The Health of Arkansas

Yesterday, Arkansas Governor Asa Hutchinson beamed as he announced a drop in the number of state residents receiving health insurance through Medicaid.

Today there are fewer Arkansans on Medicaid than when I took office in January 2015, while our state’s population continues to increase. In the last year alone, the rolls have decreased by 117,000 (10%). Because of the reduction in Medicaid enrollment, DHS is now projecting that it will spend roughly half a billion dollars LESS (taxpayer money) on Medicaid in SFY’19 than anticipated in the biennial budget.

Perhaps to some, this is great news. We’re saving money! Woopee! All those freeloaders out there sucking on the government teat are now out in the cold where they belong.

But wait. We’re talking about medical care here, people who are sick or disabled or otherwise unable to obtain health care because they can’t afford to buy insurance. By his own numbers, our governor just celebrated the fact that 117,000 people of Arkansas are no longer able to obtain health care.

Now maybe that’s not exactly true. Maybe some of those folks got well from cancer or liver failure or whatever caused them to qualify for Medicaid. Maybe some of them got great jobs and have insurance now through their employers. Maybe some of them became the sudden beneficiary of their Aunt Tilley’s fabulous estate. Or won the lottery.

Or maybe not.

The reduction might have something to do with the federal government’s deep cut in advertising about how to sign up for health care. Or the federal government’s reduction in the sign-up time period. Or the state’s questionable method of deciding who to remove from the program—the electronic data system currently in use automatically deletes anyone who doesn’t respond to a request for income information. As in, one lost piece of mail. One overlooked letter amid a pile of unpaid bills. One person’s inability to comprehend what is being asked of him as he undergoes chemotherapy.

Last year, the governor looked for all the ways he could reduce the amount of money Arkansas pays for health coverage. As reported in the Arkansas Times in the May 2, 2017, edition, the governor’s goal was to lower the income limits.

As part of the Affordable Care Act, Arkansas expanded Medicaid via a unique policy known as the private option, which uses Medicaid funds to purchase private health insurance plans for low-income Arkansans. The concept was later re-branded as “Arkansas Works” by the governor. The expansion covers adults who make less than 138 percent of the federal poverty level — that’s $16,400 for an individual or $33,600 for a family of four.

The governor’s proposed changes to eligibility remove anyone who makes more than the federal poverty line (that’s $11,880 for an individual or $24,300 for a family of four) from the Arkansas Works program. Only people who make less than the poverty line would qualify going forward. That includes not just the beneficiaries who are covered by private option plans but also those who were deemed medically frail under Arkansas Works (the 10 percent of beneficiaries with the greatest medical needs, who are currently routed to the traditional Medicaid program rather than private option plans).[1]

So just to be clear, any single person earning more than $990 per month or head of household with spouse and two children earning more than $506 per person would no longer qualify for government assistance in gaining health insurance. This hasn’t yet been implemented because the federal government has not yet responded to Gov. Hutchinson’s request for the change. But really, governor?

Even the 138% of poverty level leaves lots of people without access to care. In 2013, 21% of Arkansas adults went without health care because of the cost. Do bragging rights automatically come to Gov. Hutchinson because that number dropped to 15% by 2016? What is 15% anyway, besides a seemingly small number?

The state’s estimated population is 3,004,279. Take away 23.6% of that for people below 18 years of age (non-adults). That leaves 2,295,270 adults. Fifteen percent of that equals 344,290 adults in this state without health care. That’s a lot of friends and neighbors.

In a November 2017 report, the Arkansas Times explained another proposed part of Hutchinson’s Medicaid ‘reform.’

Those between the ages of 18-49 would be required to work 80 hours per month; if they were not working, they would have to participate in job training programs or certain approved volunteer activities. Beneficiaries must be in compliance for nine months out of the year or they would be removed from the program for the duration of the year. Beneficiaries 50 or older would not be subject to the work requirement; exemptions would be available for others who met certain criteria, such as caring for dependent children.[2]

Studies have examined the realities of financial need in the United States and have come up with a set of numbers that reveal just exactly how morally bankrupt is the governor’s reasoning (along with the increasingly evident moral bankruptcy of the entire Republican party).

