One of the Arkansas lawmakers who created his state's influential "Private Option" Medicaid expansion alternative is working on a proposal for revamping the state's public health insurance exchange program.
State Sen. David Sanders, R-Little Rock, wants to use Patient Protection and Affordable Care Act (PPACA) Section 1332 — a provision that lets a state propose sweeping changes in PPACA exchange and commercial health insurance market rules for its market — to get Arkansas a more market-oriented, less rules-driven exchange.
Arkansas has a PPACA partnership exchange. The U.S. Department of Health and Human Services (HHS) provides the enrollment and administration systems, but Arkansas helps with marketing. The state hopes to set up a state-based exchange in 2016.
Sanders — chairman of the Arkansas Health Insurance Marketplace Legislative Oversight Committee — wrote to Sherrill Wise, chair of the Arkansas Health Insurance Marketplace Board in July to ask her team to give him ideas about how to use Section 1332 waiver authority to make a state-based Arkansas exchange better, cheaper and more competitive. Sanders said he would also like to see the state use waivers to reduce dependence on entitlement programs and increase access to private health insurance.
"We're looking at data," Sanders said today in a telephone interview.
One goal is to avoid making any changes that would increase the cost of coverage or reduce access, Sanders said.
Sanders helped lead efforts to get Arkansas the authority to use PPACA Medicaid expansion money to help low-income people buy qualified health plan (QHP) coverage from the exchange system, rather than automatically enrolling low-income people in Medicaid. Arkansas is putting frail low-income people and those with disabilities in a Medicaid-based care coordination program but letting others sign up for the same QHPs that higher-income people buy. One result is that the Arkansas QHPs have the youngest enrollees in the country, Sanders said.
Sanders talked about the Arkansas Medicaid expansion alternative at National Conference of State Legislatures events, and officials in Indiana, Iowa, Pennsylvania and Utah have been trying to take a similar approach.
See also: Arkansas hospitals like Medicaid alternative.