As You Hoped And/Or Feared (Gwen Moritz Editor's Note)

by Gwen Moritz  on Monday, Aug. 11, 2014 12:00 am  

Back in June, The New York Times published a story that I wish I had thought of first: the even brighter line of distinction between the two sides of Texarkana since Arkansas accepted federal dollars to provide health insurance to the working poor and Texas rejected that part of Obamacare completely.

Reporter Annie Lowrey began her tale of two cities by introducing readers to three people she found eating meals at homeless shelters. One, Janice Marks, worked nights at Walmart on the Arkansas side of town, while David Tramel and Janice McFall were living in a tent on the Texas side.

“None of the three have health insurance,” Lowrey wrote. “But had Ms. Marks, 26, chosen to sleep on the side of town where she works, or had Mr. Tramel and Ms. McFall, who are both in their early 20s, made their camp where they had eaten their dinner, their fortunes might be different.”

The Affordable Care Act originally required all states to expand Medicaid to households earning up to 138 percent of poverty, but, as you probably remember, the U.S. Supreme Court ruled that requirement unconstitutional. So states can instead choose whether to take federal dollars (eventually states will have to pay 10 percent of the cost) to provide health insurance to the working poor, and conservative-leaning states have generally rejected it while liberal-leaning states have universally embraced it.

But Arkansas, through sheer political will that strikes me as more miraculous every day, bucked the trend. Neither Texas nor any of our five other border states — Louisiana, Mississippi, Tennessee, Missouri or Oklahoma — took the money, always with some variation on Gov. Rick Perry’s reasoning: “Texas will not be held hostage … to a broken system.”

Arkansas wasn’t held hostage to a broken system. Arkansas’ Legislature, led by Perry’s fellow Republicans, crafted the “private option” that uses those Obamacare dollars to buy private insurance for our low-income neighbors. And last week, a new Gallup poll showed what the private option and the individual mandate, a part of the Affordable Care Act that isn’t optional, have meant in our state: The share of Arkansans who are uninsured has dropped from 22.5 percent to 12.4 percent in less than a year.

The 10.1 percent of Arkansans who have gained insurance — that’s nearly 300,000 people. That’s the equivalent of the total population of the 27 least populated counties in the state. It’s three-quarters of Pulaski County. It’s Benton County and White County combined. Except the newly insured are spread throughout the state, and the overwhelming majority are adults because Arkansas had already done a very good job of insuring children. The Annie E. Casey Foundation reported last month that only 6 percent of Arkansas children were uninsured in 2012. That’s down from 9 percent in 2008, better than the national average of 7 percent and representing the biggest improvement in the country over the past 25 years.

Meanwhile, over in Rick Perry’s Texas, more than twice as many people have gained insurance — something like 750,000 of them. But that’s only 3 percent of the population. And even after that, according to the Gallup poll, 24 percent of Texans are still uninsured — a higher percentage than Arkansas had last year. Perhaps that’s because a child living in Texas is twice as likely (12 percent) to be uninsured as a child living in Arkansas. Everything really is bigger in the Lone Star State.


I understand, or I like to think I do, the political realities of getting the 75 percent supermajority votes in both houses of the Arkansas General Assembly that were required to start and continue the private option. But I can’t help wondering how many more of our working poor might have private health insurance today if it weren’t against the law for the state to spend a few bucks to let them know it was available. I also wonder about people who want them to remain ignorant and uninsured.


I gave former Gov. Mike Huckabee a bit of a hard time in this space last week. No apologies for that — he has been doling out simplistic prattle to a public that needs serious solutions. But credit where due: He pushed through the ARKids First expansion of Medicaid that has changed the lives of hundreds of thousands of our state’s children in the past two decades.

Gwen Moritz is editor of Arkansas Business. Email her at



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