For a family with two adults and two children, the average cost of living in the United States hovered around $65,000 per year in 2015. The figure excludes discretionary spending on nonessential goods and services, such as leisure, entertainment and luxury items.[3]

To be fair, another source gathering economic data specific to locations gives credit to a lower-than-average cost of living in Arkansas. For a family of four in Little Rock, the average monthly cost is $2876.46. For an individual not paying rent, the monthly cost is estimated at $819.24.[4] However, in the governor’s proposed lower income limit, in neither case is there any ‘leftover’ income adequate to buy health insurance. In case you didn’t notice, the estimated average cost of living for Little Rock is $400 MORE than the cutoff income level for those seeking Medicaid coverage under the governor’s preferred income guidelines.

It’s no secret that Arkansas is one of the unhealthiest states in the nation. We rank 48th. We have higher rates of diabetes, cardiovascular disease, cancer, and general poor health both physically and mentally. In particular, according to a January 1, 2018, report published in the Arkansas Democrat Gazette, from 2013 to 2016, “the percentage [of Arkansans] who reported that their mental health had not been good in 14 of the past 30 days rose from 14.7 to 16.4 [percent.]”

The report I’d like to hear from Gov. Hutchinson would show data about the number of marginally-employed people who have gained better-paying jobs. It would show how many of those suffering mental or physical illness have gained any improvement in their health. I’d like to hear that Arkansas is spending more, not less, on health care not only in direct services but in education—I’m talking about nutrition education, cooking lessons, and everything else humanly possible to teach people how to eat healthy—which, tragically, probably doesn’t include toaster pastries for breakfast.

I’d like to hear the governor talk about how vouchers and private schools won’t be allowed to siphon money away from public schools. I’d like to hear his analysis of how inadequate education leads to poor self-esteem and how a positive self-image is key to a person’s ability to pay attention to diet and exercise. I’d like to hear him talk about how a person who doesn’t feel good either mentally or physically is a prime candidate for substance abuse.

I’d like to hear the governor discuss the abysmal status of substance abuse treatment options in the state, a crushing health care issue that gets short shrift in public discussion. More on that in another blog.

The governor needs to say that fundamentals like good health and proper education make all the difference in how a person participates as a vital member of society or how he/she gains and maintains sufficient employment. He needs to say, again and again, that a person who is well, who has learned how to reason, and who recognizes the responsibility of self-care and citizenship is the kind of person we absolutely must gain a lot more of in this state.

At any cost.




[3] Cost of Living



Today’s Big Lie

Topping today’s fake news is the Republican mantra that Obamacare is failing and whatever faults their replacement plan may have, nothing can save Obamacare. Cited as evidence is a decrease in the number of insurance companies serving certain states. Aside from the obvious option of the federal government providing coverage as it does in Medicare, which no one mentions, is the quiet Republican sabotage that brought about this situation.

For the last seven years since the Affordable Care Act (aka Obamacare) came into law, Republicans have not only claimed they had a better plan (when they obviously didn’t),  they have worked behind the scenes to gut key elements of the ACA. Now, disingenuously, they act as though they had nothing to do with the problems they cite as evidence of its failure.

If these were decent people, they wouldn’t be able to face themselves in the mirror. But extremists have never let a little basic human decency get in the way of their agenda.

Back in 2015, as the ACA took effect and more people were for the first time able to gain desperately needed medical care, Republicans saw that they would never be able to tear this coverage out of the hands of sick and dying people without suffering political blow-back. So with their midterm election wins giving them legislative authority, they eagerly set about gutting key elements of the ACA in a strategy meant to guarantee its failure.

The law had made provisions for early insurance company losses described in the bill as a ‘risk corridor.’ Expected to decreasingly occur as the bill’s mandatory enrollment requirements gradually built up the number of healthy insured persons, the risk corridor would eventually die off. In the interim, companies were guaranteed government reimbursement to cover such losses.

