The percentage of Arkansas adults who went without medical care because of the cost fell last year for at least the second year in a row, according to a report by a private foundation.
Citing figures from the U.S. Centers for Disease Control and Prevention, the report by the The Commonwealth Fund also noted that the percentage of "at-risk" Arkansas adults who reported going without a visit to a doctor in the past two years fell from 18 percent in 2013 and 2014 to 15 percent last year.
At-risk adults were defined as those 50 or older, as well as younger adults, who reported being in fair or poor health, have had a heart attack or stroke or have ever been diagnosed with diabetes, high blood sugar, heart disease or asthma, according to the report.
Nationally, the percentage of adults who went without health care in the past year because of the cost fell from 16 percent in 2013 to 14 percent in 2014 and 13 percent in 2015, according to the report.
Meanwhile, the percentage of at-risk adults nationwide who reported going without a doctor visit fell from 14 percent in 2013 to 13 percent in 2014 and 2015, according to the report.
Released last week, The Commonwealth Fund report compiled information on changes in access to health care in the 50 states and District of Columbia since Jan. 1, 2014, when new subsidies for coverage became available under the 2010 Patient Protection and Affordable Care Act.
Based in New York City, The Commonwealth Fund focuses on independent research on health care matters.
Joe Thompson, director of the Arkansas Center for Health Improvement, said the report highlights gains that will be at stake as leaders of the Republican-controlled Congress and President-elect Donald Trump prepare to deliver on their promises to repeal and replace the health care law.
[EMAIL UPDATES: Sign up for free breaking news alerts, daily newsletters with top headlines]
"If the Affordable Care Act is repealed without an immediate replacement strategy, these numbers will dramatically reverse and significant turmoil will be injected into the health insurance marketplace," Thompson said Wednesday.
The Commonwealth Fund report noted that, according to the U.S. Census Bureau's American Community Survey, the percentage of adults 19 to 64 who lack insurance fell by significant amounts from 2013 to 2015 in the District of Columbia and all but two states.
The exceptions were Massachusetts and South Dakota. The percentage of adults who were uninsured also fell in those states but by smaller amounts.
Overall, the report said, the biggest gains in coverage tended to be in states such as Arkansas that expanded their Medicaid programs Jan. 1, 2014, to cover adults with incomes of up to 138 percent of the poverty level. This year, that threshold is $16,394 for an individual, for instance, or $33,534 for a family of four.
The District of Columbia and 24 states adopted the expansion, authorized by the Affordable Care Act, at the beginning of 2014. An additional seven states have expanded their Medicaid programs since then.
Arkansas expanded its program primarily by using Medicaid funds to buy commercial insurance for the newly eligible adults as part of the so-called private option.
In every state, the Affordable Care Act makes tax-credit subsidies available through health insurance exchanges to many people who don't qualify for Medicaid and who have incomes below 400 percent of the poverty level: $47,520 for an individual, for example, or $97,200 for a family of four.
In Arkansas, more than 324,000 people were covered under the expanded part of the state's Medicaid program as of Sept. 30.
An additional 70,979 Arkansans were signed up as of Dec. 15 for non-Medicaid plans on the state's health insurance exchange.
The Commonwealth Fund report cites information from the CDC indicating that access to care has improved along with the expansion of coverage.
Using information from the CDC's Behavioral Health Factor Surveillance System, the report found that the percentage of adults 18 and older who went without care because of the cost fell significantly from 2013 to 2015 in 39 states, and didn't increase significantly in any state.
In Arkansas, the percentage of adults who reported forgoing care because of the cost fell from 21 percent in 2013 to 18 percent in 2014 and 16 percent in 2015.
The CDC information comes from state health department surveys of more than 400,000 adults nationwide each year.
In 2013, Arkansas had the nation's second-highest percentage of adults who had gone without care because of the cost, according to the CDC information.
That year, Mississippi ranked No. 1, with 22 percent of its adults reporting that they went without care because of the cost.
By 2015, the percentage of Arkansas adults who had gone without care because of the cost was smaller than the percentages in seven other states. Mississippi, which did not expand Medicaid, still had the highest percentage, with 19 percent of its adults reporting they had gone without care because of the cost last year.
The other states with bigger percentages of adults who went without care because of the cost were Texas, Florida, Alabama, South Carolina, Louisiana and Georgia, and Arkansas tied with North Carolina and Tennessee.
None of those states had expanded Medicaid by the end of 2015, although Louisiana expanded its program on July 1 of this year.
The percentage of at-risk adults who had not seen a doctor in the past two years fell significantly from 2013 to 2015 in 17 states, including Arkansas, and increased significantly in three states, according to The Commonwealth Fund report.
State Sen. Jim Hendren, R-Sulphur Springs, said he doesn't doubt that Medicaid expansion has improved access to health care for Arkansans but is concerned about the cost to taxpayers.
During a special session this year, the Legislature approved changes to the program that Gov. Asa Hutchinson said will encourage participants to stay employed and take responsibility for their health care.
Those changes include charging premiums of $13 a month to enrollees with incomes above the poverty level and referring enrollees to job training programs.
Hendren, who was chairman of a task force that recommended changes to the state's Medicaid program, said he hopes Congress and the Trump administration will give Arkansas more flexibility to control costs while continuing to improve Arkansans' access to care.
"I don't want to lose the progress that we've made," Hendren said.
But, he said, "We're going to have to be serious about implementing some reasonable restrictions and reforms of the program to make it sustainable."
Metro on 12/29/2016