The Delta Grassroots Caucus (DGC) is a broad coalition of grassroots leaders in the eight-state Delta region. DGC is also a founding partner of the Economic Equality Caucus,
which advocates for economic equality across the USA.

East Arkansas Professionals Assess Benefits of Private Option, February, 2014

Posted on February 09, 2014 at 09:23 PM

Health care professionals and other leaders in east Arkansas assess the private option health care plan’s benefits as clearly outweighing the minuses, and they indicate that not funding the plan would be costly to the region’s hospitals and would miss an opportunity to expand coverage for many previously uninsured people.

Arkansas’ private option was passed with bipartisan support by the Arkansas legislature and Gov. Mike Beebe in 2013, and received national attention as an innovative approach to health care reform that many other states might want to imitate.

In compiling a report based on feedback from across the east Arkansas Delta, the Delta Grassroots Caucus found support from:

–Hospital administrators like Ray Montgomery of White County Medical Center and many other hospital executives;

–Physicians like Dr. Steven Collier of ArCare in east Arkansas, ophthalmologist Dr. G. Edward Bryant in West Memphis and others;

– Bipartisan elected officials like Sen. Jonathan Dismang (R-Searcy) and Rep. Mark McElroy (D-Tillar);

–Insurance executives and many others are supportive of revising and improving the plan, but warned against the consequences of pulling the funding altogether.

–Many other local leaders across east Arkansas who are concerned about health care problems in the Delta and the major missed opportunity that would result from blocking funding for the private option.

Through the private option, Arkansas would use federal Medicaid dollars to purchase private health insurance for approximately 100,000 poor Arkansans in the fiscal year beginning July 1.

• CEO Ray Montgomery of White County Medical Center, the largest health care provider for a 6-county area in east central Arkansas said “If the Private Option Healthcare Plan is not supported, hospitals throughout Arkansas will endure a profound financial impact. Cuts to Medicare reimbursement that are slated to occur this year will be far more serious; our communities will suffer and jobs will be lost.”

• CEO John Heard of McGehee Hospital in southeast Arkansas supported Montgomery’s position, and emphasized that the private option will have a major impact on rural hospitals like the one in McGehee.

• Administrators from St. Bernard’s Medical Center and NEA Baptist Memorial Hospital in Jonesboro indicate that if the private option is not funded, losses just to their two hospitals would be $8 million annually on a conservative estimate.

• Dr. Steven Collier of Augusta, CEO of ArCare, a nonprofit health care organization serving 11 east Arkansas counties, said “Funding the Private Option Healthcare Plan is the right thing to do for Arkansas… one thing is certain, a healthier population with access to health care is long overdue in eastern Arkansas. Funding the Private Option will be a significant step in the right direction.”

• Sen. Jonathan Dismang (R-Searcy) said he has consulted with many health care professionals in his district covering a large area of eastern who are supportive of the private option.

He emphasized that “What we’re doing with the bipartisan Arkansas plan is re-creating Medicaid by placing greater emphasis on the private sector and individual consumerism and much less emphasis on the federal government.”

• Rep. Mark McElroy (D-Tillar) reported he had received similar feedback from health care professionals in his district in support of the private option. “We have people signing up by the thousands, and the worst thing we could do now after we decided to do the right thing on this issue last year is to pull the plug on those people before we even give the privation option a chance.”

• Dr. G. Edward Bryant, an ophthalmologist based in West Memphis who serves a number of east Arkansas counties, and emphasized that improvements can and should be made with the private option, saying “I support the private option, but we should always remain mindful of human nature in forming programs. We should not get stuck in a rut so that we cannot see better options.”

• Dr. Bryant is a specialist, and one of the issues regarding the private option concerns the plan’s impact upon specialists such as opthalmologists, radiologists, heart surgeons, optometrists, dermatologists. He suggested that Blue Cross/Blue Shield have an extensive dialogue with specialists in Arkansas to find ways of treating those categories of health care professionals moving forward. He also suggested that expanding health care savings accounts would be another improvement that could be made for the private option.