So in 2015, Senator Marco Rubio led an effort to gut the risk corridor provision. Slipped into a massive spending law late that year, their meddling cut the payments to insurance companies from $2.9 billion to around $400 million. This left insurance companies no choice but to begin withdrawing from low income/high illness states.

Now we hear Rubio, Ryan, et al crowing about how the ACA failed as if they had no hand in that failure.

It’s not that these men want to really hurt their less fortunate brothers. It’s that they worship only two gods—money and so-called conservative values.

As noted in an excellent discussion of the Republican conundrum about health care, “Republicans will not increase the role of government [in health care] for political and ideological reasons” which is why they cannot now or ever develop a plan that is better and cheaper than the ACA.

The conservative agenda is clearly stated as limited government, a healthy culture, and a strong defense. I’ll refrain from ranting about their idea of a healthy culture, code words for “White” and “Christian.”  Sticking to the topic of this post, I’ll point out that “limited government” does not include mandating health care or providing for health care in any way. Worshiping at the feet of so-called ‘free markets,’ conservatives want the sick left to die. If relatives, neighbors or churches don’t help them and they haven’t managed to make enough money to help themselves, then it’s their fault and God’s will that they suffer.

Limited government is a loosely applied term, however. If it comes to invading private homes to rout out pot smokers, conservative lawmakers are all about it. Yet if it comes to corporate polluters lying about profitable chemicals that cause birth defects and cancer, it’s hands off. This means government is limited only when it comes to policing entities that are too big for any citizen or group of citizens to fight alone and unlimited when it comes to bringing the full police powers of the state against individuals who violate conservative cultural norms.

In one tiny example of the absurdity of the health care debate currently underway is the fact that over half of Medicaid recipients are children under the age of six who have developmental disabilities. I blogged about this last week. While seeking to reduce or eliminate Medicaid that serves such children, the Republicans simultaneously are eliminating government oversight of chemical pollution from which many such disabled children arise.

If legislators had the real interests of the American people at heart, they would throw out their replacement plan and the Affordable Care Act and expand Medicare to the entire population. They would remove profiteering insurance companies from the mix. They would instill cost controls on drug companies and medical providers.

After all, if utilities are such a vital need that they deserve government price controls, surely health care is an even greater vital need.

It doesn’t take a genius to figure out that without insurance companies taking a healthy slice of every health care dollar, costs would go down. Or that there’s a screaming need for cost controls when pharmaceutical industry profits routinely equal the profits of banks at nearly 20%, some as high as 40%.

Drug companies are quick to cry how much they need all that money so they can develop new drugs. But reality is that despite investment in new drugs and abusive advertising campaigns, their profits exceed most other industries. With that kind of loose change, it’s no wonder that one of the heaviest contributors to political candidates are drug companies, coming in right after big banks and weapons manufacturers.

World’s largest pharmaceutical firms
Company Total revenue ($bn) R&D spend ($bn) Sales and marketing spend($bn) Profit ($bn) Profit margin (%)
Johnson & Johnson (US) 71.3 8.2 17.5 13.8 19
Novartis (Swiss) 58.8 9.9 14.6 9.2 16
Pfizer (US) 51.6 6.6 11.4 22.0 43
Hoffmann-La Roche (Swiss) 50.3 9.3 9.0 12.0 24
Sanofi (France) 44.4 6.3 9.1 8.5 11
Merck (US) 44.0 7.5 9.5 4.4 10
GSK (UK) 41.4 5.3 9.9 8.5 21
AstraZeneca (UK) 25.7 4.3 7.3 2.6 10
Eli Lilly (US) 23.1 5.5 5.7 4.7 20
AbbVie (US) 18.8 2.9 4.3 4.1 22
Source: GlobalData

In fact, if you take a look at the list of corporate donors to the 2016 campaign, you can pretty much determine the current legislative agenda: more military spending, Wall-Street friendly cabinet members, and no serious effort to provide for the health and well-being of the American people.