Arkansas Center for Health Improvement

Arkansas Baseline Report: State-Level Field Network Study of the Implementation of the ACA Released

Article Date: 6/3/2015

 June 3, 2015

Partnerships with Private Sector Fuel Arkansas's Expanded Health Care Coverage, System Transformation

For more information, contact: Debra Pate, Communications Specialist (501) 526-2244, dapate@uams.edu

Robert Bullock, Rockefeller Institute (518) 443-5837, robert.bullock@rockinst.suny.edu

Little Rock, Ark. (June 3, 2015) ---- A report released today by the Rockefeller Institute of Government and the Arkansas Center for Health Improvement (ACHI) reveals significant collaboration between Arkansas's public and private sectors to expand health care coverage through the Health Care Independence Program (commonly known as the "private option") and the federally facilitated marketplace partnership.

The report is the most recent in a series of state and regional studies advanced by a national network examining the rollout of the Affordable Care Act (ACA). The national network, with 40 states and 74 researchers, is an effort of the Rockefeller Institute of Government at the State University of New York, the Washington-based Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.

The Arkansas report was prepared by the Arkansas Center for Health Improvement. "It chronicles the starts and stops that one would expect with the level of disruptive innovation that we have fostered in Arkansas," said Dr. Joe Thompson, ACHI director and co-author of the report. "We were bold in what we wanted to accomplish in our state ---- effect whole system transformation ---- and we pulled every available policy lever to achieve our goals."

Gallup, Inc. recently reported that Arkansas has reduced the percentage of uninsured in the state from 22.5 percent to 11.4 percent, the highest percentage reduction among all states. Approximately 300,000 Arkansans have gained coverage since the beginning of 2014, either directly through Medicaid for those who are medically frail or through qualified health plans with state-based premium assistance or federal subsidies. "Arkansans are demonstrating responsiveness to the opportunity and responsibility to obtain coverage," said Thompson.

The political environment in Arkansas that led to decisions related to the ACA are detailed in the report, along with the fluid status of the state's pioneering decisions in light of recent leadership transitions and uncertainty at the federal level. "Arkansas's premium assistance approach to coverage expansion necessitated bipartisan buy-in over multiple years, which is a particularly high hurdle given that initial and continued funding for the Health Care Independence Program requires a 75 percent supermajority vote in both chambers," said Craig Wilson, ACHI director of access to quality care and co-author of the report.

The state's alignment of goals to propel broader health care system transformation ---- a strategy that predates the state's decision to opt for coverage expansion ---- is also described in the report. Qualified health plans must participate in the state's patient-centered medical home program beginning this year. "Coverage expansion, whether mandated or not, was not sustainable over time in a fee-for-service model," said Wilson. "We had to move toward value-based payments and engage private sector payers to enable cost containment before coverage expansion could be considered. The individual plan premium assistance model was a natural fit to extend the reach of ongoing value-based payment initiatives," said Wilson.

As noted in the report, legislation passed earlier this year signals that the Health Care Independence Program, in its current form, will terminate on December 31, 2016, which is the close of the initial waiver period. A legislative

task force and governor's advisory council have convened to determine whether expanded coverage will continue in any form. Task force recommendations are expected by the end of the year.

"Arkansas's premium-support waiver set the stage for other states to 'do it my way.' The ins and outs of federal-state negotiations on ACA Medicaid waivers is among the hottest topics of ACA implementation. This report has the special advantage that one of its authors, Joe Thompson, served in government as Arkansas's surgeon general during the period the Arkansas waiver was developed. He brings his special insight to bear in this report," says Richard Nathan, a senior fellow at the Rockefeller Institute and the creator of the national network.

To read the report, go to www.rockinst.org/aca/states/Arkansas/2015-06-Arkansas_Baseline.pdf. or http://www.achi.net/Docs/319/

The Arkansas Center for Health Improvement is a nonpartisan, independent, health policy center dedicated to improving the health of Arkansans. It is jointly supported by the University of Arkansas for Medical Sciences, the Arkansas Department of Health, Arkansas Blue Cross and Blue Shield, and Arkansas Children's Hospital. More information on Arkansas's health system transformation efforts is available on the Center's website at www.achi.net.

The Nelson A. Rockefeller Institute of Government is the public policy research arm of the State University of New York. The Institute conducts fiscal and programmatic research on American state and local governments. Journalists can find useful information on the Newsroom page of our Web site, www.rockinst.org.

Arkansas Center for Health Improvement
1401 West Capitol
Suite 300 (Victory Building)
Little Rock, AR 72201