• Licensed insurance agents like LeVaughn Smith of Smith Insurance Agency in Helena-West Helena said that the enrollment process when it began last fall encountered serious difficulties, but has steadily improved since then and he is succeeding in signing up more and more clients. He reports increasing interest in signing up as people become more informed about the process, and he is beginning to see more younger people interested in enrolling.

Smith said that he has seen many people in their 40s and 50s who have gained health insurance for the first time after having worked hard all their lives. This has caused a deep impact on many people who had worked at low-paying jobs for many years and only with the private option have they been able to become insured.

Negative impact on the University of Arkansas for Medical Sciences (UAMS) and many other institutions of higher education in higher Arkansas if the private option is not funded:

Gov. Beebe has indicated that UAMS would lose $28 million if the legislature fails to authorize continued funding for the private option.

More broadly, east Arkansas educators like ASU System President Charles Welch have warned that rejecting the private option will result in approximately $89 million in state budget cuts, and higher education will bear the brunt of those cuts.

There is a budgetary gain of $89 million for Arkansas that will be lost if the private option is not funded.

Expansion of Medicaid facts: The expansion of the Medicaid program extended eligibility to adults with incomes up to 138% of the poverty level of $15,860 ro an individual or $32,500 for a family of four. With the private option, most recipients could enroll in private plans on the state’s health-insurance exchange and have the premiums paid by Medicaid dollars.

Health care is especially poignant for the Delta because our health problems in obesity, diabetes, heart disease and many other issues are much worse than the national averages. A baby born in the Delta today on average has a life expectancy of 10 years less than one born in northwest Arkansas.

In the extended contact section, a Table of Contents and then the detailed report follows. This is very in-depth and few will want to read the entire report, but we suggest that you can look over the table of contents in the next section and read those sections that you find most interesting.

TABLE OF CONTENTS

I. Statement from Ray Montgomery, President/CEO of White County Medical Center

II. John Heard, Chief Executive Officer, McGehee Hospital in southeast Arkansas; Chris Barber, President and CEO of St. Bernard’s Healthcare in Jonesboro, is publicly on record as a supporter of the private option; Brad Parsons, administrator and CEO of NEA Baptist Memorial Hospital NEA Baptist Memorial, Jonesboro, also publicly on record as supporting the private option

III. Bipartisan comments from Sen. Jonathan Dismang, representing a large section of east central Arkansas; and Rep. Mark McElroy, representing Desha, Chicot and part of Ashley County

IV. Dr. Steven Collier, CEO of ArCare, a nonprofit health care organization serving 11 Arkansas counties

V. LeVaughn Smith, licensed insurance agent of the Smith Insurance Agency in Helena-West Helena, who direct experience in enrolling people for the private option

VI. Dr. G. Edward Bryant, ophthalmologist based in West Memphis, and serving patients in Phillips , Lee, Monroe, St. Francis, Crittenden, Cross counties.

Note on the impact for education if the private option is not funded: President Charles Welch of the Arkansas State University system and many other educators have stated that rejecting the private option funding will result in approximately $89 million of state budget cuts, with higher education institutions in east Arkansas and across the state bearing the heaviest impact.

1. Statement of Ray Montgomery, White County Medical Center President/CEO, for the Delta Grassroots Caucus, February, 2014

(NOTE: White County Medical Center is the leading healthcare provider in a six-county area including White, Jackson, Prairie, Independence, Lonoke and Woodruff counties. It is the largest employer in this six-county area with more than 1,750 associates. The facility has a combined total of 438 licensed beds and a medical staff of 150 physicians that specialize in various areas of healthcare.)

Administrator Montgomery’s statement:

“Funding the Private Option Healthcare Plan is essential for our state, community and our working poor who need healthcare. The federal government has been paying for healthcare coverage by taking resources from our state and returning the dollars for the expanded coverage. With the implementation of the Affordable Care Act, the federal government is putting the burden on healthcare providers to provide the same care to more people but paying them less for their services. This will have a significant impact on small and rural hospitals through Arkansas and the nation, as they attempt to maintain their facilities with less financial support from the federal government.

