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Given the troubled launch of the national health insurance marketplace at healthcare.gov, President Barack Obama has been forced to trumpet good news about his signature health care law wherever it can be found. During a speech on the new law in Boston on Oct. 30, 2013, Obama pointed to examples of states that had succeeded in signing up lots of new enrollees.
Hearing one of these states Obama cited -- Arkansas -- struck us as notable, because it has become a solidly red state. In addition, a reader from Arkansas emailed us to see if we could check it out.
In the speech, Obama said that Arkansas, a state he didn’t win in 2008 or 2012, "has covered almost 14 percent of its uninsured already." The White House later reiterated this claim in a tweet.
Is it true that Arkansas has covered almost 14 percent of its uninsured residents?
The state’s Republican Legislature wasn’t inclined to expand Medicaid to adults and families with incomes up to 138 percent of the federal poverty level -- as provided for under Obamacare -- but the Democratic governor, Mike Beebe, proposed an alternative.
He proposed using the federal payments the law was offering to Arkansas to expand Medicaid and instead give it to qualified Arkansas residents, who would then use it to purchase private insurance plans on the new marketplace. In September, as the Oct. 1 startup date for the new marketplace was approaching, the U.S. Department of Health and Human Services gave Arkansas the green light to pursue this effort. It’s been dubbed "the private option."
The state sent out notices to potentially eligible residents. Once a recipient of one of these notices returns an application to accept the "private option," the department will check their income eligibility and, if they qualify, will direct them the Insure Ark website to select their plan. (The state does steer a small fraction of those newly eligible -- those with medical issues that can be better treated under Medicaid -- to traditional Medicaid instead.)
Even if someone who’s eligible doesn’t select a plan, that person will be automatically assigned a plan by the state. After the person is informed about this automatically assigned plan, they will still have a chance to choose another one if they wish.
While the new insurance is set to kick in on Jan. 1, the state considers residents to have completed the coverage process as soon as the department approves their application and directs them to Insure Ark. This mirrors the situation with people who secure coverage from the national healthcare.gov site -- they are considered "signed up" even if their coverage officially starts Jan. 1.
When we checked with the Arkansas Department of Human Services, spokeswoman Amy Webb said that through Oct. 26, the state had received 70,595 applications from potentially eligible residents, which probably undercounts the actual number received four days later, when Obama gave his speech. (This figure does not include anyone who’s signed up for the federal plan on healthcare.gov.)
Of the 70,595 applicants, Webb said, 65,138 have already been determined eligible. The remaining 5,457 have applications pending and will be processed soon, she said.
Webb added that the state has been using the ballpark figure of 500,000 for the number of uninsured residents. Using that figure, 13 percent of uninsured Arkansans have secured insurance through Obamacare. Especially if you account for the extra couple of days’ worth of applications not counted in this figure, this qualifies as the "almost 14 percent" Obama cited.
However, to the extent that Obama was using the Arkansas case as an example of how the law was working well, it’s important to note the limitations of his example for a national audience.
Residents who are eligible for Arkansas’ private option via Insure Ark only account for a fraction of the state’s uninsured population, perhaps 40 percent. A majority of the uninsured in Arkansas earn too much to qualify for the private option and must instead use a different, and for now, less functional, website -- the national healthcare.gov site.
In other words, while the success of Arkansas’ private option is real, using it as an example in a national speech glosses over the fact that the state's uninsured population that doesn't qualify for Medicaid is going to have to use the troubled national website.
Obama said that due to the health care law, Arkansas "has covered almost 14 percent of its uninsured already." That number is very close, if not spot on. But it's a case study that has limited application for the rest of the country, because of the state's unique approach to Medicaid. Many of the state's uninsured still have to get coverage from the troubled healthcare.gov website. The statement is accurate but needs additional information or context, so we rate the claim Mostly True.
Barack Obama, speech in Boston, Oct. 30, 2013
White House, tweet, Oct. 30, 2012
U.S. Census Bureau, Number and Percentage of People Without Health Insurance Coverage by State Using 2- and 3-Year Averages: 2009-2010 and 2011-2012, accessed Nov. 1, 2013
American Public Health Association, home page for Medicaid expansion, accessed Nov. 1, 2013
Arkansas Department of Human Services, "DHS Reports Number of Applications State has received for Private Option," Oct. 15, 2013
Slate, "Mike Beebe Strikes a Good Deal for Arkansas Health Care Providers," Feb. 27, 2013
Arkansas Times, "The questionnaire that will determine whether beneficiaries get "private option" plans or traditional Medicaid," Sept. 9, 2013
Arkansas Times, "'Private option' auto-assignment policy aims to enhance competition and keep Arkansas Blue Cross from dominating the market," Sept. 15, 2013
Arkansas Times, "More than 50,000 Arkansans have enrolled in the "private option" for Medicaid expansion," Oct. 15, 2013
Arkansas Times, "More than 60,000 Arkansans have enrolled in the ‘private option’ for Medicaid expansion," Oct. 24, 2013
Email interview with Amy Webb, spokeswoman for the Arkansas Department of Human Services, Oct. 31, 2013
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