HJAR May/Jun 2020

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2020 35 purchase plans—or use a nationwide mar- ketplace created by the federal government. In 2011, the Arkansas General Assembly re- jected establishing a state-based exchange, choosing to rely on the federal model. Before passage of theACA, Medicare ben- eficiaries experienced a gap, often called the “donut hole,” in their prescription drug coverage that could expose them to up to $2,000 in out-of-pocket costs annually. In 2011, the ACA began providing subsidies to Medicare enrollees to phase out the cov- erage gap. In 2016, 37,972 Medicare Part D enrollees in Arkansas received discounts averaging $965 per person. 2012 TheACA’s medical loss ratio requirement took effect in 2012. Under this provision, insurance companies covering individuals and businesses must spend 80-85 percent of every premium dollar on actual clinical services provided to individuals and quality improvement efforts; the rest may be used This year marks the 10th anniversary of the ACA, the most sweeping overhaul of the American healthcare system in recent history. In this column, I will look back on milestones in the law’s history at the federal level, and in Arkansas. 2010 After a hard-fought battle in Congress, President Barack Obama signed the ACA into law on March 23, 2010. Taking effect that year was a provision al- lowing young adults to remain on their par- ents’insurance until they turned 26. Between November 2010 and November 2011, about 13.7 millionAmericans ages 19-25 stayed on or joined their parents’ insurance; 6.6 mil- lion of them were newly eligible to do so because of the ACA. 2011 The ACA requires each state to create its own health insurance marketplace—an ex- change where consumers can shop for and Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement for administrative costs, marketing, and profit. In 2018, 147,415 Arkansans received rebates averaging $110 per person because of insurance company spending that did not satisfy this requirement. Also in 2012, the federal government launched the Comprehensive Primary Care initiative with the goal of improving primary care delivery in participating states, a group that has included Arkansas from the first year. In 2017 and 2018, Arkansas providers received $90 million through the initiative for practice transformation, enhanced care coordination, and achievement of quality milestones. The U.S. Supreme Court in 2012 struck down mandatory Medicaid expansion, thrusting states into the role of deciding whether to expand their Medicaid programs. 2013 The Arkansas General Assembly in 2013 authorized an innovative form of Medicaid expansion. Originally known informally as