Our hospital and most other hospitals throughout Arkansas are facing major challenges with reimbursement cuts currently in play. My hope is that healthcare providers, commercial insurance payors and the state and federal payors can continue to work together in developing transformational steps that will improve quality and reduce costs in order to improve healthcare for our patients and our community.

If the Private Option Healthcare Plan is not supported, hospitals throughout Arkansas will endure a profound financial impact. Cuts to Medicare reimbursement that are slated to occur this year will be far more serious; our communities will suffer and jobs will be lost.

There are numerous benefits to the Private Option Healthcare Plan, and my hope is that our legislators will agree as they analyze the choices and the current research. They have made great strides in vetting the best plan for all Arkansans under these difficult constraints.

Unproven payment strategies that are instituted at the federal and state levels designed to address reducing healthcare costs are worrisome. The uncertainty surrounding those strategies is a concern for the healthcare system as a whole. In fact, federal policymakers are currently involved in researching which payment model works best in practice in order to implement it on a broad scale. That research is going on simultaneously while the Affordable Care Act is being put into place, just as we learn more details about it every day. We hope there will be enough “testing” to assure the success of these strategies. If they fail, we may find ourselves worse off than our current problems.

There are no easy solutions. We must keep the focus on improving care for our patients through the development and standardization of care modules, minimize costs and variation unrelated to the delivery of quality patient care, move from fee-for-service payment to a value-based population health payment model, and implement strategies that require personal health accountability.

Regardless of the outcome, our hospital will continue to serve the residents of White County and surrounding counties through innovative approaches to medicine and quality patient care. White County Medical Center is partnering with physicians, clinics, and other providers throughout the region to provide a variety of services and care for patients in a high-quality and cost effective manner.”

2. Hospital administrators across east Arkansas express views similar to those of White County Medical Center Administrator Ray Montgomery:

For example, John E. Heard, Chief Executive Officer of McGehee Hospital in southeast Arkansas, agreed with Administrator Montgomery’s support of the private option. Heard said that this is a very important issues for rural hospitals like the one in McGehee. He said expanding coverage for many Arkansans will be an important benefit.

Other examples are the administrators at the two major Jonesboro hospitals that serve a broad area in northeast Arkansas; both have made public statements that the private option would alleviate major financial burdens of uncompensated care for their institutions.

Chris Barber, president and CEO of St. Bernard’s Healthcare, said that if the private option is not funded, St. Bernard’s could lose up to $8 million annually. He told the Jonesboro Sun on Feb. 2, 2014 that there are more than 17,000 northeast Arkansans who have access to care that they did not have before the private option. Barber and many other administrators have stated that without insurance, people wind up in the emergency room in distress, and many of them are not able to pay for the medical services they need.

Similarly, Brad Parsons, administrator and chief executive officer of NEA Baptist Memorial Hospital in Jonesboro said undoing the private option would be a major setback for health care. He said that the private option would relieve the financial burden of nearly $4 million in annual uncompensated care.

DELTA CAUCUS BACKGROUND INFORMATION ON EXPANDED COVERAGE:

A vital problem with health care in the Delta and in Arkansas as a whole, is the large pool of uninsured patients. As we understand it, this works a hardship on hospitals who have to provide uncompensated care. The emergency room visits of uninsured patients place a financial burden on hospitals. This affects people who have insurance because these costs have to be paid for, and they cause higher insurance premiums for everyone else.

Under Arkansas’ private option, about 250,000 Arkansans are eligible for coverage that started Jan. 1, 2014. Most recipients can sign up for private plans on the state’s health insurance exchange and have their premiums paid by Medicaid. About 10 percent of those would be covered under the traditional Medicaid fee-for-service program.

The Arkansas Department of Human Services reported as of early February, 2014 that 85,309 people had been approved for coverage as of Jan. 20, 2014. Out of that number, 76,899 had completed enrollment in private option plans and another 8,410 were enrolled in traditional Mediciad. These numbers are expected to continue growing until the March 31, 2014 deadline for enrollment.

