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The human impact of health care expansion 

In recent years, my partner and I have come to spend chunks of time at our second home — a little cottage across the street from temperance fanatic Carrie Nation's "Hatchet Hall" in the gorgeous, historic community of Eureka Springs. Thus, I get to spend almost all of my life in perhaps the three funkiest spaces in Arkansas — Little Rock's SoMa neighborhood, the Hendrix College campus, and Eureka Springs. But, it is the last of these that immediately ratchets down my blood pressure and enhances my productivity. It is also this time in Eureka Springs that has helped me best understand the importance of the Medicaid expansion debate in full throttle this week at the State Capitol.

Despite its natural and architectural beauty and relatively high property tax values, Eureka Springs is ground zero for the health care coverage crisis in Arkansas. The economic travail facing many community members is shown in the fact that nearly seven in 10 students in the Eureka Springs schools are eligible for free or reduced lunches. More directly to the issue of health care, 35.9 percent of all Carroll County adults of working age and more than half of the county's adults making less than 138 percent of the federal poverty level are uninsured, placing it second in the state in both categories.

This rate of uninsured is so high in and around Eureka Springs because the community's residents are disproportionately self-employed and seasonally employed. The waitresses, antique shop owners, artists and massage therapists (many working multiple jobs) who are vital to creating the wonderful community that is Eureka Springs rarely have access to insurance coverage through employers and generally lack the incomes necessary to purchase coverage on the individual market.

Because Eureka Springs has a vibrant communitarian spirit, when a medical emergency hits these individuals, the whole community comes together to try to help. Fundraising concerts are held to help the waitress cover the health care costs from a sledding accident and donation jars with a resident's photo pop up at cash registers all over town when the person faces an expensive operation. Increasingly, having been a part-timer in the Eureka Spring community for nearly three years now, I recognize the faces on these fundraiser posters and jars.

Such public expressions of personal health care needs make human the abstractions of the health care debate underway in Little Rock. The increasingly nationalized ideological debates about the pros and cons of the "private option" at the heart of the "Arkansas Plan," the abstract concepts such as "churn" (folks moving back and forth from Medicaid to the health exchanges that will be reduced under Arkansas's proposal), and the mammoth numbers (250,000 uninsured to be covered and a $550 million positive economic impact on the state) are all fascinating and important. But, it's vital to remember that real humans are at the heart and soul of those policy debates and economic analyses. While the health coverage crisis hits many with whom I interact regularly, it is in Eureka Springs where it is omnipresent in the lives of folks who make up such a wonderful community that has become so important to me.

We know that the "private option" plan agreed to by the Beebe administration and Republican legislative leaders is slightly more expensive than traditional Medicaid would be. We are right to worry about whether the necessary number of insurers will enter the market in rural areas — like Carroll County — to provide real choice to the newly insured. We should be concerned about whether such a large number of folks (many of whom have never before had access to private insurance) can be processed during the open-enrollment period along with the tens of thousands of other new participants in the health care exchanges. In short, it's not a perfect plan, and it's a plan in which uncertainties will remain as implementation occurs.

What is certain are the ramifications of the failure to take advantage of the opportunity offered to Arkansas. The legislators at work in the General Assembly have focused on ideology and economics in their debates over Medicaid expansion. Ultimately, their decision is about a human impact — for good or ill — in communities like Eureka Springs and in towns large and small all over Arkansas.

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