If the health-care crisis yielded to simple solutions, Arkansas at least would be home free by now. But the state learned once again that even the offer of a big federal subsidy will induce few employers to insure their workers.
Gov. Beebe struck out Monday on a tour of the state to urge businesses to take advantage of ARHealthNet, the state-sponsored insurance program that was begun with fanfare late last year. When Gov. Mike Huckabee and his health director, Dr. Joe Thompson, unveiled the plan after obtaining a waiver from the federal Medicaid division, we expressed doubt that it would amount to much. We hoped we were wrong. They talked about covering 80,000 workers with the limited-benefit plan. That would be a sizable segment of the roughly 378,000 Arkansans who have no health insurance. Employers could buy into Medicaid for their low-income workers (wages up to 200 percent of the federal poverty line) by paying only 27 percent of the cost of medical benefits; Washington would pay the other 73 percent. Employers would essentially be paying the state’s low matching share of Medicaid for their workers.
For such a wonderful opportunity, there were a couple of rubs. First, businesses do have to pay something and most consider that with their tight margins even the 27 percent is too much. Second, to participate a company has to insure its other employees, too, rather than providing benefits only to its poorest employees. They have to do that with private plans for which they and their employees pay the full load.
After seven months, only 178 businesses have enrolled to cover 655 workers, roughly four per business. Beebe and Thompson, who is his new surgeon general, think that the program just needs promoting. We hope so. But experience is not encouraging. Eight other states started a similar program with about the same cheerless results. Arkansas’ earlier initiatives proved even more disappointing. After spending $500,000 preparing it and promoting it, the state abandoned a drug-discount program several months ago because not enough people expressed an interest to drive much of a discount.
Previous legislation establishing small-business insurance pools going back 15 years proved worthless. To make a dent in the problem, there will have to be mandatory participation, a concerted effort at cost control and a real financial participation by state government if it is a state program. A half-dozen states — mainly big ones but also tiny Maine — are moving toward that with mixed results. In the end, it must be a federal remedy because only the national government can impose both effective cost controls and the financing that an equitable universal system requires. —Ernie Dumas
