Where the States Stand

Via: The Advisory Board Company

The Atlanta Journal-Constitution is doing some reporting in Arkansas on the private option, the state’s unique version of Medicaid expansion which uses funds available via Obamacare to purchase private health insurance for low-income residents. Our friends from Atlanta made the trip because Georgia is one of the 22 states still refusing the federal funds to expand health care coverage. The state has said thanks but no thanks to a projected $35 billion over ten years and Georgia now has the second-highest uninsurance rate in the nation (19.1 percent). Arkansas, which moved forward with the private option, slashed its uninsurance rate in half (down to 11.4 percent). So, the AJC asks, could the Arkansas approach be a “red state solution” in a refusnik state like Georgia?


Their first report, part of a three-part series, was published over the weekend, and covers familiar ground for those who’ve followed the debate in Arkansas closely.

Hospitals like it: far more of their patients are now paying customers; doctors like it: insurance companies pay them much more than Medicaid does; insurance companies like it: they get a lot more business, much of it paid for by the government.

And 233,000 of the state’s neediest citizens now have health insurance because of the private option. The AJC spoke with one, Donna Foster, a Morrilton single mother who works as a home caregiver for $9 an hour. Her job doesn’t offer insurance, and despite health problems, she was unable to afford the care she needed. She is now covered via the private option, was diagnosed as diabetic, and is able to get the medication and treatment she needs: “I don’t have to worry about paying (my) doctor bill off or getting the lights cut off.” Another, from southeast Arkansas, is a Republican who doesn’t like Obama but is thankful that he qualified for the private option and was able to get the surgery he needed. 


There are, of course, many, many more stories like Donna Foster’s. Stories that are only possible because against long odds, Arkansas found its way to a politically plausible path toward coverage for its neediest citizens. I’m skeptical that the specific policy details of the private option and its implementation will move the needle in a state like Georgia. The “red state solution” is simply something that can be plausibly sold as not Obamacare even as it takes advantage of billions in federal dollars available because of the health care law. If (when?) the ideological fever in Georgia and other states finally breaks, it will be because the pressure from hospitals and from chambers of commerce and from, yes, the Donna Fosters becomes too great. Until then, Arkansas will remain an island in Dixie on maps like the one above. There are aspects of the Republicanized version of Medicaid worth questioning, but that remains something to celebrate.