Health expert says data still incomplete to assess Arkansas Works, Obamacare changes

Dr. Joe Thompson, CEO of the Arkansas Center for Health Improvement and a former state surgeon general, says the data is still incomplete to shape policy over two of the biggest health insurance programs in Arkansas.

Appearing on this week’s edition of Talk Business & Politics, Thompson discussed the state’s Medicaid expansion program, known as Arkansas Works. Thompson helped craft its predecessor, the private option.

He said that less than four months into the new work requirement component of Arkansas Works, which has seen more than 12,000 Arkansans removed from the Medicaid rolls, he’s not sure a decision to alter the policy can be made.

“Because we’re only three months, four months into individuals being totally subject to the work requirement, I think there is a need to evaluate it and there’ll be a requirement by the feds to look at the outcome,” Thompson said.

“You know, that outcome really has two parts. A successful policy for a work requirement would have an individual get a job or increase their income from their job, number one, but number two, would have them also engage and get private health insurance. You have to have both: improved salaries or higher earnings and private health insurance for this work requirement to be a success.”

The work requirement was advocated and pursued by Gov. Asa Hutchinson and a supermajority of GOP state lawmakers. There is debate as to how many of the 12,000-plus leaving the rolls are doing so because of income increases or because they have failed to complete the program’s online notification requirements.

The controversial Affordable Care Act, often referred to as Obamacare, will also have a new set of political parameters to be viewed with Democrats taking control of the U.S. House of Representatives. Chances of a “repeal and replace” law are slim to none with a divided Congress.

Thompson said as individuals are currently in the open enrollment process for next year, it will be several more weeks before any apparent trends will present themselves that could or should be addressed.

“I think much is going to be determined by the open enrollment process that we’re in now. If states have fewer people, sicker people enrolled, then the insurance markets across the nation are going to become much more unstable, and there would be demands for action,” he said.

“People in Arkansas don’t really recognize it. We have the most stable and the lowest increases of any state in the nation, so we’ve been pretty protected from this, but other states are having 30, 40, 50% rate increases each year, and the politics around that has started having privately insured people affected,” Thompson said.

Arkansas’ private option/Arkansas Works program, which has utilized private insurance carriers for the Medicaid expansion policies, has aided the state’s stability.

“We put a big guaranteed purchaser, Medicaid, in the middle of the insurance marketplace, and it made the private insurance carriers much more comfortable offering coverage and stability in rates of the coverage that they offer,” he said.

Thompson also addressed a new Georgetown study that was released this week that showed the number of uninsured children in Arkansas rising from 4% to 4.4%, a trend that is heading in the wrong direction for the first time in years.

“That is a concerning trend that we saw… For over the last decade, the number of uninsured children has been going down nationwide and in Arkansas. And nationwide, statistically significant increases were noted this week. Arkansas’ were not statistically significant, but they were in line.

“I don’t think we know yet what’s going on there. There are some issues around the noise that’s in the insurance world about the instability of the Affordable Care Act and the negative conversations that have been on the air waves for the last five years. We’ve also got some other things that are concerning. The substance abuse opioid epidemic and some things that could be affecting parents’ actions that are in the best interests of their children, and that may be getting diverted from some other causes,” Thompson said.

On Monday night in Little Rock, Thompson will moderate a discussion between former Governors Mike Huckabee and Mike Beebe, both of whom oversaw a number of health policy initiatives during their terms as Arkansas governor.

Huckabee championed ARKidsFirst, a small business health insurance pool, a statewide indoor smoking ban, and the Tobacco Settlement Act, which dedicated proceeds from a landmark national tobacco settlement into state health programs.

Beebe oversaw the private option, a state tobacco tax increase that created a statewide hospital trauma network, and the Payment Improvement Initiative, which has pushed for efficiencies in health care delivery and a reduction in a fee-for-service model of health care.

The Monday night event with Huckabee and Beebe will also include introductions by Gov. Asa Hutchinson. The Clinton School of Public Service is hosting the forum, which celebrates the 20th anniversary of the Arkansas Center for Health Improvement. The public can attend the 6:00-7:30pm event at the Statehouse Convention Center for free, but you must make a reservation. Visit here for more information.

You can also watch Thompson’s full interview in the video below.