With Tuesday’s election of Republican Matt Bevin as the new governor of Kentucky, the future of the state’s thriving health insurance market — established under the Affordable Care Act — is suddenly at risk, leaving half a million newly-insured residents hanging in the balance.
Outgoing Democratic Gov. Steve Beshear, who is retiring because of term limits, embraced President Obama’s landmark health reform law, making Kentucky the most politically conservative state to create its own health insurance exchange, known as Kynect, and to expand Medicaid to cover more poor adults living near the poverty line.
The result? Nearly a quarter of the state’s entire population gained health insurance.
Since enrollment through the Affordable Care Act (aka “Obamacare”) began two years ago, half a million formerly uninsured Kentuckians have gained affordable health coverage. That includes more than 400,000 low-income Kentuckians covered through the Medicaid expansion and another 100,000 who purchased private plans, often with federal subsidies to offset the costs. These coverage expansions helped drive down Kentucky’s uninsured rate from 20.4 percent to 9 percent, the largest drop of any state in the country, as Rep. John Yarmuth (D-KY) highlighted in this tweet:
Thanks to the drop in uninsured patients, hospitals in the state realized a reduction of $1.15 billion in uncompensated care within the first year of the Medicaid expansion, according to an independent report commissioned by the state. And the economic impact extends beyond the health care sector: researchers project that the expansion could inject as much as $30 billion into the state’s economy through 2021, in the form of tens of thousands of new jobs, revenue, and cost savings.
But after Bevin’s win Tuesday night, the success of health care reform in the state is now under significant threat, with the tea-party-backed governor-elect vowing to unravel Beshear’s policies — and take down the health of the state’s residents along the way. As NBC political analyst Perry Bacon Jr. writes:
Republican Matt Bevin’s win in the governor’s race here gives the Republicans near total control of statehouses in the South and could result in the dismantling of one of the most extensive efforts to implement Obamacare of any state in the country.
Bevin has promised to to eliminate Kynect, the popular state exchange where Kentuckians can shop for health insurance or find out if they are eligible for Medicaid. Rolled out in 2013, Kynect has established itself as such a successful system that it has been lauded as a national model. But the governor-elect has been firm on his vow to eliminate the state exchange, which would leave the federal government running that operation.
“I am going to get rid of Kynect,” he said in an interview prior to the election, according to USA Today. “We don’t need a state exchange.” But that move is likely to come at a price. Kynect Director Carrie Banahan has said that it would cost at least $23 million to dismantle the Kynect system and that most of the seven insurance companies using it would probably not go to the federal exchange, leaving Kentucky residents with few options for insurance under the federal system.
On Friday morning, in his first public remarks since winning the election, Bevin reiterated his commitment to dismantling the model program, stating that his intent is to have the Kynect system shut down “by the end of the year.”
Bevin has also expressed his desire to get rid of the Medicaid expansion. Earlier this year and over the summer he campaigned on the promise of ending the Medicaid expansion completely, saying Kentuckians would simply be ineligible to renew their coverage under his administration.
“… you may or may not have access to Medicaid going forward.” – Gov.-elect Matt Bevin
“When you reenroll, you may or may not have access to Medicaid going forward,” Bevin said in an interview with Politico. “People are not [supposed] to be on it for extended periods of time. It’s not meant to be a lifestyle. It really isn’t.”
More recently, he’s suggested that he might seek unspecified concessions from federal authorities to freeze the program instead — a move that would also result in loss of coverage for tens or hundreds of thousands of low-income Kentuckians. Either way, Bevin has made it clear that he does not intend to keep enrolling people under the current, expanded criteria, which allows people making 138 percent of the federal poverty level to enroll.
“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, according the Associated Press.
Bevin’s position stands in stark contrast to the vast majority of Kentucky voters, who don’t want to see the system dismantled. According to a Bluegrass poll conducted just before the election, 54 percent of voters said they would like to see the state’s next governor continue the state exchange and Medicaid expansion, while only 24 percent said they wanted them repealed. And in the the latest Kentucky Health Issues Poll, voters ranked reducing the costs of health care and improving the state’s health as two of the top five priorities they want their next governor and the legislature to work on in the coming year — both of which would be worsened by Bevin’s anti-Obamacare agenda.
If he does scale back or get rid of the expansion, Bevin would leave hundreds of thousands of Kentuckians in what’s known as the “Medicaid coverage gap,” created by the Supreme Court when it struck down the part of the law that mandated the Medicaid expansion in all 50 states. The millions in the gap, located almost exclusively in the 20 states that did not expand Medicaid, make too much money to qualify for the program under the stricter criteria — which, on average across non-expansion states, covers only those who make less than half (44 percent) of the federal poverty level — but not enough to afford private insurance, even with Obamacare’s subsidies.
According to the CDC, the ten states with the highest rates of uninsured residents are all governed by Republicans who rejected the Affordable Care Act’s Medicaid expansion. Overall, the average uninsured rate in states where GOP legislatures and governors have refused to allow the Medicaid expansion stands at 14.4 percent — nearly double the rate (7.5 percent) found in states that have accepted federal funds to expand Medicaid to include more low-income residents. In the three worst states — Alaska, Texas and Oklahoma, which are all run by Republicans — an average of 1 in 5 residents (20 percent) is uninsured. Experts have warned that Republican governors’ refusal to expand Medicaid puts low-income Americans “at risk of more serious health conditions,” and, according to projections from Harvard researchers, is expected to cause an estimated 14,458 entirely preventable deaths in the next three years alone.
“People are afraid they’ll get insurance, they’ll lose it, and won’t have a way to pay for their health care.” – Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services
The uncertainties surrounding Bevin’s plans — or lack thereof — are already causing panic among the newly-insured and those who depend on Medicaid for themselves and their children. By Wednesday morning, “Kynect call centers were inundated by residents asking whether they should still enroll,” USA Today reports, citing state officials.
“People are afraid they’ll get insurance, they’ll lose it, and won’t have a way to pay for their health care,” said Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, who urged the public to continue to enroll. Coverage gained now can be guaranteed through the end of 2016, she said.
After that, the future is uncertain for Kentucky, a state that already ranks among the worst in the nation across a variety of health indicators: 50th in smoking, 40th in obesity, 43rd in sedentary lifestyles, 41st in diabetes, 48th in poor mental health days, 49th in poor physical health days, 50th in cancer deaths, 49th in cardiac heart disease, 43rd in high cholesterol, 44th in annual dental visits and 48th in heart attacks.
“This is going to be chaotic,” Regan Hunt, the former director of non-profit organization Kentucky Voices for Health, said of Tuesday’s election results. “You want to believe the folks who are representing the state will actually take into account the needs and overall well-being of Kentuckians, but I honestly don’t know what’s going to happen next, and that’s scarier than anything else.”