If the private option is not funded, the people mentioned above who are now covered by the private option will lose that coverage in July, 2014. The legislature will either have to restore those funds or allow those people to go without care.

There is a budgetary gain of $89 million that will be lost if the private option is not funded. There will then be the funding issue that obviously those funds will have to come from somewhere—taking funding from other programs, eliminating tax cuts approved last year, or raising taxes, or some combination of those. Higher education will bear a large part of the funding cuts, as explained earlier.

DHS Director John Selig has stated that the Affordable Care Act basically made a trade-off for hospitals, cutting their Medicaid reimbursements while reducing their uncompensated care because more people will be insured. The Medicaid cuts are now in place so the hospitals have taken that blow, and if they cannot get help for the uninsured through the private option they will be taking another blow and this would be doubly damaging for many hospitals.

3. Bipartisan statements from one Republican and one Democratic member of the legislature who have consulted with many health care professionals in their districts and indicate that the clear majority of them are supportive of the private option.

Sen. Jonathan Dismang, (R-Searcy) said he has consulted with White County Medical Center CEO Ray Montgomery and other health care professionals in his district and the clear majority are supportive of the private option. Sen. Dismang’s district includes an extensive area in east Arkansas from Searcy down through Prairie, Woodruff, Monroe, Lonoke counties and down to DeWitt.

Dismang said that “What we’re doing in Arkansas is re-creating Medicaid by placing greater emphasis on the private sector and individual consumerism and less emphasis on the federal government.”

Arkansas’ plan has received extensive national attention due to the emphasis on the private sector and individual consumerism Sen. Dismang referred to. In the Delta Grassroots Caucus, we have partners across eight states and many of them received information about Arkansas’ private option through our grassroots coalition and thought a similar plan should be considered for their states.

The Caucus board of directors reports that there has been considerable surprise when grassroots leaders in many of the other seven states learned that only a year after the national attention given to Arkansas’ bipartisan passage of the private option by Gov. Mike Beebe and the legislature last year, that there is now a debate about not providing the funding this year.

Rep. Mark McElroy (D-Tillar) said he has consulted with many health care professionals in his district covering Desha, Chicot and part of Ashley county, and while of course assessments will not be unanimous on such a complex set of issues, most were supportive of the private option. Many of them recommended adjusting, tweaking and improving the private option rather than pulling the plug on the funding entirely after thousands and thousands of Arkansans have signed up and are now covered for the first time.

McElroy said “This is a plan designed by Arkansans that relies more on the private sector and less on the federal government. We voted for it last year because it was good for the people of Arkansas then and it’s just as good for the people of Arkansas now. The worst thing we could do is change our vote before we even give it a chance to work.”

“If we fund it as we decided to do after the laborious debate last year and give it a chance to work and then it fails to do so, I’ll be the first to say let’s go with another plan. But don’t pull the rug out from under thousands of Arkansans before we’ve even given it a fair try,” McElroy said.

DELTA CAUCUS BACKGROUND INFORMATION ON EMPLOYER MANDATE ISSUE:

An important issue regards the penalties on employers if the private option is rejected. There have been differing points of view on this subject.

The Arkansas Chamber of Commerce cited a Jackson-Hewitt Tax Service estimate that if the legislature does not re-authorize the use of federal funds to buy private health insurance for low-income Arkansans, then Arkansas businesses will face a cost of between $27 and $41 million. The Jackson-Hewitt report in question stated that states not expanding Medicaid allow their large employers to be exposed to employer “shared responsibility” tax penalties.

Senator Michael Lamoreaux of Arkansas expressed a different point of view, saying that taxes will not immediately go up if the private option is defeated, saying that they might go up in 2015 if there is no intervening action in the meantime, such as if President Obama decides on another delay on the employer mandate. Other legislators indicated disappointment that earlier reports had not indicated that the employer mandate was delayed until 2015 and it’s possible Congress might repeal the employer mandate by then.

