Report: Rural uninsured Arkansans drop with Medicaid expansion

The percentage of low-income Arkansas adults living in small towns and rural areas who lack health insurance decreased from 45% in 2008-09 to 22% in 2015-16, says a new report that credits the Medicaid expansion program known today as Arkansas Works.

The report considered adults with incomes up to 138% of the federal poverty level. The state’s overall uninsured rate among that population fell from 46% to 21% during that time period. The uninsured rate in metropolitan counties in Arkansas fell even further, from 47% to 21%.

The report is titled, “Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion.” The report was produced by Georgetown University’s Center for Children and Families and the University of North Carolina’s NC Rural Health Project.

The report said Arkansas’ 23-point decline in the uninsured in non-metropolitan areas trailed only Colorado, Nevada, Kentucky, Oregon and New Mexico, first to fifth. Across the country, 14% of non-elderly Americans live in small towns and rural areas.

The report said the uninsured rate for low-income adults living in non-metropolitan areas dropped from 35% to 16% among those states that, under the Affordable Care Act (Obamacare), expanded their Medicaid populations for individuals earning up to 138% of the federal poverty line. Because of a Supreme Court ruling, states could choose whether or not to expand those populations. In states that chose not to expand, the percentage of uninsured low-income adults in small towns and rural areas fell from 38% to 32%. Wyoming experienced the steepest drop among non-expansion states, falling from 47% to 28%.

Instead of simply increasing the number of Arkansans covered by Medicaid, Arkansas obtained a federal waiver allowing it to use those dollars to purchase private insurance. The program was begun under Gov. Mike Beebe and continued under Gov. Asa Hutchinson under the name “Arkansas Works.”

At the beginning of August, the program covered 265,223 individuals, down from 285,564 on Jan. 1.

The overall uninsured rate for children and non-elderly adults across the United States fell from 18.2% to 10.7% from 2010 to 2017. In states that expanded Medicaid, it decreased from 16.4% to 7.6%. It fell from 20.3% to 15.7% in non-expansion states.

The report referenced a study that found that rural hospitals were more likely to close in non-expansion states. Another study found that community health centers in expansion states have seen an 11% decline in uninsured patients at the same time that their Medicaid patients increased 13%.

Bo Ryall, president and CEO of the Arkansas Hospital Association, said Arkansas Works “has been a lifeline for our small rural hospitals. The decrease in the number of the uninsured has translated into a reduction in uncompensated care for hospitals. Arkansas Works is the reason that we have not seen the hospital closures experienced by the states who chose not to expand Medicaid.”

The program has been controversial since it was created in 2013. Opponents have said it is an unaffordable expansion of government-funded health care. The state has been responsible for an increasing share of the program’s cost that will top out at 10% in 2020.

Opponents have tried to end Arkansas Works in previous legislative sessions by voting against funding the Department of Human Services’ Division of Medical Services, the agency that administers the program. All funding bills require 75% majority approval.

Incoming Senate President Pro Tempore Jim Hendren, R-Sulphur Springs, said Tuesday that he does not expect so bitter a fight during the upcoming 2019 legislative session.

“Recent primaries have proven that most Arkansans support our efforts to reform the program to ensure its long-term viability rather than abolish it,” he said. “Also traditional Medicaid reforms that we have implemented have made our ability to pay our required matching funds sustainable.”

“Arkansas elected officials showed real leadership in becoming one of the few Southern states to expand Medicaid. Their constituents are better off for their decision to look beyond the politics of the day and choose the path best for Arkansas,” said Rich Huddleston, executive director of Arkansas Advocates for Children and Families. “We urge today’s policymakers to look to these phenomenal results and to take steps to ensure that Arkansans keep their coverage.”