Former Arkansas surgeon general brags on Medicaid expansion

I have written often about the Affordable Care Act not being fully implemented since 15 states have not expanded Medicaid. Rather than repeat my arguments, let me reference the attached editorial written by Dr. Joe Thompson, the former Surgeon General of Arkansas, which I read in Friday’s The Charlotte Observer. The reason for their interest is North Carolina has a Democrat governor working with a Republican majority General Assembly and the issue of Medicaid expansion is of importance. The editorial is entitled “Medicaid expansion works in deep red Arkansas. It would work in North Carolina too.”

“My home state of Arkansas is unusual among Southern states in having adopted Medicaid expansion early and in our own fashion.

I was Arkansas’ surgeon general in 2013 when the state first faced the question of whether to expand Medicaid. Like North Carolina now, Arkansas then had a Democratic governor and a Republican-controlled legislature. Fortunately, we avoided an impasse; lawmakers on both sides of the aisle came together to approve an innovative alternative to traditional Medicaid expansion that provides private health insurance coverage to about 250,000 people earning up to 138% of the federal poverty level.

The effect on Arkansas’ uninsured rate was swift and dramatic. A 2015 Gallup report showed that since Arkansas’ Medicaid expansion program took effect in January 2014, the state’s uninsured rate had been cut roughly in half, dropping from 22.5% to 11.4% ― the biggest reduction in the nation.

According to the U.S. Census Bureau, Arkansas’ uninsured rate was 8.2% in 2018. North Carolina’s was 10.7%, the ninth-highest rate in the nation. Arkansas’ reduced uninsured rate led to a 55% reduction in uncompensated-care losses at hospitals. This has been especially important for rural hospitals, which treat many low-income patients.

Since January 2010, only one rural Arkansas hospital has closed for financial reasons. In the five neighboring states that have not expanded Medicaid, more than 50 rural hospitals have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

Expanding Medicaid also has helped stabilize Arkansas’ health insurance market, improve competition and control premiums. Since 2014, at least three insurers have offered plans through the Health Insurance Marketplace in each county in the state. The competition encourages low rates: In 2014, 38 states had marketplace premiums lower than Arkansas’; today, only six states have lower premiums.Medicaid expansion has brought billions of new federal dollars into Arkansas’ economy: $1.7 billion between January 2014 and June 2015 alone, according to the Kaiser Family Foundation. Arkansas also is saving money because some individuals previously covered under traditional Medicaid, which in Arkansas is 30% state and 70% federally funded, are now covered under Medicaid expansion.

The federal government currently is paying 93% of Medicaid expansion costs and will pay 90% in 2020 and thereafter. A consultant told a legislative task force in 2016 that Medicaid expansion would save Arkansas $757 million between 2017 and 2021.Thirty-six states have now decided to accept Medicaid expansion.

Arkansas has become a firmly red state, but it has reauthorized its Medicaid expansion program with a supermajority vote every year because of the demonstrated benefits to the working poor, the economy and the health care infrastructure. Last year, Arkansas added a work and community engagement requirement that currently is blocked by a federal judge’s order, but however that issue ultimately is resolved, it is clear that Medicaid expansion has had tangible, positive results. There’s a reason the number of states rejecting it continues to shrink each year.

Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement. He was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe.”

In spite of efforts to naysay it, hobble it and kill it, the Affordable Care Act is stabilizing some. It needs more stability and Medicaid expansion would help in the remaining 15 states. I have also advocated the US government paying back the money they withheld from insurers causing some to leave the market, inviting those companies back to the market. I have also advocated the reduction of the Medicare eligibility age from 65 to age 62 or even 60. And, where options don’t exist, Medicare could be offered as an option for younger adults.

What frustrates this retired benefits manager, consultant and actuary is the fact people getting harmed by decisions to harm the ACA is not a major factor. There is too much focus on winning an argument that people getting screwed does not seem to matter. Please help make it matter. Even as we speak, the eating away at the edges of the ACA could lead the Supreme Court to rule it unconstitutional. If this occurs it would be a damn shame.

22 thoughts on “Former Arkansas surgeon general brags on Medicaid expansion

  1. Keith, excellent post. While I’d love it if we could do Medicare for all, I do not feel the political climate is right at this point. The measures you talk about-lowering the age requirement especially, would be a winning argument for whomever wins the Dem nomination. These incremental changes would really help stabilize the markets. Expanding Medicaid too, is such a no-brainer. Just think if all 50 states had it. Time for the Red State legislatures to stop the obstruction. Doing otherwise shows us what they’re all about- because it has Obama’s name on it, it must be bad. Ridiculous

    • Jeff, thanks. The Dem candidate should focus on simple changes to stabilize the ACA. If they do make minor changes to Medicare, they need to measure the results. It would be more than fair to say let’s study whether Medicare for All makes sense, but that will take time.

      It has disappointed me that Dems did not work with McConnell to stabilize the ACA this year. With Marco Rubio and Donald Trump leading changes to the ACA that hurt people plus the abysmal effort to repeal and replace it, the Dems had a better hand. Keith

      • Well, I’m not so sure McConnell is interested in anything except getting unqualified and far right judges confirmed. But I get your point Keith. A little cooperation would be nice. Seems so far-fetched, sadly.

      • Roger, sadly that is true. On top of all other concerns, the current president must change what preceded him. I have mentioned this before and there is plenty of real news on the subject, but senator Marco Rubio and president Donald Trump screwed American people to win an argument. They both took actions that increased premiums, but denied they did. Yet, so very few people know this. Keith

      • Very often the painful details become lost until they happen to you….I witnessed this with the UK Personal Taxation system. It was ‘simplified’, which translated into a number of folk lost tax allowances while the wealthy did well out of the tax cuts to the higher rates.

      • Roger, you just defined our tax law change. I paid more due to a limit on deduction for state and property taxes that was imposed. Keith

      • My approach (with Sheila’s consent) is whenever Trump turns up on our TV or radio I turn it off with the comment ‘You have not earned the right to speak in our house,’….he might not know I am doing it, but being the petty creature he is, should he be aware it would infuriate him.

      • Roger, I love your muting the sound when the president comes on. I actually do not watch him live or read his tweets, as I don’t like being lied to. I just read what he said later or watch a summary on the news.

        By the way, a funny retort to his witch hunt claim is “If this a witch hunt, then you better get off your broom.” Keith

  2. Thank you for this Keith. I do not think people in the UK realise how close such a system could come to them. This would be a catastrophe because we have grown up with a free NHS and believe it is a right (which it is). Our societies would not be able to cope.

  3. Note to Readers: Regarding my references to Marco Rubio and Donald Trump, please Google “Marco Rubio and ACA Risk Corridors” and “Donald Trump defunding ACA copays and deductibles for poor people” and read one of the many articles.

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