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.

Good idea in Arkansas, but GOP wants to kill it

I saw a news piece on PBS Newshour a few weeks ago about a variation of the Medicaid expansion under Obamacare being done in Arkansas. Governor Mike Beebe and the legislature received permission to use the Medicaid subsidies in the insurance exchanges as they felt the people in need would be better served by insurance companies than under Medicaid. As of last month about 83,000 people had been signed up under the Medicaid expansion. Per the news piece, it is working quite nicely and other governors are taking notice.

Well, to the chagrin of the governor, a new Republican legislator has joined the Arkansas assembly and is convincing others to kill the idea. The GOP argument is the same that is being used in other states when Obamacare phases down its funding of the expansion from 100% to 90% it puts the state on the hook. The Obamacare precept is as people use the system and tap more preventive resources the costs will come down. Three reputable organizations, The Commonwealth Fund, RAND Corporation and Economic Policy Institute have all said the Medicaid expansions is good for state economies and are worth investigation.

The Arkansas model is of interest to me and others. As an Independent voter who is a retired benefits manager and consultant, I would like to see this model continue to see if it is more meritorious than placing the people in need into Medicaid. I also believe it is a model that Republican led states could get behind, as the exchange concept is in keeping with Republican concepts. The truth that does not get talked about enough is, Obamacare, while detested by the GOP for political reasons, can trace its roots to the Heritage Foundation and Romneycare, which was supported for the country by none other than Mr. Tea Party, former Senator Jim DeMint.

Having DeMint’s earlier support does not make anything necessarily a good idea, I just find it ironic and hypocritical of his adamant opposition to Obamacare. If you doubt the veracity of this comment, I encourage you to Google Jim DeMint and Romneycare. And, here is one final truth. Obamacare, now that it is past many of its rollout issues in this phase, is showing promise and is taking shape, building off the earlier phases’ success.

Arkansas, please don’t kill a good pilot. Let’s study it and see if it is a better model. And, please do not kill it for political reasons, as that just hurts people and that would be a shame.