From the Arkansas Advocate:
Arkansas ranks 48th in a nationwide assessment of health care access, affordability, equity and outcomes, according to a Commonwealth Fund report released Wednesday.
The foundation analyzed 50 health indicators for all 50 states plus the District of Columbia. In the six categories into which the report divided the indicators, Arkansas ranked:
- 42nd in health care access and affordability
- 41st in prevention and treatment of health problems
- 36th in avoidable hospital use and cost
- 49th in healthy behaviors
- 36th in health disparities based on income
- 48th in health disparities based on race and ethnicity
Oklahoma, Texas and Mississippi are the three states the Commonwealth Fund ranked below Arkansas overall. The organization advocates for equitable health care and provides grants for health research and improvements.
In a press briefing Tuesday, the authors of the report said they believe proposed federal cuts to public benefits, primarily Medicaid, will worsen the health care landscape and undo years’ worth of progress improving health outcomes and insurance rates. Arkansas Advocates for Children and Families, part of the Casey Foundation’s KIDS COUNT network, expressed similar concerns earlier this month after the Annie E. Casey Foundation released a report ranking Arkansas 45th in child well-being nationwide.
A federal budget bill moving through Congress would reduce Medicaid spending by $625 billion over 10 years. Arkansas was the first Southern state to expand Medicaid in 2013, but it is among the states with a trigger law to end the expansion program if federal funding for Medicaid is reduced.
More than 800,000 Arkansans are on Medicaid, and more than half are children.
The federal budget bill would also add new Medicaid work requirements for some non-disabled adults. AACF has repeatedly denounced such requirements, and Wednesday’s report asserted that working adults would lose Medicaid coverage under such requirements “because of the known difficulties associated with submitting documentation, filing paperwork, and securing internet access.”
About 5 million Americans could become uninsured as a result, report co-author Sara Collins said.
Arkansas became the first state to implement a work requirement for some Medicaid recipients in 2018, but a federal judge struck down the policy the following year. The initiative cut 18,000 people’s Medicaid coverage.
Additionally, the budget bill’s proposed changes to the Affordable Care Act, including a reduced open enrollment period and the expiration of pandemic-era subsidies for care plans under this law would lead to even more people losing insurance coverage, Collins said.
“When people go to the marketplace in November [2026], they are going to see their premiums spike,” she said. “They will see major increases in their premiums, so we’ll potentially see dropoffs in enrollment pretty quickly.”
Every state saw a decrease in its uninsured adults between 2013 and 2023, and the Affordable Care Act was a major contributor to this, the report states. Arkansas’ uninsured rate nearly halved, from 24.2% to 12.5%, during that time.
Arkansas also saw fewer instances of avoidable hospital use and cost from 2019 to 2023, according to the report, particularly for Medicare beneficiaries, who are at least 65 years old.
However, 3% more children in Arkansas were uninsured in 2023 compared to 2019, and there was no change in the proportion of uninsured adults in Arkansas during that time, according to the report.
Almost every state saw fewer adults forgo medical care due to the cost between 2013 and 2023. Arkansas’ rate dropped from 21% to 13.9%, according to the report.
Nationally, the percentage of working-age adults without health insurance fell from 20.4% in 2013 to 11% in 2023, and the percentage of adults that skipped medical care because of the cost declined from 15.9% to 11.7%, the report states.
Child health
The report notes that fewer children have been receiving all seven recommended early childhood vaccinations against infectious diseases in 36 states, including in Arkansas. In 2019, 73.9% of Arkansas children had received all of these vaccines, but this percentage dropped to 67.1% by 2023, the report states.
“In some instances, children start the vaccine series but don’t receive all doses — sometimes because they lack health insurance coverage,” the report states. “Children living in poverty or in rural areas are less likely to complete the vaccination series, with access-related barriers and logistical challenges key contributors to their lower vaccination rates.”
Vaccine hesitancy also has grown nationwide since the COVID-19 pandemic in 2020. Report co-author Kristen Kolb said Tuesday that the federal government’s recent actions and rhetoric “could further erode the public’s confidence in vaccines.”
U.S. Health and Human Services Secretary Robert F. Kennedy Jr. has publicly expressed doubts about the effectiveness of vaccines, and earlier this month he removed and replaced the entire Centers for Disease Control and Prevention panel that advises national vaccine policies.
Kolb called this a “serious disruption,” noting that the panel might not recommend that insurers pay for vaccinations.
Arkansas is one of several states that has seen the recent community spread of measles, a disease once considered eliminated by herd immunity thanks to vaccination rates.
Wednesday’s report notes that the CDC no longer recommends COVID-19 vaccines for pregnant women, despite evidence that this demographic is “at greater risk for severe complications” from the illness.
Maternal and infant mortality rose nationwide between 2018 and 2022, and Arkansas consistently has high rates of both. The report ranked Arkansas 49th in infant mortality with a rate of 7.7 deaths per 1,000 live births, compared to the national average of 5.6.
The Casey Foundation’s report earlier this month stated that Arkansas’ rate of child and teen deaths worsened from 2019 to 2023, totaling 300 per 100,000.
More broadly, Arkansas’ rate of premature deaths from preventable causes per 100,000 people worsened over roughly the same time period, from 230.9 to 259.6, according to the Commonwealth Fund.
The report also noted racial disparities in health outcomes. The rate of Black people in Arkansas per 100,000 who died before the age of 75 from preventable causes in 2020-21 was 405.6, compared to 316.2 among white people, 225.5 among Asian Americans and 203.4 among Hispanic people.
Similarly, infant mortality for Black babies in Arkansas was 12.8 per 1,000 live births, compared to 7.2 for white babies, 5.7 for Asian American babies and 4.6 for Hispanic babies, according to the report.
The report’s overall analysis of Arkansas’ health landscape paints “a complicated and mixed picture,” Arkansas Advocates for Children and Families economic policy director Pete Gess said in a Tuesday email. He noted infant mortality and decreasing child vaccination rates as particularly concerning. He also said the state government will likely be required to direct more public funding to Medicaid, nutrition assistance and other “basic needs programs” in the face of federal budget cuts.
“All of these changes create stress for children and families in our state, and we can expect diminishing health outcomes,” Gess said.
