Arkansas’s approach to the implementation of the Patient Protection and Affordable Care Act (ACA) through early 2015 has been marked by political volatility and, in the midst of this volatility, both innovation and flexibility. To a large degree, Arkansas has used the ACA as a tool to achieve comprehensive health care system transformation in a state with nearly three million citizens and one of the lowest median household incomes in the nation.
During the ten years prior to passage of the ACA, average annual health insurance premiums nearly doubled for Arkansas families, pushing the statewide rate of uninsured working-age adults to 26 percent, with some counties approaching 40 percent. Prior to 2014, an estimated 550,000 Arkansans lacked health care coverage. A generally unhealthy population with health risks and a disease burden near the top of most national indicators had strained Arkansas’s delivery system to a tipping point.