Study finds Arkansas and Kentucky lower uninsured rates more than Texas

The rate of uninsured residents in Arkansas and Kentucky, both of which expanded their Medicaid populations but in different ways, dropped significantly between late 2013 and late 2014 compared to Texas, which did not expand its Medicaid population.

Those findings come from a study by Health Affairs, which considered the first-year effects of Medicaid expansion options in the three states. Thirty states, including Arkansas and Kentucky, along with Washington, D.C., expanded their Medicaid populations as a result of a U.S. Supreme Court ruling making the expansions optional. The others, including Texas, did not.

Kentucky expanded its traditional Medicaid population, while Arkansas in 2013 created the private option, which uses Medicaid dollars to purchase private insurance for Arkansans with incomes up to 138% of the federal poverty level. The program serves about 200,000 Arkansans and is paid for almost entirely by federal funds, with Arkansas expected to pay for 5% starting in 2017, a number that increases to 10% by 2020.

Health Affairs surveyed 5,665 adults by telephone in the three states.

Researchers found that Arkansas and Kentucky experienced significant decline in adults skipping medication because of cost, and a decline in individuals having trouble paying medical bills. Also, more individuals with chronic conditions obtained regular care, according to the report’s abstract. According to a New York Times story about the report, the number of uninsured low-income Arkansans fell from 41.8% to 19.4%, while Kentucky’s numbers fell from 40.2% to 12.4%.

Those numbers represented a 14% larger decline compared to Texas, the report’s abstract said.

Researchers found no major differences between the expansions in Arkansas and Kentucky except for the fact that the percentage of residents who had trouble playing medical bills decreased more in Kentucky than in Arkansas. According to the Times report, the percentage having difficulty paying medical bills fell 14.3% in Kentucky and 7.6% in Arkansas.

According to the study’s abstract, “Despite vigorous debate over the use of private insurance versus traditional Medicaid to provide coverage to low-income adults, there is little evidence on the relative merits of the two approaches.”

The report comes as Arkansas and Kentucky lawmakers consider changes to their Medicaid expansions.

Arkansas’ private option, officially known as the Health Care Independence Program, has been controversial since it was created – barely receiving the three-fourths vote in the Legislature it needed for funding in 2013 and 2014. Supporters say the program has helped Arkansas lead the nation in reducing its percentage of uninsured residents and in reducing the uncompensated care provided by hospitals. Opponents say it is an unaffordable concession to Obamacare.

In 2015, legislators agreed to Gov. Asa Hutchinson’s (R) request to fund the program through the end of 2016 while he works with a legislative task force to consider a next move in the context of overall Medicaid reform.

He is requesting a waiver from the federal Department of Health and Human Services to create a replacement, Arkansas Works, that will last beyond the scheduled termination of the private option at the end of 2016. Among the changes would be requiring individuals eligible for Medicaid to enroll in employer-sponsored insurance where available, and implementing work training referral requirements.

In Kentucky, newly elected Gov. Matt Bevin (R) campaigned saying he would end expansion but since has expressed support for a modification of the program.