Repeal of the Affordable Care Act, or Obamacare, will be particularly harmful to Arkansas.

So says an analysis by Joan Alker, executive director of the Center for Children and Families at the Georgetown University Health Policy Institute. She notes that critics of Obamacare typically don’t talk much about the Medicaid expansion portion of the program, which is working well, particularly in Arkansas.

Repeal without replacement is a particular problem in Arkansas, Alker writes of vows by Congress and Donald Trump to begin moving qjuickly.

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This is especially troubling for Arkansas because it has seen its uninsured rate decline very sharply since the Affordable Care Act was implemented in 2014. Among non-elderly adults (ages 19 through 64), Arkansas’ rate of uninsurance declined over 10 percentage points – from 24% in 2013 to 14% in 2015, one of the top ten largest declines in uninsurance rates in the country. Latest enrollment figures show that over 300,000 people are enrolled in the private option in Arkansas. Private option enrollees account for 80% of the Arkansas marketplace.

I recently blogged about another state that begins with the letter “A” that faced some special challenges (Arizona) as Congress moves quickly to repeal the Affordable Care Act. Arkansas’ private option faces the risk of a more imminent collapse of its system of coverage — because even if a repeal bill delays implementation of the key changes (i.e., repeal of the Medicaid expansion, elimination of the premium tax credits for the marketplace) for, say two years, many experts believe that the marketplace will collapse more quickly. So that means that, in most states, the Medicaid expansion could continue along until the money actually goes away, but not in Arkansas.

Arkansas uses the federal marketplace to provide coverage for the Medicaid expansion.

So far, all six members of Congress from Arkansas are in favor of repeal and none has yet offered a replacement.

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