to stand firm against any proposals that would reverse these health care gains and instead find bipartisan solutions to strengthen the health care system.

You can also check out our blog post on poverty data, some of which was released today.