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HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 45 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement the expansion population. 8 A decade ago, opponents of expansion warned that Arkansas’ 10% share of the cost would bankrupt the state, but Arkan- sas’ spending on the program is more than offset by the economic benefits. Aconsultant hired by a legislative task force estimated in 2016 that the program would have a net positive impact of $757 million on the state budget between 2017 and 2021 through a combination of reduced state expenditures and increased tax revenues. 9 The 10% state to 90% federal match continues to be a lev- eraged investment of limited state dollars ensuring care, achieving access, and secur- ing the future of our healthcare system. Public policies are dynamic. The only thing we can safely predict about Arkan- sas’Medicaid expansion program and oth- er public health policies is that they will change. Policymakers will look for innova- tive ways to address continuing challenges in our healthcare system, such as poor health outcomes, especially for mothers and infants; health disparities; and financial pressures on rural hospitals. The Medicaid expansion programwill likely look different in the future, but policymakers should en- sure that it continues to strive for three ba- sic objectives: financial protection through coverage, accessibility to needed healthcare providers, and quality outcomes in main- taining health and treating disease. n REFERENCES 1 Arkansas Center for Health Improvement. De- cember 2023. Unpublished analysis of Arkansas All-Payer Claims Database data. 2 Nolin, J. “Will Georgia Republicans embrace full Medicaid expansion by another name?” Georgia Recorder. Jan. 31, 2024. https://georgiarecorder. com/2024/01/31/will-georgia-republicans- embrace-full-medicaid-expansion-by-another- name/ 3 Witters, D. “Kentucky, Arkansas post largest drops in insurance rates.” Gallup. Feb. 8, 2017. https://news.gallup.com/poll/203501/kentucky- arkansas-post-largest-drops-uninsured-rates. aspx 4 Kaiser Family Foundation. “The ‘Private Op- tion’ Medicaid Expansion in Arkansas Has Helped Reduce the Uninsured Rate and Un- compensated Care Costs While Boosting the State’s ACA Marketplace.” Aug. 26, 2015. https://www.kff.org/medicaid/press-release/ the-private-option-medicaid-expansion-in- arkansas-has-helped-reduce-the-uninsured- and-uncompensated-care-costs-while-boosting- the-states-aca-marketplace/#:~:text=Like%20 more%20traditional%20Affordable%20 Care,the%20state's%20hospitals%2C%20 with%20Medicaid 5 Wessel, J. “Rural Hospital Closures in Arkansas and Surrounding States Since 2012.” Arkansas Center for Health Improvement. Last updated Jan. 9, 2024. https://achi.net/library/rural- hospital-closings-in-southern-states/ 6 Center for HealthcareQuality &Payment Reform. “Rural Hospitals at Risk of Closing.” Accessed Jan. 31, 2024. https://chqpr.org/downloads/ Rural_Hospitals_at_Risk_of_Closing.pdf 7 Wessel, J. “Data Watch: Arkansas Individual Marketplace Health Insurance Premiums.” Ar- kansas Center for Health Improvement. Nov. 29, 2023. https://achi.net/library/data-watch- arkansas-individual-marketplace-health-insur- ance-premiums/ 8 Kaiser Family Foundation. “Medicaid Expan- sion Spending: FY 2022.” Accessed Jan. 31, 2024. https://www.kff.org/medicaid/state-indicator/ medicaid-expansion-spending/?currentTimefra me=0&sortModel=%7B%22colId%22:%22Locatio n%22,%22sort%22:%22asc%22%7D 9 Brawner, S. “Dropping Medicaid Expansion Would Cost Arkansas $757 Million, Consultant Says.” Little Rock Public Radio. March 7, 2016. https://www.ualrpublicradio.org/local-regional- n ews /201 6 - 03 - 07/d ropp i ng -me d i c a i d - expansion-would-cost-arkansas-757-million- consultant-says insurance market and allowed us to expe- rience lower premium increases than most states have seen. People who are medically frail are enrolled in traditional Medicaid rather than the expansion program, which has resulted in an expansion population that is relatively young and healthy — and low- risk for insurers to cover. Since 2017, average marketplace premiums in Arkansas have been lower than in any of the surrounding states. 7 Arkansas’ economy has also benefited. The federal government pays 90% of the costs of Medicaid expansion, which means that billions of federal dollars have flowed intoArkansas that the state would not have received if we had not expanded Medicaid — although Arkansans’ federal tax dollars would have continued to pay for Medicaid expansion in other states. In fiscal year 2022 alone, Arkansas received $2.5 billion in fed- eral funding to provide health coverage for Last Updated: January 9, 2024 Source: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill