Against all odds, Arkansas appears poised to move ahead with a plan that will bring private coverage to a population very close to the poverty level while defanging the controversial Medicaid expansion that is now viewed as an optional part of the Patient Protection and Affordable Care Act (PPACA).
The Arkansas solution became law toward the end of April after a few early fits and starts in the state legislature, when Arkansas Democratic Governor Mike Beebe signed a bill that would allow — if the federal government grants a waiver — those for whom the Medicaid expansion was intended to buy private health insurance through the Arkansas health insurance exchange or marketplace.
Arkansas’ DHS staff is working on a timetable for the necessary waiver, but we do not yet know when the waiver application will be submitted. There must still be a public comment period for the waiver, so May is out of the question in terms of a waiver submission. Advocates for the premium assistance solution, like Selig, believe it is better for consumers while satisfying politicians who do not want to expand a federal program. The consumers will have better access to care with a private insurance card rather than a Medicaid card, Selig said, echoing what many states think of the Medicaid program access.
Moreover, it will attract new carriers to the market, Selig hopes. The industry has been supportive of expansion all along and now there seems to be a number of carriers interested, he said. The 100 percent to 133 percent FPL are not the Medicaid frail, Selig pointed out. These 250,000 or so individuals that will now get to go on the exchange, if HHS approves Arkansas’ law, to buy private insurance tend to be relatively young and healthy. The Medicaid frail will stay in the Medicaid program and not go into the private sector because they need more comprehensive care than the essential benefits package, according to Selig.
The state of the Mississippi exchange
Arkansas’ plan may indeed be homegrown, but Mississippi Insurance Commissioner Mike Chaney wanted to use that option for signing up Mississippi individuals that were in the top of the FPL range and who would normally be eligible for Medicaid.
Where other states stand
In Missouri, which has a Democratic governor like in Arkansas, and a Republican legislature that is “veto proof,” according to one health advocate there, Medicaid expansion did not pass. Although it has the same configuration as Arkansas, the branches of government failed to hash out a compromise.