Report gives credit to ACA for rise in statewide insurance coverage

Healthcare coverage created by the Affordable Care Act has increased the number of Arkansas children who are covered, but one in four adults still do not have insurance, according to a report on health coverage in the state.

“The healthcare system in Arkansas is practically unrecognizable when compared to just a few years ago,” Marquita Little, health policy director for Arkansas Advocates for Children and Families, wrote in the report. “Now, we offer comprehensive coverage to many of the Arkansans who were left out of the healthcare system for decades.”

The annual report, Clearing the Hurdles To Coverage, which was released Thursday (Nov. 17) by AACF, looks at the impact of the coverage option established by the Affordable Care Act a year after it went into effect. Survey data included in the report shows the impact of expanding health coverage and ways in which it can be improved.

In 2014, the number of children younger than 19 without insurance fell to 4.9% “as more children enrolled in coverage with their parents,” Little wrote. “Despite these gains in coverage, access to important screening, preventative and treatment services lags behind.”

Compared to the national average, Arkansas children are 13% less likely to have early medical screenings.

Meanwhile, the number of adults enrolled in coverage increased to 270,000 as a result of Medicaid expansion, helping low-income adults.

Before expanding coverage in Arkansas, more than 500,000 adults were without insurance, but the number was more than cut in half when they enrolled with the new coverage options.

In 2014, the percentage of Arkansas adults without insurance fell to 18%, from 32% in 2013. By mid-2015, it’s fallen to 9%.

Hispanic adults are most likely to not have insurance, with 54% having no coverage.

“Many of the persistent gaps between families at different income levels even dwindled as the state has moved toward a seamless health coverage environment,” Little wrote.

Between 2008 and 2013, as the percentage of children younger than 18 in poverty increased to 29%, from 24.7%, the percentage of children younger than 19 without insurance fell to 6.5%, from 9.4%, the report showed.

“The state not only avoided coverage losses for kids but continued to reduce insurance rates,” according to the report.

In 2014, when the new coverage options became available, child poverty fell to 26.4%, and the percentage of children without insurance fell to 4.9%.

The new options within the ACA allowed the state to be “hugely successful in increasing access to coverage for children and their families,” Little wrote. “But we can do even better.”

Little offered the following recommendations to see all Arkansans covered:

· Remove administrative hurdles to enroll and remain covered
· Invest in consumer outreach and education
· Eliminate coverage barriers for immigrant children living here legally
· Improve access to children’s healthcare services
· Safeguard funding for children’s coverage

The changes would close the coverage gap for “legally residing immigrant children, older children and youth and families in consistently uninsured regions of the state, like Northwest Arkansas,” Little wrote.

Outreach strategies should be focused on increasing enrollment for children in schools because as children get older, the percentage who don’t have insurance increases. The percentage of children ages 0-1 without insurance is 6%, but for children ages 11-18, the percentage is 61%.

Data shows that children living in the northwest part of the state have less access to coverage. The central portion of the state also saw an increase in children without insurance.

Both regions have a higher number of Hispanics, and these children are more likely to not have insurance, which might be “a major driver for the geographic disparities,” the report shows. More than 10% of Hispanic children younger than 19 and living in households earning less than 200% of the federal poverty level are without insurance.

Also, 56% of immigrant children do not have insurance, compared to 4% of children without insurance who are born in the United States.

And, 12.5% of children who speak a language other than English at home are without insurance, compared to 5% of children with no insurance who speak English at home.

A national report by the Georgetown Center for Children and Families and the National Council of La Raza recommends removing the five-year waiting period required before immigrant children legally living here can enroll in Medicaid or ARKids First.

More than two-thirds of Hispanic children are eligible for these insurance programs but don’t sign up “because of language barriers, complex eligibility requirements and lack of knowledge of their eligibility,” the study shows.

The healthcare system has continued to change, and a new version of the Medicaid expansion will create a state-based health insurance marketplace. As it becomes available, “it will be critical to effectively roll out these system changes to protect the recent achievements in health coverage,” Little wrote.