A Vested Interest


A Vested Interest

Should Arkansans whose income makes them eligible for Arkansas Works, our unique approach to the Affordable Care Act’s expansion of Medicaid, be required to work in order to receive health insurance?

The Arkansas Legislature and Gov. Asa Hutchinson said yes. A federal judge in D.C. says no — at least not the way Arkansas has done it. And not the way contemplated in Kentucky, where Gov. Matt Bevin has threatened to end Medicaid expansion for more than 400,000 people if work requirements aren’t allowed.

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Bevin’s threat seems to confirm the idea of work requirements being punitive for people who dare to be too poor to afford health insurance. We’re relieved not to have heard that kind of talk in Arkansas, where poverty is as least as prevalent as in the Bluegrass State. Both states were unusual in the Southern region for accepting federal Medicaid expansion money, and the result was dramatic declines in the number of uninsured residents as the ACA took effect.

But our state did it in a way that presented unique advantages and challenges. Instead of merely expanding traditional Medicaid to people who were not quite poor enough, Arkansas used the federal money to buy private, commercial health insurance from the Obamacare exchange for eligible residents.

This was brilliant in that it created a much larger pool of customers — many of them young and healthy — for the exchange plans, and their premiums were paid without fail. This results in lower and more stable premiums for everyone, including higher-income individuals who also buy from the exchanges.

But it also means that the state is paying a monthly premium to a private insurer whether or not the Arkansas Works patient accesses any health care. So Arkansas has a strong incentive that is not at all punitive to want to keep track of every Arkansas Works beneficiary, to make sure they are still living in Arkansas and are still eligible.

And that will continue to be necessary even without a work requirement.