A “perfect storm” is coming regarding healthcare coverage for people in Arkansas, which already ranks near the bottom on many health indicators such as the worst state to be born in and 50th in the country in life expectancy. A state that ranks among the top five states for poverty is now facing loss of healthcare coverage for more than 200,000 people previously covered by the Arkansas Health and Opportunity for Me (ARHOME) Medicaid program, the Medicaid expansion program that covers low-income residents that came about under the Affordable Care Act (ACA) 13 years ago. This comes at the same time that many are struggling to pay higher costs for food, gas and other supplies related to Trump tariffs and the closure of the Hormuz Strait because of the Iran war.
Arkansas was first in the country to approve a Medicaid expansion that was a hybrid program that used federal money to pay private insurers. Recently the Trump Administration denied an extension of that program that provided health plans for low-income Arkansans between the ages of 19 and 64. If nothing is done, it will disappear by the end of the year.
“This hybrid system we have in Arkansas is probably going to implode unless our leadership does something creative,” said Dr. Dan Bell, who with his wife, Suzie Bell, co-founded the free ECHO Clinic in 2005. “The other thing happening is the work requirement for the Medicaid program will kick in fully Jan. 1. People considered able bodied will be required to work, volunteer or go to school 80 hours a month to keep Medicaid. A quarter of the 800,000 folks in Arkansas are expected to lose coverage because of that. Also, Centene, the company providing half of the Medicaid expansion coverage, is leaving the market.”
According to Benefitsusa.org, between September and December 2018, more than 18,000 Arkansans lost their Medicaid coverage because of the work requirement. Researchers at Harvard Medical School found that 97 percent of those who lost coverage were already compliant with the work requirement or would have qualified for an exemption. They did not stop working. They lost coverage because they could not successfully navigate a broken reporting system including a website that was difficult to use, or lack of access to internet. Another barrier was being required to check in monthly. That program was rescinded by a court order.
Dr. John House, owner of the Health First Clinic in Eureka Springs, said he is not surprised at either of the actions to take away healthcare coverage from low-income people.
“Those in power in Washington, D.C., as well as Little Rock, seem intent on punishing those least able to fight back,” House said. “As a physician, I can tell you that we are already seeing people lose their health insurance due to cuts made last year. We seem destined to return to the days before the ACA when people used the ER for primary care. Hopefully, Arkansas and the country will push back at the ballot box this November.”
The Arkansas Hospital Association states that the cutbacks could harm hospitals around the state: “Shifts in patient coverage models directly impact the financial viability of Arkansas hospitals, which are already struggling under commercial reimbursement rates that sit at the very bottom of the nation. When coverage contracts, patients do not stop needing healthcare; they simply seek care in emergency departments where local facilities bear the cost. Rural hospitals cannot continue to absorb rising operational costs under this financial strain without being forced to scale back vital community services.”
Bell said when the ECHO Clinic was founded, about 30 percent of people in Eureka Springs didn’t have healthcare insurance. With the Medicaid expansion, that got down to seven –eight percent. But with all this happening, he said there is a good chance a lot of people going to be out in the cold.
ECHO downsized from free monthly clinics to an annual MASH (May All Stay Healthy) Clinic when people were able to get health coverage. Recently ECHO has started holding free MASH clinics in the spring and fall.
“On October 3, the uninsured can come into our clinic to see the doctor or a dentist—which is a big thing,” Bell said. “If you go to doctor only a couple times a year, you can usually control hypertension and sometimes diabetes. At ECHO, we have been watching this coming so we have kept our infrastructure in place so we can be there for the county if it is needed. Carroll County in a unique situation in that we have a safety net for medical care as this perfect storm unfolds—the Boston Mountain Rural Health Clinic. ECHO successfully recruited the Boston Mountain to share our facility on Highway 62.”
Rural health clinics provide outpatient physician and non-physician services in rural and medically underserved areas. RHCs are paid on a cost-related basis by Medicare and Medicaid and provide free services to the poor.
“In Carroll County, we have a wonderful safety net in Boston Mountain,” Bell said. “They have the ability to see people who are uninsured and low income for a very low cost. For as little as $10, people get to see a doctor and get x-rays and other tests that are needed. When we hold our MASH clinic and see things, we directly refer patients to Boston Mountain. It is a nice arrangement. It is important for a lot of people. It is a perfect storm, but we have a safety net.”
ECHO helps fund its operations with a thrift store, and this past year provided $30,000 towards purchasing medicine for those in need.
There are concerns statewide about how the cutbacks will impact hospitals, particularly rural hospitals. Emergency rooms are required to see patients regardless of their ability to pay.
“Hospitals are going to have to see these folks and they aren’t going to get compensated,” Bell said. “It is going to clobber some of the local hospitals struggling to survive. Our local hospital is in the crossfire, too. Local clinics could also be impacted, some more than others.”
President Trump also recently announced an end to subsidies for Part D Medicare drug coverage enacted under the Biden Administration. Millions of Americans over the age of 65 are expected to face higher premiums for Medicare Part D drug coverage starting in 2027.