The state of Arkansas found a way to implement the federal Affordable Care Act so that it not only expanded access to health insurance but also improved the private insurance marketplace, a former director of that state’s Medicaid program said Thursday.

But a leader of the Kansas Legislature said it’s unlikely that program will be replicated here any time soon because of political opposition to the federal program and concern over its long-term impact on the national debt.

Andy Allison, who was executive director of the Kansas Health Policy Authority before he went to Arkansas in 2011, and Rep. David Crum, R-Augusta, the assistant majority leader in the Kansas House, were two of the keynote speakers Thursday at the annual Economic Policy Conference on the Kansas University campus in Lawrence.

“Arkansas had the seventh highest un-insurance rate in the country before this,” Allison said. “We have now experienced the largest single percentage reduction in un-insurance in the country.”

Arkansas is one of only a handful of states that voted Republican in the 2012 presidential election and yet still approved expanding Medicaid under the Affordable Care Act.

Allison said that was possible because of a unique program that state came up with that appealed to the state’s Republican-dominated Legislature — a “private option” plan that steers the healthiest 90 percent of people applying for coverage into a private health insurance plan and reserves the state’s Medicaid program just for the 10 percent who have the most serious long-term health issues.

The state had to receive a special waiver from rules of the Affordable Care Act to adopt that program, Allison said.

The result, he said, was a huge influx of healthy young adults into the private insurance marketplace, which not only helped reduce premiums across the board, but also increased the number of people enrolled in private insurance. That, in turn, has helped attract more insurers to that state, Allison said.

That’s the opposite of what has been predicted by many critics of the program who have said it represents a federal takeover of the health insurance industry.

“The private individual insurance market in the state of Arkansas is five times bigger than it otherwise would be,” Allison said.

Under the federal law, most individuals are now required to carry health insurance. Most receive it as a benefit from their employer, but those who don’t can purchase it through online exchange markets set up by the federal government and some individual states. Many can also receive subsidies to lower the cost of those policies.

The law initially required states to expand their Medicaid programs to cover more people, but that provision was struck down by the U.S. Supreme Court as an unconstitutional mandate on states. Now, Medicaid expansion is optional for states, even though the federal government pays for more than 90 percent of the cost of the expansion.

In Kansas, Gov. Sam Brownback, a Republican, has declined to expand Medicaid. And early in his administration he returned a $31.5 million federal grant to help set up a state-based exchange.

Kansas Insurance Commissioner Sandy Praeger, who also spoke at the conference, said the result of that has been that an estimated 80,000 to 100,000 people in Kansas can’t take advantage of the Affordable Care Act because they earn too much to qualify for the state’s Medicaid program but not enough to qualify for the subsidies to buy private insurance.

“Because you have to make at least 100 percent of the federal poverty level to be eligible to purchase on the exchange for subsidized coverage,” Praeger said.

The current threshold for adults to qualify for Medicaid in Kansas is about 35 percent of the poverty level, Praeger said. And that only applies to adults with dependent children. Childless adults in Kansas do not qualify for Medicaid unless they are elderly or disabled.

Rep. Crum, who is not running for re-election this year, said there is still political opposition in the Statehouse to expanding Medicaid. But he touted the state’s own Medicaid reform program known as KanCare, which privatized the system and placed elderly and disabled patients into managed care programs administered by private insurance companies.

“In my opinion it would have been very difficult administratively to expand Medicaid in Kansas at the same time we were reforming Medicaid under our (KanCare) waiver,” Crum said.

Earlier this year, the Legislature passed a bill that prohibits the governor from expanding Medicaid without legislative approval.

“There is bipartisan recognition in Washington that entitlement programs such as Social Security, Medicare and Medicaid present an unsustainable unfunded liability,” Crum said. “The idea that programs funded by the federal government are free has contributed to our $18 trillion federal debt.”

Thursday’s conference was sponsored by KU’s Institute for Policy and Social Research.