Twelve years ago, President Barack Obama, a Democrat, signed the Affordable Care Act (ACA) or Obamacare into law. Since its passage, experts in health care say they have a clearer picture of the law’s impact.
Under Gov. Mike Beebe, a Democrat, a bill was passed in the Arkansas General Assembly and eventually approved by the Obama administration to expand the state’s Medicaid program. It allowed low-income individuals to receive a tax-credit to help them pay for private insurance. In a report released in 2020, The Kaiser Foundation estimated 51,392 Arkansans receive a tax-credit, averaging about $382.
According to Ballotpedia.org, Arkansas is one of the 31 states to expand Medicaid under the ACA.
Dr. Joe Thompson, who was Arkansas surgeon general when the ACA passed, says provisions in the law helped address health insurance plans that limited coverage for patients with pre-existing conditions.
“Before the Affordable Care Act it was common for individuals who had a condition, before they got insurance to be offered insurance but not to cover that condition. The Affordable Care Act took a step in making sure that pre-existing conditions were not an exclusion in insurance policies both for the state and nationwide,” Thompson said in an interview with KUAR News.
In Arkansas, 34% of adults have a pre-existing condition, according to the Kaiser Foundation.
Prior to the ACA, patients with cancer had difficulty finding health insurance plans that would fully cover them, Thompson said.
“If you had cancer previously and been successfully treated you would be offered a policy for potentially a heart attack or another condition, but it would have a rider that would exclude if that cancer came back, coverage for that condition,” he said.
A report by the Arkansas Department of Health in 2020 estimated that 126,740 Arkansas residents developed cancer between 1997-2017 and are still alive.
Thompson, who is currently the president and CEO of the Arkansas Center for Health Improvement, said the pandemic shows the importance of making sure individuals have a health insurance plan.
“The ACA through offering insurance coverage has really relieved a lot of the fiscal anxiety that uninsured individuals would have faced had they gone into the pandemic without health insurance coverage,” he said. “At least for Arkansas and many other states that took advantage of the Affordable Care Act, individuals in those states have health insurance. When they got sick, they could seek out care, testing and treatments without concerns about having to pay for it.”
Once the federal government ends the public health emergency, Thompson said health insurance plans will play an important role in dealing with the pandemic.
“Some funding for COVID-19 will cease to flow to states. I think that is where our more traditional insurance, those through Arkansas Works and in the insurance exchange will be so important to continue to provide individuals financial coverage for health issues that may be ongoing and caused by COVID-19 or other conditions that are common that happened before COVID-19,” he said.
Moving forward, Thompson said improvements will be needed to the ACA to bring down the cost of health insurance. According to reports from the Kaiser Foundation and McKinsey Center for the U.S. Health System Reform, premiums increased by 2% to 6% from 2014-2015, which is the second year the ACA was in place. The Commonwealth Fund found that prior to the passage of the ACA, premiums were rising by 10% or more between 2008 and 2010.
“Congress made an intentional decision to move for coverage first and then not deal with cost containment or value-based purchasing, where what we are buying is getting us good outcomes,” Thompson said. “There are ongoing efforts to try and move us from the fee-for-service system that has a lot of services provided to more of a value-based system that gets us good outcomes that we all want and expect. The Affordable Care Act only dealt with coverage only and tried to stimulate the move to value.”
ARHome, which was signed into law by Republican Gov. Asa Hutchinson, replaced Arkansas Works as the state’s healthcare program and Thompson believes it is a step in the right direction to move the state into a value-based system with health insurance coverage.
“People will continue with their basic health insurance coverage to provide that financial support,” Thompson said. “ARHome attempts to go beyond that and try to set up additional programs, particularly in rural Arkansas, for pregnant moms, their kids and individuals that had substance abuse issues and for those transitioning out of corrections or foster care and into mainline society. It is trying to make sure some of the social aspects and some of the support needs for those individuals are in place so they don’t need as much health care in the future.”
ARHome went into effect on January 1 and currently provides health insurance to 300,000 low-income Arkansans using Medicaid, according to the governor’s website.
