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Rural Hospitals, Communities Depend on Affordable Care Act

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An estimated 147,000 Arkansans may have lost their employer-sponsored health coverage because of the pandemic, according to the State Health Access Data Assistance Center.

LITTLE ROCK, Ark. -- The U.S. Supreme Court on Nov. 10 is to hear oral arguments in a case that is likely to decide the fate of the Affordable Care Act. Texas and more than a dozen other states are asking the court to repeal the 2010 law that overhauled the private health insurance market and expanded Medicaid.

ACA opponents believe the so-called "individual mandate," which requires people to have health insurance, is unconstitutional. However, April Reign, who hosts the web series "What's at Stake," a project of the advocacy group Health Care Voter, said the ACA also put patient protections in place, including banning insurance companies from setting lifetime dollar limits on benefits.

"For those people who have chronic issues, for those people who need surgeries that were unexpected," she said, "that could be debilitating and lead to bankruptcy."

More than 360,000 Arkansans could lose health coverage if the ACA is repealed, according to the Economic Policy Institute. However, experts say that number likely would be higher since the pandemic, because more people have lost jobs and employer-based coverage.

The ACA also bars insurance companies from discriminating against people with pre-existing conditions. Research from the Kaiser Family Foundation has found that nationwide, 130 million people could be denied coverage if that protection ends -- and Reign pointed out that figure also could grow.

"And let's remember," she said, "that's not including the over 8 million people who now are survivors of the coronavirus."

The survival of many rural hospitals hinges on the ACA, Reign said. According to an Urban Institute report, hospitals in Arkansas could lose $836 million in revenue without Medicaid expansion. It's estimated that hospitals' uncompensated care costs have fallen by 57% in Arkansas since the law took effect.

"Part of the issue here is that the Republicans have said that they're going to 'repeal and replace,' but we have yet to see what they are going to replace it with," she said, "and that's the scary part, because we don't know what we don't know."

Republican Gov. Asa Hutchinson consistently has supported Arkansas' Medicaid expansion under the ACA, which currently covers an estimated 250,000 people.

The EPI data is online at epi.org, the Kaiser data is at kff.org, and the Urban Institute study is at urban.org.