There are obviously many variables and many decisions at federal and state levels that could change parts of this complex equation. It does appear obvious that it would be better to avoid large tax penalties. Randy zook, CEO of the Arkansas Chamber of Commerce, said “This additional expense will have a chilling effect on the growth plans of Arkansas businesses. Witn nearly 100,000 Arkansans still unemployed, those companies do not need to deal with added costs.”

4. Statement of Steven F. Collier, MD, Chief Executive Officer, ARcare, based in Augusta, Arkansas, and serving 11 Arkansas counties.

ARcare is a private non-profit corporation developed to provide affordable care to meet the primary medical and dental care needs of the residents in rural Arkansas, especially in the communities of Cleburne, Craighead, Cross, Independence, Jackson, Lonoke, Monroe, Prairie, White, and Woodruff counties.

“Funding the Private Option Healthcare Plan is the right thing to do for Arkansas. There is no greater vantage point from which to see the tremendous need for the Private Option than from that of a community health center serving eastern Arkansas. Day after day, uninsured patient after uninsured patient walk through our health center’s door, humbly seeking medical attention. Medical attention that they might not be able to get at other medical facilities in the state. Holding true to our mission, we see these uninsured patients. Needless to say, funding the Private Option will open so many healthcare related doors for these individuals.

Further, one can only imagine the number of citizens in eastern Arkansas that choose not to seek any medical treatment at all, as they have no health insurance. They fear being turned away at the door, or worse, in their eyes, facing mountains of bills and collection agency calls after being treated. Funding the Private Option will resolve these problems.

Creating a health friendly environment in our communities by removing these barriers is exactly what Arkansas needs. With a healthier population, we create a stronger workforce, thus sustaining economic development in a part of the state that so desperately needs it.

The far reaching positive impacts of the Private Option to eastern Arkansas are far too numerous lay out at this point, and many of which may not be recognizable until we see the progress first hand. With that said, one thing is certain, a healthier population with access to health care is long overdue in eastern Arkansas. Funding the Private Option will be a significant step in the right direction.”

5. LeVaughn Smith, licensed agent for the Smith Insurance Agency in Helena-West Helena, Arkansas, who has hands-on experience in dealing with many people in his local area who are interested in signing up for the private option plan.

Mr. Smith has 50 years of experience as a professional insurance agent.

Smith is speaking from the standpoint of an insurance executive in the heart of the Delta who works with people every day regarding enrollment in the private option. He said that the process went extremely slowly when enrollment began last fall, but lately the process has steadily improved and “lately we’re seeing a lot more interest. A lot of this is an educational process—at first there were computer issues and they didn’t understand it, but the more they learn the more they are interested in signing up.”

Smith said that as his agency has walked many people through the process, he has seen some of them leave his office with deeply emotional responses because in many cases they had worked hard all their lives on jobs with modest incomes, and had never obtained insurance before.

He said one client left his office with tears in her eyes, saying “this is the first time in my life I’ve had health insurance even though I’ve worked all my life.”

Smith said that at first he had seen many people in their 40s and 50s who had jobs but never had coverage. He said he did not see large numbers of older people with severe health problems, because many of those were already covered by Medicaid.

Recently Smith indicates that he is now seeing younger people coming in to enroll in the private option. This is widely reported to be crucial to include younger, healthier people in the pool of those participating in order to help stabilize the process for the long term.

Smith said that after a difficult process at first, he has successfully enrolled 75 of 80 clients interested in signing up, and many more are expressing interest.

As the deadline of March 31, 2014 for enrollment draws near, Smith said he is seeing the interest pick up and expects the numbers to become very heavy as the deadline is publicized and people realize their ability to sign up for now is about to pass and will not open again until Nov. 15.

The Smith Insurance Agency helps clients with computers in their offices. Some of the lower income people in their area do not have a great deal of knowledge about use of computers, again pointing out the educational process involved here and need to help them navigate the system.

With the agency’s help, they obtain estimates from Blue Cross Blue Shield on insurance preimums, tax credits and whether they qualify for the private option. In contrast to the difficulties of being “kicked out” of websites and computer systems, the process is increasingly working better and they are signing up more people and showing increasing interest in enrolling.

