Study: Arkansas’ western counties have higher uninsured rates

Counties along the state’s western edge had higher uninsured rates among the population served by Arkansas Works than the rest of the state in 2017. Eight of the state’s nine counties with the highest overall uninsured rates also were in western Arkansas.

That’s according to an analysis of county data released April 9 by the U.S. Census Bureau’s Small Area Health Insurance Estimates program.

The uninsured rate for Arkansans of all income levels under age 65 in 2017 was 9.3%, or 226,179 people.

Meanwhile, 19% of working-age adults ages 18 to 64 who were living at or below 138% of the the poverty line, or 77,535, were uninsured. The number of Arkansans at that lowest income level decreased by more than 53,000, from 461,411 in 2013 to 408,357 in 2017.

That’s the population potentially served by Arkansas Works, the state program that uses mostly federal dollars to purchase private health insurance.

Originally known as the “private option,” Arkansas Works was created by legislators and Gov. Mike Beebe’s administration in 2013. It was created after the U.S. Supreme Court ruled states could choose whether or not to expand their Medicaid populations under the Affordable Care Act, otherwise known as Obamacare.

Uninsured rates in that population ranged from a low of 11.3% in Phillips County, an eastern Arkansas county whose seat is Helena-West Helena, to a high of 36.4% in Sevier County in southwest Arkansas. Its county seat is DeQueen.

Benton County in Northwest Arkansas had the second highest uninsured rate for the population potentially served by Arkansas Works, 29.1%. Its county seat is Bentonville. Sebastian County (Fort Smith) had the third highest uninsured rate at 25.7%. Yell County in west-central Arkansas (Danville) was fourth with a rate of 25.2%.

The uninsured rate for working-age adults ages 18 to 64 who were living at or below 138% of the poverty line ranged from 11.3% to 19.5% in 58 Arkansas counties.

Sixteen of the other 17 counties had uninsured rates of 20.1% to 30% in that population, and all of them were in the western part of the state except Bradley County (Warren), which is in south-central Arkansas.

Along with Sevier, Benton, Sebastian and Yell counties, the others were Carroll, Washington, Madison, Crawford, Johnson, Pope, Scott, Polk, Montgomery, Howard, Pike and Hempstead counties.

Aside from Phillips County, other eastern Arkansas counties also had low uninsured rates among the population served by Arkansas Works. Jefferson County, home of Pine Bluff, had the third lowest rate at 13.4%. The second lowest was Ouachita County (Camden), at 13%. Lee County, (Marianna), was tied for fourth lowest with Clark County (Arkadelphia), with 13.5% uninsured in that population.

Other eastern Arkansas counties with low uninsured rates among the potential Arkansas Works population were Mississippi County (Blytheville), sixth lowest, 13.8%; and St. Francis County (Forrest City), seventh lowest, 13.9%.

So why the low uninsured rates among the Arkansas Works population in eastern Arkansas and higher rates in western Arkansas?

Craig Wilson, health policy director for the Arkansas Center for Health Improvement, attributed the discrepancy to two factors.

“The eastern part of the state, including the Delta, has had more developed infrastructure for public program outreach historically including the faith community,” he wrote via email. “It [western Arkansas] is also reflective – particularly for the four counties we mentioned – of concentrated pockets of migrants who historically have higher rates of uninsured.”

Those four counties were Sevier, Benton, Sebastian and Yell Counties. According to the U.S. Census Bureau, Sevier County has the state’s highest percentage of Hispanic residents, at 33.8%. Yell County is second at 20.4%. Benton County is fourth at 16.7%. Sebastian County is eighth at 14.4%.

Sevier County also had the highest overall uninsured rate with 17.7% of its population under age 65 uninsured. Polk County (Mena) was next highest with 13%, followed by Sebastian County with 12.9%. Carroll County (Berryville) was fourth highest at 12.8%, followed by Washington County (Fayetteville) with 12.4%. Benton County was tied with Izard County (Melbourne) for the 19th highest at 10.4%.

Fifty-five counties had overall uninsured rates at 10% and below for Arkansans under age 65. The lowest was Grant County (Sheridan), with 6.1% uninsured, followed by Ouachita and Greene (Paragould) at 7%. Lonoke (largest city, Cabot) was next at 7.1%, followed by Jefferson and Clark at 7.2% and Phillips at 7.3%.

Rounding out the top 10 counties with the lowest uninsured rates were Saline (Benton-Bryant) at 7.5%, Mississippi at 7.6%, and Hot Spring (Malvern) at 7.6%. Pulaski County, the state’s largest county and home of Little Rock and North Little Rock, had the 11th lowest uninsured rate at 7.7%.

The uninsured rates were helped by high percentages of insured children. The statewide uninsured rate for children under age 19 was 4.3%.

Nationwide, the report found the median county uninsured rate was 10.6% for the population under age 65, with the rate ranging from 2.3% to 33.7%. Moreover, 38.4% of counties, or 1,206, had uninsured rates at or below 10% for residents under age 65. There are 3,142 counties in the United States. From 2013 to 2017, 95.5%, or 2,996, saw a decrease in uninsured adults under age 65.

As of Dec. 31, 2017, 31 states and the District of Columbia had expanded Medicaid under the Affordable Care Act. In those states, 9.3% of counties had estimated uninsured rates above 20%. In non-expansion states, 81.9% of counties had rates that high, the report said.

Among other Deep South states, only Louisiana had uninsured rates below 10% in a majority of its parishes. Like Arkansas, it participated in the Medicaid expansion program. In Kentucky, which also participated in Medicaid expansion, every county had a rate below 10%.

But other Southern states had not participated by that point. Mississippi, Georgia, South Carolina and Florida had no counties with fewer than 10% uninsured, while Tennessee, North Carolina and Alabama had only a small number of counties each.

Oklahoma and Texas, which also did not participate in Medicaid expansion, had no counties with rates below 10% according to the SAHIE analysis. Missouri, which did not participate, had 12 counties out of 114 reach that low of a rate.