HJAR May/Jun 2020

36 MAY / JUN 2020 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY rendered the entireACAunconstitutional. A federal judge ruled later that year that the law is unconstitutional; the case is headed to the U.S. Supreme Court. With implementation of the work and community engagement requirement, Ar- kansas Works enrollees who were not ex- empt or deemed in compliance through wage data or other information digitally available to Medicaid were required to report work or community engagement activities. By the end of 2018, over 18,000 individuals were terminated for failing to comply with the requirement. 2019 A federal judge’s 2019 ruling struck down Arkansas’s work and community engage- ment requirement. Earlier this year, an ap- peals court upheld the judge’s ruling; that case is also expected to reach the U.S. Su- preme Court. The ACA continues to be a subject of debate in and out of court, but it has un- questionably transformed the healthcare landscape. Whether it is the protection for pre-existing conditions, the opportunity for young adults to stay on their parents’ in- surance, the stabilizing effect onArkansas’s insurance market, or the increased access to health care that has been crucial in fight- ing the spread of COVID-19, some aspect of the law has affected each of us. There is still much to fix in theAmerican healthcare system, especially in the area of cost, but we have come a long way in 10 years. n the “Private Option,” the program uses a premium-assistance model to secure private health insurance, offered on the insurance marketplace, forArkansans with incomes up to 138 percent of the federal poverty level. Arkansas was the only Southern state to opt for Medicaid expansion the first year it was available. As of February of this year, 250,476 Arkansans were enrolled. Also in 2013, the website for the federal health insurance exchange, Healthcare.gov, launched amid early technical challenges. 2014 TheACA’s individual mandate and protec- tions for pre-existing conditions took effect in 2014. The former required individuals to obtain health insurance to avoid a tax pen- alty; the latter prohibited premium differ- ences based upon health risks and required health plans to allow individuals to enroll regardless of their health status, age, gender, and other factors. 2015 In 2015, theACAbegan requiring employ- ers with 50 or more full-time employees to offer their employees health insurance or face financial penalties. Also that year, the Arkansas General As- sembly approved the Arkansas Healthcare Transparency Initiative Act, which includ- ed a mandate for certain entities to submit healthcare data to a state database, the Ar- kansas All-Payer Claims Database. In 2017, the initiative expanded to include medical marijuana data, hospital discharge and emergency department data, vital records data, and disease registry data. 2016 By 2016, Arkansas’s uninsured rate was 9.4 percent, or half of its 18.8 percent rate in 2013, the year before coverage began un- der the Private Option. Also, four insurers were participating in the state’s health insur- ance marketplace. Meanwhile, surrounding states that had not expanded Medicaid saw higher uninsured rates thanArkansas’s, and struggled to maintain competitive insur- ance markets. Also in 2016, the Arkansas General As- sembly renamed the expansion program “Arkansas Works” and added features in- tended to strengthen employer-sponsored coverage, and promote wellness and per- sonal responsibility. 2017 TheArkansas General Assembly approved modifications to Arkansas Works in 2017, including limitations on retroactive eligi- bility, and the incorporation of a work and community engagement requirement as a condition of eligibility. Also that year, Congress eliminated finan- cial penalties for failing to comply with the individual mandate. 2018 Arkansas’s attorney general announced in 2018 that Arkansas was joining 19 other states in a lawsuit maintaining that the re- peal of the individual mandate’s tax penalty “The Affordable Care Act continues to be a subject of debate in and out of court, but it has unquestionably transformed the healthcare landscape.”