We often mention the 211,611 who have gained coverage under the private option. They would lose their health insurance if Tom Cotton enacted his policy agenda, even though for political reasons Cotton absolutely refuses to admit it or respond to questions about what would happen to them. Cotton would also dramatically cut funding for the old Medicaid and ARKids programs, which would hurt the state’s neediest citizens: the elderly in nursing homes, low-income children, the disable, and extremely poor parents. 

Sometimes lost in the shuffle in these conversations is another group of Arkansans — around 38,000 people who have purchased health insurance on the newly created Arkansas Health Insurance Marketplace, the health insurance exchange created by Obamacare. While the private option offers zero-premium insurance to low-income Arkansans, these are the folks that make too much to qualify for the private option (more than 138 percent of the federal poverty level, or around $16,000 for an individual or $32,540 for a family of four). 


Almost all of these consumers — 90 percent — are receiving subsidies to help lower the cost of that health insurance.  Some of them were shut out of the market before because they had pre-existing conditions. If Cotton was successful in his goal of root-and-branch repeal of the Affordable Care Act, these 38,000 consumers would lose their health insurance plans. The subsidies would also vanish, and insurance companies would once again be allowed to discriminate based on pre-existing conditions. 

I asked the Arkansas Insurance Department for an update on how many consumers were covered on the Marketplace (by which I meant the non-PO Marketplace; confusing matters, private option beneficiaries are also covered by Marketplace plans). In any insurance market, there will be “churn” — people moving on or off plans. To take the obvious example, someone covered by the Marketplace who gets a new job that offers insurance might transition off the Obamacare plan and onto employer-sponsored insurance; someone who loses their job might transition onto on Obamacare plan (folks who have a major life event like losing a job can sign up even after open enrollment is over). 


Here’s the latest on non-PO Marketplace enrollment: 

38,210 are now covered by Marketplace plans. 


That includes: 36582 are current with their payments; 801 have enrolled and their first payment is now due; 827 are in a “grace period” (a three-month grace period to consumers late on a payment, only available if they have made at least one payment). 

It’s natural to focus on the private option, a unique policy which has attracted national attention. There are more than five times as many private option beneficiaries as non-PO Marketplace consumers.The gains in coverage in Arkansas — where the rate of uninsurance has been cut in half since the enactment of the health care law Cotton is so eager to repeal — have been largely due to the private option. It’s also the private option in particular that Cotton — fearing offending independents, swing voters and moderate Republicans who might favor the policy — has studiously avoided taking a position on (even though he has in fact voted to repeal it multiple times).

But the conversation should include these 38,000 consumers too. If Cotton achieved his policy goal, all of them would lose their health insurance plans. Unlike the private option beneficiaries, some consumers might end up being able to get just as good of a deal on a hypothetical post-Obamacare private market. Healthier or more affluent consumers might even do better (although they too would be thrown off of their current plans). But many of these consumers might find themselves suddenly unable to afford insurance. Remember, 90 percent of these consumers are getting subsidies, and Cotton wants to eliminate those subsidies. Insurance companies, meanwhile, could go back to the days of trying to shut out people with health problems from purchasing insurance in the first place. While Cotton believes that everything was fine and dandy for people with pre-existing conditions before Obamacare, that’s just not true. For many Arkansans with health problems, the Arkansas Health Insurance Marketplace was a lifeline. As Sen. Mark Pryor put it, Cotton would “throw them to the wolves.” 

In all, between the private option and the Marketplace consumers, that’s 250,000 Arkansans who Cotton would kick off of their health insurance plans. He has no plan for them. Maybe if he says “Obama” enough, no one will notice.