Smith said that in his 50 years of experience in the insurance field “this is one of the better ideas I’ve seen.” He said it will take time for all the beneficial impact to kick in, but as more people are covered, emergency room visits and costs go down, the program should stabilize. He said after seeing so many hard-working people get coverage for the first time, it would be a major step backward if the legislature does not follow through on last year’s passage and does not fund the private option.

6. Statement Dr. G. Edward Bryant, an ophthalmologist based in West Memphis and serving patients in Phillips , Lee, Monroe, St. Francis, Crittenden, Cross counties; Dr. Bryant is a specialist

One of the key issues in the private option is that there is some concern as to how specialists will be affected. Dr. Bryant is a specialist who is supportive of the private option, although like most of the experts we consulted he is in favor of making improvements and adjustments in Arkansas’ plan as we move forward.

“I support the private option, but we should always remain mindful of human nature in forming programs. We should not get stuck in a rut so that we cannot see better options.”

Dr. Bryant suggests that Blue Cross/Blue Shield have an extensive dialogue with specialists in Arkansas to find ways of treating those categories of health care professionals moving forward. He also suggested that expanding health care savings accounts would be another improvement that could be made for the private option.

Dr. Bryant’s detailed comments are below:

I. Reducing the number of uninsured patients and costs

A. The uninsured in the delta are the working poor and unemployed. The new ACA will Insure many of these individuals. Unfortunately it appears Blue Cross shield of Arkansas and other insurances in Arkansas have grouped working people into this risk pool. The co-pay and deductible for many working individuals will encourage emergency room visits and noncompliance with office visits. I feel that working through employers is the way to insure the working poor. Employees should be given Tax incentives or supplemented payments to ensure their workers. This would encourage business and hopefully ensure reasonable co-pays and deductibles. The employee should be responsible for a medical savings account to supplement the cost of co-pays and deductibles.

B. Medically fragile individuals should be placed in special pools assigned primary care physicians and more closely monitored. It is important to separate truly fragile chronically ill individuals from those people who, although they have a chronic disease, are not disabled.

II. Employers’ mandate issues

A. Employer mandate should be structured to allow each employer to design insurance plans that match his employees’ demographics. He should not be required to insure his employee population for optional programs that have cost but not value. Co-pays and deductibles for office visits, ER visits and routine medical procedures should be negotiated, not mandated. Maximum out-of-pocket cost to the employee should not be a universal government dictated amount, but determined by the employer and employees of individual businesses. Wellness plans are good but had very little value. Generally the drivers of illness in the working population are smoking, substance abuse, obesity and accidents. Incentives to decrease these causes of illness may be helpful.

III. Specialists’ reduced reimbursements

In my opinion, there is very little scarcity in the primary care in the rural areas I serve. Again I will say there is not a shortage of primary care in rural areas where the population can sustain practices. The additions to advance practice nurses and primary care rural health clinics and community health centers have provided adequate primary care in many areas. The scarcity is in the readily available access to specially care. To penalize specialistd because of perceived overvalue of their services is completely wrongheaded and detrimental to access of care. We cannot in this modern time run a health care system that provides high-quality, technologically advanced care by penalizing specialists. There is difficulty obtaining specially care in rural areas now. the newly insured patients in rural areas will be in a group that cut specialists paid 15%. This will not help the availability of specialists in rural areas or even the availability of appointments for these individuals referred to a urban area. We should be promoting special care clinics in rural areas of the population would not support a resident specially community.

For some specialists, such as rheumatologists, optometrists, nonsurgical ophthalmologist, neurologist, they are among specialist who received a 15% reduction in payments for newly insured individuals. These specialists rely heavily on evaluation and management codes. They do not do procedures. To lump all specialists into a category that they make too much money, so we need to reduce their pay, is unconscionable. These individuals now with newly insured through the private option will be paid similar to an advanced practice nurse for their years of training and knowledge.

