LITTLE ROCK — Up to 90 percent of uninsured Arkansans will be eligible for health insurance under the new federal healthcare law, Arkansas’ surgeon general said Wednesday.
Dr. Joe Thompson told the state House’s Public Health, Welfare and Labor Committee that many low-income Arkansans will be either eligible for a tax credit to offset the cost of buying health insurance or qualify for Medicaid.
He said the law favors states where many people make low incomes and high numbers of people are uninsured. According to the U.S. Department of Commerce’s Bureau of Economic Analysis, Arkansas ranks 45th amongthe states in per-capita income.
Thompson referred to a survey in the past year by the Arkansas Center for Health Improvement, which said that up to 500,000 Arkansans ages
19-64 are uninsured.
Thompson said if the state implements the new law correctly, 400,000-450,000 uninsured residents will have health insurance by 2014 when most of the federal health-insurance changes are in effect.
About half of those people will be eligible for Medicaid once the program rules change in 2014. Currently, those on Medicaid must make less than $6,000 a year, have less than $2,000 in assets and be disabled.
The new rules require states to offer Medicaid coverage to anyone who makes up to 133 percent of the federal poverty level. Based on the current poverty level, that amount is $14,400 for an individual and $29,326 for a family of four.
The federal government will fully fund the new Medicaid enrollees until 2016 and then will gradually reduce the amount to 90 percent by 2020. The state will pay 10 percent of the cost, estimated by Thompson to be about $200 million a year.
State Sen. Cecile Bledsoe, R-Rogers, questioned whether the 500,000 Arkansans without coverage were people who chose not to have insurance.
“When you actually get to the true number of Arkansans that are working poor and cannot afford that, I have talked with many people who feel that number is so much lower,” Bledsoe said. “It just seems like we are taking the best health-care system in the world and ... we’re throwing it out and starting anew to take care of issues that if we had looked at the true number of the working poor who did not have insurance that we would be able to cover them and cover them well.”
She estimated that only 10 percent of the uninsured are working people who could not afford coverage.
Thompson said the number of people working whocannot afford insurance is much higher than 10 percent. He said more than half of the 500,000 uninsured are members of young working families. He said the families have children who are covered by the low-income insurance program ARKids but cannot afford coverage for the adults.
“We’ve got a large number of working individuals that the resources they have just don’t meet the cost of insurance coverage,” Thompson said.
He acknowledged that the law will be disruptive to some people and insurance companies.
“It disrupts the current system, which if you have insurance it’s a really, really good system. We have 500,000 Arkansans who don’t have health insurance, and it’s really not a good system,” Thompson said.
Thompson said the new law does not address the physician shortage many areas are facing.
He said the problem has existed for at least a decade and he is worried how the current number of doctors will manage to care for an additional 500,000 people.
“We didn’t have enough last year or five years ago, and we won’t have enough providers for the next two to three years,” Thompson said. He said despite the financial barriers being resolved, some people will struggle to have access to health care because there are not enough doctors.
He said lawmakers will need to consider giving nurse practitioners, pharmacists and other medical personnel more legal rights to meet basic medical needs in order to free physicians from routine work.
He gave the example of providing children with the influenza vaccination through their school nurses instead of having parents remove students from school to visit the doctor.
State Rep. Tim Summers, R-Bentonville, voiced concern about doctors not moving to rural areas where most patients are on Medicaid.
“We’re seeing some problems now with doctors, at least in our area, accepting Medicare/Medicaid patients,” Summers said. He said many doctors can make more money working with non-Medicaid patients.
Thompson said it’s up to the state whether to encourage doctors to move to rural areas. He said the lack of health-care access is worst in rural areas of the state, where the uninsured rate hovers between 22 percent and 31 percent.
Other information on how the health-care law will affect Arkansas:
Thompson said he worries that the penalty against employers not offering insurance is too low. He said some employers will stop providing health insurance and send employees to get coverage through the insurance exchanges. Companies will be required to provide a voucher to pay some of the cost and will be penalized by the federal government.
He said there will be more transparency in medical information. For example, Medicare will launch a website in 2011 that allows consumers to compare physician quality and patient experience.
A program that will begin in January 2011 will give consumers cash to purchase nonmedical services and supplies so they can remain in their homes instead of moving to nursing homes. Like the Medicare program through the Community Living Assistance Services and SupportsAct, all working adults will have deductions taken directly from their paychecks. After five years participants can receive financial help if they become disabled or unable to live alone. Consumers can opt out of the program.
Possible legislation for lawmakers to consider includes authorizing health professionals to exchange information electronically and expanding the role of the state Insurance Department to allow the Insurance Commission to force companies to repay unspent insurance premiums.
Medical coverage for mental-health problems will be covered on the same level as other types of medical care.
Northwest Arkansas, Pages 9 on 07/22/2010