During a debate last year in the Arkansas General Assembly over the private option, Rep. Sue Scott (R-Rogers), who voted for the policy, explained, "When I look at the numbers, I see faces with those numbers." It was a welcome reminder — the details of health care policy can be confusing (and the heated politics can be exhausting), but this is an issue with major stakes for people's lives. People like Tamara Williams, and the other Arkansans profiled in this story.
The private option uses Medicaid funds available via the Affordable Care Act (the ACA, or Obamacare as many call it) to purchase private health insurance for low-income Arkansans. The policy is the state's unique version of Medicaid expansion, a provision in the ACA to expand coverage that was left up to the states to pursue or not. Arkansas is one of 26 states plus the District of Columbia to expand coverage, while 24 states have refused the federal money to do so.
Arkansans between the ages of 19 and 64 who make less than 138 percent of the federal poverty level (that's around $16,000 for an individual or $33,000 for a family of four) qualify for the private option. Prior to the ACA and the private option, nondisabled adults without dependent children, no matter how poor, were not eligible for Medicaid in the state. For parents, if you made more than 17 percent of FPL, your income was too high to qualify. For a family of two, making $2,675 a year was too much to qualify for Medicaid; for a family of four, $4,054. If Arkansas had chosen not to expand (or defunds the private option in the future), people who make more than 100 percent of FPL level would be eligible for subsidized insurance on the ACA's health care marketplace, but people making less than the poverty line (or, for parents, people making between 17 and 100 percent) would be out of luck — like the nearly 5 million Americans estimated to be without insurance this year because they fall into the coverage gap in states that refused to expand Medicaid.
More than 150,000 Arkansans (and counting) have gained coverage under the private option. Most beneficiaries are enrolled in plans offered by private insurance companies, such as Blue Cross Blue Shield or Ambetter (around 10 percent of the newly eligible are routed to the traditional Medicaid program because they were screened as medically needy). Beneficiaries do not have to pay anything for premiums and have very little cost-sharing. Another 40,000 Arkansans who make too much to qualify for the private option have purchased their own coverage on the marketplace created by the ACA, with 90 percent of them qualifying for subsidies made available by the ACA to help them with the cost of premiums.
A little more than four months into the private option, the Arkansas Times has been talking to people who have gained coverage to hear about their experiences. Here are some of their stories.
For Tamara Williams, a North Little Rock mother of three, gaining health insurance came in the nick of time. Williams had her first mammogram in late February and it came back abnormal. After a follow-up and a biopsy, doctors informed her that she had invasive ductal carcinoma. She had surgery in late March and is scheduled to begin chemotherapy this month.
A year ago, Williams likely never would have gone to the doctor. "The Affordable Care Act saved my life," she said.
Prior to gaining coverage under the private option, Williams had been without health insurance for 10 years. Her kids — an 18-year-old son who has ADHD, a 17-year-old daughter who has sickle-cell anemia, and an 8-year-old son who has chronic asthma — were covered by ARKids, but Williams herself didn't have options.
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