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An Arkansas Solution to a National Problem (Davy Carter Commentary)

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Arkansans are innovative people. From farmers who engineer their own equipment when there are no other options to entrepreneurs like J.B. Hunt and Sam Walton who used groundbreaking concepts to build Fortune 500 companies, our state is embedded with a history of innovation. 

In that same innovative spirit, for the past four years, Arkansas has become a national leader in health care policy. In fact, Arkansas is a shining example of what states can accomplish in health care if given enough flexibility and control over designing programs that best serve their citizens. Today, Congress is once again considering potential changes to our nation’s health care system that put the innovative efforts of a number of states like Arkansas in a precarious place.

In 2013, when the Arkansas General Assembly began addressing how the Affordable Care Act would impact our state, the matter was at its height of political polarization. To say the debate was a challenge would be a massive understatement, and without the political courage of many we would be left today continuing to build on a flawed health care system with even more controls from the federal government. To be sure, the easy way out of the unpopular federal law was to just say “no.” As with most complex issues, things aren’t that easy, and Arkansans deserved better. 

Just saying “no” would have done nothing to protect Arkansans from the mandates, higher taxes and regulatory burdens of the health care law. If there are doubts, just take a look at what is happening in the many states that just said “no.” It’s not pretty. 

As we all know by now, instead of adopting President Obama’s version of Medicaid, Arkansas crafted its own plan, the private option, now known as Arkansas Works. Perhaps less widely known, the reason Arkansas was able to pursue its own path was because early on we figured out that we had a certain amount of leverage over the Obama administration. We asked. They gave. So we asked for more. So instead of covering new Medicaid recipients the same old way, Arkansas was given the flexibility to establish a model more like a public-private partnership, using federal funds to buy insurance for Medicaid recipients, making it work more like a traditional consumer insurance plan. One of our primary goals was to take advantage of existing expertise in the free market to drive efficiencies and provide patients and health care providers with a health care system that was functional, efficient, accountable and effective. 

Just a year into the program, Arkansas notched America’s steepest reduction in its rate of the uninsured, from 22.5 percent to 12.4 percent. Our hospitals saw a 46.5 percent decrease in patients admitted without insurance, resulting in an estimated $60 million decline in uncompensated care in those same 12 months.

Today we have even more data that shows our innovative approach is working. A recently released three-year study just published in the journal “Health Affairs” compared Arkansas with Kentucky, two states that handled Medicaid in different ways, and with Texas, a state that just said “no.” Arkansas’ changes were associated with important gains for patients, including better access to preventive health services, improved medication compliance, out-of-pocket savings and enhanced management of chronic disease. Some of the numbers are truly staggering. For example, we saw a 41 percentage point increase in patients having access to a regular source of care, one of the most important indicators of health care success. Perhaps the most important development is that more insurance carriers are competing for business here than in most all of the other states.

To be sure, even with all of Arkansas’ successes there are many people in our state facing other health insurance challenges outside of the scope of the private option debate, such as the self-employed.  

No one ever said that the private option was perfect, but rather a foundation from which a better system could be built. But have no doubt, our state’s ability to build on this foundation can only be achieved if Congress continues to provide flexibility to the states. Sam Walton once said, “I have always been driven to buck the system, to innovate, to take things beyond where they’ve been.” Given the chance, I am confident Arkansas will continue to do just that.

(Davy Carter is a banker, attorney and former speaker of the Arkansas House of Representatives. Follow him on Twitter: @DavyCarter.)

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