Gov. Matt Bevin said in a press conference he will seek permission from the federal government to reshape the federal-state health program that covers about 1.3 million Kentuckians.
Michael Clevenger, CJ
HAZARD, Ky. – A sweeping plan to overhaul the state’s Medicaid program met its most forceful opposition yet in a region of Kentucky with some of the state’s deepest poverty and highest rates of enrollment in the federal-state health plan for the poor.
Wednesday was the third and last public hearing on Gov. Matt Bevin’s proposed “waiver,” or request from the federal government – which provides most of the state’s Medicaid money – to reshape the program into one he argues will make Kentuckians healthier and more responsible for their care.
But, as in hearings last week in Bowling Green and Frankfort, it met largely with criticism from those opposed to efforts to scale back the dramatic expansion of Medicaid under the federal Affordable Care Act that added coverage for 440,000 Kentuckians.
Bevin’s proposal “turns the clock back,” said John Rosenberg of Prestonsburg, a veteran legal aid lawyer and advocate for older Kentuckians, who said many Eastern Kentuckians who had lacked health coverage gained it for the first time under the Medicaid expansion.
Scott Wegenast, with AARP of Kentucky, said his organization is especially concerned about the impact on many older Kentuckians, generally between 50 and 64, who lost jobs and insurance during the recession but are too young to qualify for Medicare. Many were able to get health coverage through the Medicaid expansion.
“This particular group suffered under downsizing,” he said.
Rosenberg and many of the other speakers at the three-hour hearing were especially critical of the proposal’s elimination of dental and vision benefits from basic Medicaid coverage.
Dr. Lucy Triplett Short, a Knott County dentist, became emotional as she spoke about the satisfaction of treating patients who gained health coverage under the Medicaid expansion, many who had long suffered untreated dental disease.
“We really hope you will leave the benefit intact and allow these people to receive the care they truly do deserve,” she said.
And Elizabeth Hensley, from Clay County, said she found it insulting that Bevin claims his proposal would restore dignity of low-income people through measures such as paying premiums for health coverage and being required to work.
“The Bevin administration is obviously out of touch with the poor and people who live in poverty,” she said.
Under Bevin’s proposal, people could earn points toward paying for dental and vision care through a rewards program, but that also drew criticism.
“To say you must earn what is a basic right, what most of us take for granted, is very insulting,” said Mary Meade McKenzie, executive director of Kentucky River Community Care, a mental health agency based in Hazard.
About 150 people attended Wednesday’s hearing at Hazard Community and Technical College, the largest crowd so far at the three hearings.
Vickie Yates Brown Glisson, secretary of the state Cabinet for Health and Family Services, presided over the hearing and told the audience all comments would be considered before the state submits a final plan to the federal government. Glisson said she expects to submit a plan for federal consideration by Aug. 1.
Officials with the U.S. Department for Health and Human Services, which must approve the plan, have been noncommittal but have pointed out that the federal government has already rejected some of Kentucky’s provisions sought by other states, such as the requirement that “able-bodied” adults work up to 20 hours a week.
Bevin, a Republican who took office in December, has pledged to scale back Kentucky’s $10 billion-a-year Medicaid program that now covers more than 1.3 million Kentuckians, calling it unsustainable.The federal health law expanded Medicaid from a program mostly for very poor women, children and the disabled to one that offers health coverage to anyone below 138 percent of the federal poverty level or about $16,200 a year for an individual.
In changes aimed largely at the “expansion” group of people added to Medicaid – about 440,000 – Bevin wants to impose premiums, cut some benefits and require “able-bodied” adults to work at least 20 hours a week or show some other “community engagement” through volunteer work.
People could earn credits to pay for other services such as dental and vision care through a “My Rewards” account for activities including taking a health assessment or financial literacy course.
The program would push people to move to employer-based insurance, if available, though the state would subsidize additional costs.
Kentucky is among 31 states and the District of Columbia that have accepted some form of Medicaid expansion under the law; Kentucky’s was launched in 2014 under Bevin’s predecessor, Democrat Steve Beshear.
Many of the speakers thanked state officials, who also included Medicaid Commissioner Steve Miller and Scott Brinkman, Bevin’s cabinet secretary, for holding the hearing in Eastern Kentucky, a region they said often gets overlooked.
Nowhere in Kentucky is Medicaid more important than in Eastern Kentucky, which has some of the state’s highest rates of poverty and saw some of the greatest growth under the expansion.
The state’s 10 poorest counties – with a third or more of citizens in poverty – all are in Eastern Kentucky, according to U.S. census figures, and in all but two of them more than half the residents rely on Medicaid for health care. Kentucky’s overall poverty rate is about 19 percent.
Perry County, the site of Wednesday’s hearing, saw the greatest rate of growth in the expansion in Medicaid enrollment under the federal health law, said Jason Bailey, executive director of the Kentucky Center for Economic Policy in Berea.
Bailey, who spoke at the hearing, attacked as flawed some of the assumptions in Bevin’s proposal, including the belief Kentucky can’t afford Medicaid expansion or that the governor’s changes would prompt more people to get jobs and obtain insurance from employers. In fact, he said, Medicaid has pumped $62.8 million alone into the Perry County economy since the Medicaid expansion.
“No county in the state has benefited more from the Medicaid expansion than Perry County,” he said.
More importantly, more people – most of them the working poor in jobs such as fast food or construction – are able to get health care through Medicaid their jobs don’t offer or that they can’t afford, he said. Work requirements and premiums have been shown to reduce coverage and “drive more people into deep poverty,” he said.
“Medicaid is a safety net program that provides a lifeline,” he said. “Reducing its reach will only make problems deeper.”
Contact reporter Deborah Yetter at (502)582-4228 or at firstname.lastname@example.org.