Arkansas state officials and medical experts made a strong case for accepting expansion of the state’s Medicaid rolls under the federal Patient Protection and Affordable Care Act, but Republican lawmakers continue to be skeptical despite the evidence.
The issue is one provision of the so-called "Obamacare" — reducing the number of uninsured people by creating coverage options for those with low incomes. States that opt in would expand coverage to individuals with family incomes up to 138 percent of the federal poverty rate. That may sound like a lot of money, but in dollars it translates to $14,494 annually for an individual or $24,645 for a family of three.
Here’s the case for taking part, as explained by Arkansas’ surgeon general, Dr. Joe Thompson, in a television interview last week:
"In Arkansas, we have one of the most restricted Medicaid programs in the nation. To be on Medicaid today, an adult who doesn’t have kids and isn’t pregnant has to be disabled for 12 months. Their family can have no more than $2,000 in assets, and as an individual, they have to make less than $3,000 a year. So the expansion requires us to go to a higher level of coverage and get rid of those asset tests, giving the poorest of our citizens a mechanism to help pay for their care."
Medicaid is now available only to families earning up to 17 percent of the federal poverty line, one of the lowest eligibility requirements in the nation.
The Arkansas Medicaid program now costs about $4.8 billion annually and covers approximately 780,000 citizens. The Urban Institute has estimated that about 250,000 adults would be also eligible for Medicaid if Arkansas accepts the expansion — roughly half of those now without health insurance.
The federal government would pay 100 percent of the cost of the expansion for three years, and then the state’s share would increase each year until 2020, topping out at 10 percent. The program would not affect the 30 percent share the state already pays for people on Medicaid.
The U.S. Supreme Court, in upholding the constitutionality of the Affordable Care Act, also ruled that states have the right to opt out of the Medicaid expansion. Five states, including Texas and Florida, have already decided to do so.
Republican legislators question whether the state will be able to afford the Medicaid program as it stands now, much less adding additional costs. Gov. Mike Beebe had the same question and has been doing useful research. Last week he was able to get confirmation that the state could opt out later if it falls into recession and can’t afford it.
Generally, doctors haven’t been enamored by Medicaid. Nationally, about 31 percent of physicians are accepting new Medicaid patients, mostly because of low reimbursement rates, according to an article in the journal Health Affairs. But Arkansas doctors are among five states with an acceptance rate above 90 percent.
And last week the Arkansas Medical Society’s board of directors voted by a 3-to-1 margin to support Medicaid expansion. The board thus joined the Arkansas Board of Health, the Arkansas Hospital Association and the Arkansas Foundation for Medical Care in supporting the program.
That’s a pretty broad cross-section of the health-care community.
One thing the medical experts know is that we’re already paying for the medical care of poor people. A study by the Hospital Association estimated that $338 million was spent on indigent care in 2010.
"The uninsured are already accessing medical care," David Wroten, executive vice president of the medical society, told a reporter. "They are going to ERs (emergency rooms)."
Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, told a legislative committee last week that UAMS would lose about $20 million if the state opts out of the Medicaid expansion. On the other hand, the hospital would end up $22 million in the black under the expansion, he said, because of the money previously lost on uncompensated care for the indigent.
Sen. Paul Bookout, D-Jonesboro, who works for St. Bernards Healthcare, said many rural hospitals are in danger of closing, in large part because of having to treat the indigent who have no insurance coverage.
Members of the health-care community know they have a moral and ethical obligation to provide care for the poor so it’s not a political issue for them.
Many Republican legislators argue philosophically that it’s not "free money" and that the federal government doesn’t have surplus funds to cover the program.
Of course, there’s no such thing as free money. Health care, from the public perspective, is a matter of priority, and it should be a high priority.
If we take the attitude that we shouldn’t take these federal dollars because the U.S. government is operating at a deficit and piling up debt, we should also refuse federal highway dollars. And we should reject federal drought disaster funds. And we should insist on closing down the Jacksonville Air Force Base and stopping those constant training flights around central Arkansas.
We could do such things for philosophical reasons and let other states get the federal dollars instead. If our national leaders could work together for the common good, we could set some priorities.
Roy Ockert is editor emeritus of The Jonesboro Sun. He may be reached by e-mail at firstname.lastname@example.org.