Health care at risk

What’s best for all should be aim

Arkansas has been on a pathway toward better health for a number of years. Now, it appears, we are in danger of losing our way.

The voters’ decision to devote 100 percent of tobacco-settlement funds to health-related programs through an initiated act in 2000 led to the creation of the Fay W. Boozman College of Public Health at UAMS and multiple other important health programs. Legislation in 2009 increased the state’s tobacco tax to fund a statewide trauma system that today is anchored by UAMS’ level-1 adult trauma center and Arkansas Children’s pediatric center.

Trauma deaths in Arkansas have been cut by 50 percent, saving state taxpayers nearly $200 million a year.

Arkansas’ unique approach to health-insurance expansion has dramatically reduced the number of uninsured, increased the availability of preventive and primary-care services for health screening and management of chronic diseases like diabetes and hypertension, and increased the number of individuals who have a relationship with a primary-care professional to provide the right care at the right time in the right location.

It has stabilized the health-insurance market with rate increases far below those in most other states, and reduced unpaid care, thus avoiding the rural hospital closures experienced in surrounding states. Payment reforms have enabled shared savings and increased the productivity of the Arkansas work force.

Most recently, the Healthy Active Arkansas initiative was launched with broad public and private collaboration to focus on the problem of obesity and physical activity, and the Arkansas Legislature passed a resolution recognizing the importance of health in all policy decisions.

All of these advances are focused on the goal of a health system that produces better health outcomes at an affordable cost. This is progress, but we still live in a state marked by poor population health with disparities in health outcomes linked to race, poverty and lack of education.

However, the foundation is now in place to tackle these problems if we recognize we are all in this together and ill health anywhere affects us all.

Unfortunately, many of these advances are at risk. The American Health Care Act passed by the U.S. House of Representatives would roll back federal support for health-insurance expansion that would result in 23 million additional uninsured individuals by 2026 and cut more than $800 billion from federal support of the Medicaid program. The proposed U.S. Senate bill is little better. Both would shift costs to states, individuals, families and businesses. It’s estimated the AHCA could cost Arkansas hospitals $5.4 billion over the next decade through combined effects of an increase in the cost of treating uninsured patients and a reduction in Medicaid payments.

Our state’s plan to limit eligibility for Medicaid to 100 percent of federal poverty rather than the current 138 percent and add a work requirement for individuals below 100 percent of poverty level may also result in increased numbers of uninsured. If the number of uninsured Arkansans begins increasing again, much of the progress and groundwork that has been laid may start to erode. That will have a long-term effect on the economy of our state and the health of its citizens.

On top of this, the budget presented by President Trump includes further cuts to Medicaid and a proposed 20 percent cut in the budget of the National Institutes of Health, which funds much of the groundbreaking research conducted at UAMS and other academic medical centers.

Everyone deserves the opportunity for a healthy life. To achieve that goal, we need adequate health-care infrastructure and a stable, well-functioning, coordinated health system that includes incentives for producing better results at a lower cost.

The importance of an economically viable hospital to a rural community cannot be overstated. Erosion of financial support for health care will threaten them, and also threaten academic medical centers like UAMS.

We need bipartisan, clear thinking about what is best for all. We must maintain funding for health care for our most vulnerable citizens and neighbors. We must maintain adequate funding to support our health care infrastructure. We must take a systemwide approach to quality improvement and payment reform aimed at reducing cost.

But these goals cannot be achieved with increased numbers of individuals locked outside the health system through financial barriers. Our future hinges on a healthier, better-educated population.

Let’s all work toward that as our highest goal.