The Medicaid revamp proposed by Gov. Matt Bevin last week is built on a belief that providing health care to low-income people somehow robs them of their dignity. Also, that 20 percent of Kentuckians lacked health insurance only a few years ago, not because they couldn’t afford it, but because they were disengaged or didn’t understand deductibles.
On that dubious base, Bevin wants to replace a fairly straightforward system with a red-tape tangle of penalties, incentives, premiums and cutbacks in coverage, including some proposals that the federal government already has rejected in other states.
Bevin’s plan would create new administrative costs while caring for fewer Kentuckians — almost 86,000 fewer in five years, by the administration’s estimate.
The governor stressed that his overarching purpose is improving health outcomes, a goal we heartily endorse. Bevin is right that our state’s economy would gain if more Kentuckians were healthier. But it’s hard to see how health outcomes can be improved by eliminating dental and vision care, denying medicine for failing to pay a $1-$15 monthly premium or any of the other barriers to care that Bevin’s plan would erect.
Some of what Bevin announced is smart, such as creating rewards for quitting smoking.
Renegotiating contracts with managed care companies is expected to save taxpayers $280 million over the next six months, administration officials said. Kentucky’s five Medicaid managed care companies earned far higher profits than their counterparts in every other state in 2015, according to a Milliman Research Report. The state can claw back much of that excess profit, but squeezing out maximum savings on the front end is better.
Bevin wisely wants to expand access to residential treatment for addiction and mental illness in 20 counties in a pilot program aimed at stemming Kentucky’s drug abuse epidemic and preventing the spread of hepatitis and HIV.
Also, what Bevin is proposing — a five-year demonstration project that requires federal approval — is light years more responsible than his early campaign promise to revoke the Medicaid expansion that’s part of the federal Affordable Care Act.
More than 420,000 low-income Kentuckians gained health care through the Medicaid expansion; most of them work in low-wage jobs or are caregivers or students. Another 100,000 Kentuckians obtained private health insurance, made affordable by government subsidies. Since the programs began in 2014, Kentucky’s uninsured population has declined from 20 percent to 7.5 percent while providers have enjoyed a steep drop in uncompensated costs. The federal government has paid the full cost of both programs, but next year the state must pick up 5 percent of the Medicaid expansion, topping out at 10 percent in 2020.
Bevin’s plan would divert tax dollars into administering requirements aimed at teaching personal responsibility, while depriving “able-bodied adults” of medical care, even though going without preventive care multiplies the chances that the “able bodied” will become sick, disabled and unfit for work. How that enhances personal dignity, we’re not sure.
Bevin also wants to move people into employer-provided insurance after a year of Medicaid, reimburse employees their share of premiums and make up differences in benefits. It sounds unwieldy and impractical. Kentuckians covered by employer-based health insurance have declined from 70 percent in 1980 to 56 percent, while low-wage workers frequently change jobs.
Healthy people are more productive. A healthy workforce will attract employers. The state will spend less on healthier people. Bevin’s desire for better health outcomes is right on. But if that’s really what he wants, his plan still needs work.
Kentuckians should help make it better by sending comments to Medicaid Commissioner Stephen Miller by July 22 and speaking up at public hearings June 28 in Bowling Green, June 29 in Frankfort and July 6 in Hazard.