A powerful health-care proposal
The best public policy is intentionally designed and ensures accountability to the people it serves and the taxpayers. Being intentional and thoughtful about accountability were the goals for Rep. Michelle Gray and myself when Gov. Asa Hutchinson gave legislators the reins to build a new Medicaid expansion program.
For more than a year, we and work groups of legislators have worked closely with Department of Human Services Secretary Cindy Gillespie and her team to develop a new program to replace Arkansas Works, which expires at the end of 2021. This massive collaborative effort resulted in a bill filed Monday that creates the new Arkansas Health and Opportunities for Me Act, also known as ARHOME.
ARHOME is intentionally designed to make a difference in the lives of Arkansans in order to improve their health and life circumstances and to continue to build a strong health-care infrastructure in the state that is so vital to our overall economy.
Not only is ARHOME designed to provide health-care coverage, but it also addresses long-standing health-related social issues in our state through what we call Life360 HOMEs (Maternal Life360 HOMEs, Success Life360 HOMEs and Rural Life360 HOMEs).
Life360 HOMEs is focused on incorporating all resources and opportunities needed for our citizens to seek care at the right time and to manage health-related social needs that not only impact their physical and mental well-being but also their long-term economic independence.
Maternal Life360 HOMEs is intentionally designed to improve maternal and infant health outcomes, in which Arkansas sadly ranks 49th in the nation. This is unacceptable, and we must do better. This program could truly have an impact on those outcomes because almost 60 percent of the enrollees in the current Medicaid program are women. We know from claims data that:
1. Less than 60 percent of pregnant women in Medicaid used prenatal services in their first trimesters, which are critical for healthy pregnancies and babies.
2. About 21,000 babies are born under Medicaid each year.
3. Of those babies, approximately 10 percent or 2,100 newborns required a stay in the neonatal intensive care and 1,700 were low birth weight, meaning they weighed less than 5 pounds 8 ounces.
Not only does this cost more than $144 million annually; these babies are born into the world with complicated health problems that will affect them for the rest of their lives. Maternal Life360 HOMEs, anchored by our participating birthing hospitals, will work with expecting mothers and two years after birth on an effort to improve their health outcomes and their babies’ early development. Given that most brain development happens within the first five years of life, this focus on early development could have positive lifelong implications.
Over 40 percent of Arkansans live in rural Arkansas. Study after study has shown an increase in mortality rates for rural Americans as well as an increase in illnesses, such as cardiovascular diseases, diabetes, substance abuse disorders and mental illnesses.
Rural Life360 HOMEs is intentionally designed to address these facts head-on. Anchored by participating Critical Access Hospitals, Rural Life360 HOMEs will connect citizens to resources needed to deal with the complex health issues they face and help improve their health and circumstances.
One way to help with these issues is by using crisis intervention and having hospital-based acute crisis units similar to the four Crisis Stabilization Units in Arkansas. We don’t need to build new facilities to help rural populations. Instead, we can use open beds in our participating Critical Access Hospitals to meet this need.
Currently, there are about 15,000 veterans enrolled in Arkansas Works, over 17,000 enrolled who were formerly incarcerated, another 2,500 who were in DHS Division of Youth Services custody, and 4,400 more who were in foster care.
Success Life360 HOMEs is intentionally designed to provide these target populations with intensive social supports to help them address the unique issues they face as they combat mental illnesses, substance abuse disorders, homelessness, and/ or disabilities.
It is so smart to use our existing health-care infrastructure to partner with us to solve our state’s problems. And that is exactly what Life360 HOMEs is designed to do.
Government programs and policy must be accountable, with the ability to measure our successes. We as legislators are accountable to the taxpayers of Arkansas to create and implement effective, efficient policy.
We must constantly assess our programs and adjust course as needed. We must always ask: Is this working? Does this make sense? Are we utilizing our resources to the best of our ability in both health policy and in financial policy? This legislation creates an accountability and oversight committee to help define goals and measure success.
ARHOME uses the same financial structure as Arkansas Works of partnering with Arkansas insurance companies to purchase qualified health plans, which increases the physician and hospital reimbursement rates 25-65 percent above what traditional Medicaid can pay. This opens the door for increased access for our Medicaid patients and is critical, especially in rural Arkansas where the percentage of Medicaid patients is higher.
Furthermore, using insurance plans has proven to successfully stabilize premiums for all health insurance products in the private marketplace for Arkansans. Today, Arkansas ranks sixth in the nation for lowest insurance premiums. We added accountability here too by making sure the qualified health plans work to meet targeted health goals for our citizens in the program.
Finally, Arkansas negotiated a split for this program with the federal government, meaning that the federal government pays 90 percent of the cost and Arkansas pays the remaining 10 percent. This has successfully brought billions of federal dollars into our state’s health-care infrastructure and has helped save our rural hospitals from closing.
During this emergency health crisis, we saw firsthand how important our entire health-care infrastructure is to our state. Hospitals increased ICU bed capacity by 19 percent to meet the needs of covid-19 patients.
We did this by using all of the rural and Critical Access Hospitals.
It was also eye-opening to see nurses, lab techs, doctors and hospital employees laid off during the early days of the pandemic, revealing that the margins in the majority of our rural hospitals are razor thin. We cannot afford to veer off course and pursue alternate paths. By using qualified health plans, Arkansas will leverage and bring in an additional $600 million to $700 million annually of federal dollars, totaling approximately $3 billion over the next five years. These dollars are essential to keeping our rural hospitals open.
For all of these reasons I believe ARHOME is truly the most responsible and pragmatic policy approach we can take. It is intentionally designed to serve Arkansans, to be good stewards of our taxpayers’ money, and to be accountable for the outcomes we desire to make our state a better place for our citizens.