HJAR Sep/Oct 2020

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2020 37 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement non-expansion states will see increasing portions of their populations fall into a coverage gap, being eligible neither for Medicaid, nor for marketplace subsidies, according to the study. Having a healthcare safety net in place may be more important now than at any point in our lifetimes. Whatever changes may lie ahead for Arkansas Works in 2021, it is clear that, especially during these combined public health and economic crises, we should not reverse the progress we have made in providing health coverage to Arkansans in need. n REFERENCES 1 Sommers BD, Maylone B, Blendon RJ, et al. Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low- Income Adults. Health Affairs. 2017;36(6):1119- 1128. https://www.healthaffairs.org/doi/ full/10.1377/hlthaff.2017.0293. 2 Remler DK, Korenman SD, and Hyson, RT. Esti- mating the Effects of Health Insurance and Other Social Programs on Poverty Under the Affordable Care Act. Health Affairs. 2017; 36(10): 1828-1837. https://www.healthaffairs.org/doi/abs/10.1377/hlt haff.2017.0331?journalCode=hlthaff. 3 Garfield R, Claxton G, Damico A, et al. Eligibility for ACA Health Coverage Following Job Loss. KFF. May 13, 2020. https://www.kff.org/ coronavirus-covid-19/issue-brief/eligibility-for- aca-health-coverage-following-job-loss/. through the state’s unique premium assistance model, reduced uncompensated care costs at hospitals, shored up hospitals’ finances to the extent that Arkansas has largely avoided hospital closures, and recaptured federal tax dollars that otherwise would have supported Medicaid expansion programs in other states. The program has made a difference in people’s lives. A 2017 study published in Health Affairs 1 looked at two expansion states, Arkansas and Kentucky, and one non- expansion state, Texas. The study found that in the first three years of Medicaid expansion in the two expansion states, the acquisition of insurance by previously uninsured people was associated with a 41 percentage point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23 percentage point increase in self-reported excellent health. Medicaid expansion also helps to lift people out of poverty. Another 2017 2 study in HealthAffairs compared different types of social programs, and found that Medicaid, including Medicaid expansion under the ACA, has an impact on poverty reduction that is comparable to the impact of all non- health-related social programs combined. For children, Medicaid has a greater impact on poverty reduction than all non-health- related programs combined, according to the study. The COVID-19 pandemic has given Arkansans new reasons to be thankful that our legislators had the foresight to expand Medicaid at their first opportunity, a distinction no other Southern state can claim (Louisiana adopted and implemented expansion in 2016). The program has meant that fewer Arkansans have had questions about whether COVID-19 testing will be covered, fewer have had to worry about treatment costs, and more have had a coverage safety net as the economic downturn has caused many to lose jobs, income, and employer-sponsored insurance. A KFF study from May 3 found that if unemployment caused by the pandemic extends into January 2021, when unemployment insurance benefits likely would expire for many families, expansion states can expect to see increasing portions of their populations become eligible for coverage through the states’ Medicaid expansion programs. In contrast, “ Medicaidexpansionhadalreadyprovenitsvalue in Arkansas before the pandemic. The program hasextendedhealth insurancecoverage tonearly 300,000 people , increased insurancemarket competition through the state’s unique premium assistancemodel, [and] reduced uncompensated care costs at hospitals. ”