IV. Health savings accounts

I’m in favor of making health savings accounts easier to obtain and less costly. There should be no reason an individual cannot set up a health savings account without an insurance company or Third-party intermediary. This can be done through our tax system similar to retirement accounts. Health savings account can be used to reduce the cost of insurance and eventually make insurance just major medical. The only reason I see that this is not being done is that some bureaucratic individuals want to control the money placed into the health insurance system for their benefit or benefits of their cronies. Even individuals with limited income over time can develop a very substantial health savings accounts that can be used to offset expenses and lesson the burden of premium payment. This also should free up money to be used by those individuals’ health costs that are not covered by insurance. Regardless of what an individual thinks should be covered, the use of these accounts will stimulate the medical economy.

Anytime money is taken by taxes or insurance premiums it lessens the value of that money to the end-user (the taxpayer or premium payer). Money taken by taxes or insurance premiums returns to the end-user less value for the product they buy. There is an intrinsic cost to administrating the tax system or insurance company. If the patient or taxpayer is able to use their money locally without the use of these bloodsucking intermediaries that money has more value.

By providing health savings accounts to people with modest incomes at a tax-free rate with their ability to benefit from these funds if unused we accomplish two goals. One, we lessen the incentive to utilize the health care system for trivial reasons. Second, we decrease the cost of the health care premium to the individual or government entity paying the premium.

V. Lack of health care providers in the Delta

In my opinion, there is very little scarcity of the primary care in the rural areas I serve, except for Crittenden County. Again I will say there is not a shortage of primary care in rural areas where the population can sustain practices. The addition to advance practice nurses and primary care rural health clinics and community health centers have provided adequate primary care in many areas .The scarcity is in the readily available access to specialty care.

Crittenden County is next to Shelby County, Tennessee. Patients with the means often travel to Memphis for the primary care. This flight of the patients makes primary care in Crittenden County less desirable. Also if rural area paid more than urban doctors would be there.

VI. Question to Dr. Bryant asked by Delta Caucus partners–The federal health care website and enrollment process was a fiasco in the beginning but has gradually improved since then. As we understand it, the Arkansas enrollment process has gone more smoothly than in many other areas. Is this accurate, and if so, why?

It appears that the Arkansas website has been successful. Many of my colleagues are seeing newly insured individuals insured by the new private option. We are less optimistic about the municipal employees and teachers in the state of Arkansas. The addition of large co-pays and deductibles to the insurance plan make it likely that many insurance patients will see the emergency room is a less expensive cost of care due to not having to pay upfront charges. The addition of large co-pays and deductibles also make it likely that these individuals will delay care. Also, although I have not seen this personally, there is concern that the medically fragile in place to Medicaid and who are adults may incur larger costs and have less access to care. An adult if subject to the same restrictions as part Medicaid may run out of visits and lab expenses very rapidly. My understanding is an adult has $500 of lab and12 visits with a limited pharmacy card. If these are truly medically fragile individuals then these limitations will rapidly be exceeded.

PRIVATE OPTION: If Arkansas does not get stuck with the over cost then this is a good way to go, so far. I Have seen numerous people with problems I can fix recently that have gone to the doctor because they now have insurance. Now after we help them we need to find a way to get the ones that can work back to work.

DELTA CAUCUS BACKGROUND INFORMATION ON SPECIALISTS’ REDUCED REIMBURSEMENTS AND HEALTH SAVINGS ACCOUNTS:

Arkansas Blue Cross and Blue Shield reduced reimbursements to specialists such as heart surgeons, radiologists, opthalmologists, optometrists, dermatologists and other specialists. The reimbursement is specifically for the new private option patients for policies bought on the new health care exchange (but not for existing commercial insurance such as group plans). The specialists will get 15% less only for services also provided by general practice physicians.

Blue Cross did this to save money so that consumers’ rates do not continue rising even higher, and to preserve reimbursements for primary care physicians. The specialists often make substantially more than general practitioners, but of course not in all cases.

We understand that health savings accounts are a positive feature of the plan. These accounts should help control health care costs by making Medicaid recipients more sensitive to the cost of medical care. When money is contributed to a health savings account they are not taxed as long as the money is spent on health care.

Taking major steps in support of health savings accounts would be an important step in improving the private option and assuring its funding.