Improving the Arkansas Health Care System

by Dr. Joe Thompson  on Monday, Sep. 10, 2012 12:00 am  

Dr. Joe ThompsonArkansas Surgeon GeneralDirector, Arkansas Center for Health Improvement

Our health care system is at a tipping point. Arkansans’ insurance premiums have more than doubled in 10 years (from $6,355 in 2000 to $11,816 in 2010), pushing many working citizens into the ranks of the uninsured. One-fourth of 19-64-year-old Arkansans lack health insurance. In some rural counties almost 40 percent are uninsured. However, many of our citizens are not healthy and do need care. According to the Arkansas Department of Health, 53 percent of Arkansas adults suffer from at least one disease, like cancer, heart disease, or diabetes. Most chronic diseases are preventable, but when people don’t have health insurance they tend to avoid seeing doctors. People with untreated chronic diseases get sicker until finally medical care is unavoidable, much more expensive, and usually much less effective.

It’s no wonder that the American Hospital Association reported that the cost of uncompensated care experienced by Arkansas community hospitals more than doubled over 10 years, from an estimated $216 million in 2000 to an estimated $338 million in 2010. With rural counties having a higher proportion of uninsured individuals who cannot pay, should we be surprised when physicians, nurses, and pharmacists don’t want to move there? Will we be surprised when the next rural hospital closes?

Uncompensated care certainly threatens the financial health of our hospitals and clinicians, but they don’t absorb it alone. Arkansas families with health insurance pay an extra $1,500 per year tacked onto premiums to defray the expense of treating those who can’t afford to pay. And, those who can’t pay for their care too often face bankruptcy. The American Journal of Medicine reports that in 2007 medical debt accounted for 62 percent of all bankruptcies, up nearly 50 percent from 2001. The impact of these bankruptcies cascades across communities, affecting businesses that extend lines of credit or loans to these families.

Paying for insurance can be difficult. Arkansas has the third lowest median family income in the country—if you lined up every family from poorest to richest, the middle family makes $38,413 a year (in Maryland it’s $68,933). Most Arkansas families (78 percent) earn at or below 400 percent of the federal poverty level. This means they’ll now be eligible for federal subsidies to help purchase private health insurance or be eligible for Medicaid expansion under the Affordable Care Act.

Although most buy insurance through their employers, many employers don’t offer coverage. Importantly, the Affordable Care Act does not require 95 percent of Arkansas businesses — those with fewer than 50 employees — to do anything. It does require individuals to engage and take responsibility for their future health care costs. At 78 percent, Arkansas has the highest percentage of families in the nation who may qualify for help in gaining coverage.

Arkansas Initiative

With rising costs, an unhealthy workforce, and increasing health care needs, even before the Affordable Care Act, Arkansas embarked on a Health System Improvement Initiative to better meet Arkansans’ needs in four areas:

• Curb rising costs and improve the quality of medical care

• Provide greater access to medical services in underserved areas

• Accelerate use of health information technology

• Reduce the number of uninsured citizens

Payment System Improvement

 

 

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