Kentucky election puts Medicaid expansion in crosshairs

October 16, 2015 byAdam Beam

Kentucky, one of the only Southern states to expand Medicaid under President Barack Obama's Affordable Care Act, could become the first state to repeal that expansion depending on the outcome of a closely contested governor's race.

Kentucky voters have made it clear they don't like Obama or his policies, with the president's disapproval rating consistently at or above 60 percent in public polls. But when outgoing Democratic Gov. Steve Beshear used Obama's signature law to allow more people to qualify for taxpayer-funded , about 400,000 people signed up for it.

Republican nominee for governor Matt Bevin, along with the legislative leaders of his party, say the state cannot continue to pay for the health insurance of able-bodied adults. Taxpayers pay for health insurance for a quarter of Kentucky's population under the current expansion, which Bevin wants to repeal and replace with a different plan.

Twice as many people signed up in the first year as state officials had predicted, more than doubling the expansion's estimated cost in 2017 from $33 million to $74 million. Those costs could swell to $363 million by 2021, further straining finances in a state wrestling with a multi-billion-dollar pension liability.

Yet Kentucky's uninsured rate has dropped from a high of 20.4 percent in 2013 to less than 10 percent last year. Hospitals covered less than $60 million of uncompensated care last year, down from $160 million in 2013. New Medicaid enrollees received more than 54,000 preventative screenings, including for breast and colorectal cancer, of which Kentucky has some of the highest rates in the nation.

But the politics run deeper than the question of cost. Obama is so unpopular that most Democratic politicians avoid invoking his name by calling the state's expansion "Beshearcare" after the state's Democratic governor who cannot seek re-election because of term limits. The governor remains popular, and the expansion—which he authorized by executive order—has been praised for bringing better health care to thousands of residents.

One of them is Tyler Offerman, 26, who lives in Lexington and says he grew up without health insurance. He said he went years without seeing a dentist, leading to painful problems with his teeth. Offerman used his new Medicaid benefits for thousands of dollars in dental work. He now has access to a primary care physician for guidance given his family history of cancer. Now, he is starting an adventure tourism business leading backpacking and hiking trips.

"Being on Medicaid certainly gave me the safety net I needed to take the risk to be a young entrepreneur," he said.

Democratic nominee Jack Conway has said he would continue the Medicaid expansion unchanged. He cites a study from earlier this year by Deloitte and the University of Louisville projecting that Kentucky's savings and increased revenue from the expansion would be more than enough to pay the state's costs.

But Bevin rejects that study. He initially said he would reverse the expansion "immediately" but has since clarified he would repeal the current expansion and replace it with something else. He said the state cannot keep enrolling people under the new requirements.

"I can't make this more clear: there will be nobody in the state of Kentucky re-enrolling under the current Medicaid construct at 138 percent of poverty," Bevin said during a debate on Kentucky Sports Radio last month. The current expansion allows people making 138 percent of the federal poverty level to enroll.

Bevin spokeswoman Jessica Ditto said his plan would not take away health insurance from 400,000 people, as Democrats say. She said some might be offered a new plan that would require them to pay "token amounts" for a premium. Some might be offered a higher deductible plan coupled with a health savings account. And others still "may graduate from medical eligibility just as they might now by exceeded income thresholds."

Bevin says he will apply for a federal waiver, as five other states have done. Indiana, for example, expanded its Medicaid program but required new enrollees to pay monthly premiums or risk losing coverage.

"It's giving people a vested interest," Bevin said of Indiana's program. "Having skin in the game is a big, big differentiator between whether or not the person has the dignity that goes with making decisions for themselves."

Katrina Kelly has skin in the election. The 29-year-old from Lexington says she cannot afford health insurance with the $6,000 she made last year as a self-employed landscaper. But on Medicaid, she had access to physical therapy that took away the terrible pain she had been living with in her shoulders.

If she loses Medicaid, Kelly would most likely have to pay a penalty on her income taxes for not having health insurance.

"It would definitely be a heartache on having to pay a penalty for something I have no control over," she said.

Explore further: Survey: Big growth in Medicaid enrollees in expansion states

Related Stories

Survey: Big growth in Medicaid enrollees in expansion states

October 15, 2015
States that opted to expand Medicaid under the Affordable Care Act saw enrollment increase on average by 18 percent during the first full year of expansion, according to a report released Thursday.

Indiana wins federal OK for state-run Medicaid alternative

January 27, 2015
Indiana has received federal approval to expand health coverage to about 350,000 uninsured residents through a state-run program Gov. Mike Pence said Tuesday will help the state's working poor families.

Is Obama's health overhaul losing steam?

October 15, 2015
The health care law's historic gains in coverage may be leveling off: The Obama administration announced Thursday it expects only a slight overall increase in enrollment next year.

Support for Medicaid expansion strong among low-income adults

October 8, 2014
Low-income adults overwhelmingly support Medicaid expansion and think the government-sponsored program offers health care coverage that is comparable to or even better in quality than private health insurance coverage, according ...

Expanding Medicaid in Pennsylvania would increase federal revenue to the state, study finds

March 28, 2013
Expanding Medicaid in Pennsylvania under the Affordable Care Act would boost federal revenue to the state by more than $2 billion annually and provide 340,000 residents with health insurance, according to a new RAND Corporation ...

Affordable Care Act helps Virginia improve HIV outcomes

October 8, 2015
Low-income HIV patients enrolled in Affordable Care Act (ACA) health care plans achieved better outcomes and the resulting cost savings allowed the state of Virginia to support care for more patients, according to a groundbreaking ...

Recommended for you

Medicaid work requirements and health savings accounts may impact people's coverage

June 20, 2018
Current experimental approaches in Medicaid programs—including requirements to pay premiums, contribute to health savings accounts, or to work—may lead to unintended consequences for patient coverage and access, such ...

What a pain: The iPad neck plagues women more

June 20, 2018
Is your iPad being a literal pain in the neck?

Living the high life: How altitude influences bone growth

June 19, 2018
High altitude is a particularly challenging environment—the terrain is physically challenging and the land has a relatively poor crop yield, so food can be sparse. Most importantly, oxygen levels are lower meaning that ...

Introduction of alcohol found to adversely impact fertility rates in hunter-gatherer community

June 19, 2018
Fernando Ramirez Rozzi, a research director with the French National Centre for Scientific Research has found that the introduction of alcohol to a Baka pygmy hunter-gatherer society caused fertility rates to fall. In his ...

Risks of cancer and mortality by average lifetime alcohol intake

June 19, 2018
The risk of mortality, and of developing a number of cancers, is lowest in light drinkers consuming an average of less than one drink per day across their lifetime, and the risk of some cancers increases with each additional ...

Bad habits that lead to cancer, chronic disease corrected by simple lifestyle intervention

June 19, 2018
Does this sound like someone you know? He or she spends too much time in front of screens, gets little exercise and eats a diet high in fat and low in fruits and vegetables.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.