How will clinics fare if Bevin drops kynect?

Just a few years ago, Louisville's  Family Health Centers were on the brink of closing clinics and laying off staff.

More than half the patients at the network of seven community clinics had no health insurance. Operating losses for the clinics, a medical safety net for the poor, had reached $2.5 million.

Then the Affordable Care Act kicked in. Enrollment in health plans surged through kynect, Kentucky's award-winning health insurance exchange created under the federal law also known as Obamacare.

Now Family Health Centers' budget is in the black, with more than 80 percent of patients enrolled in health coverage and able to pay for care. This year it opened a gleaming new full-service clinic on East Broadway in a former antique warehouse, renovated with a $5 million federal grant.

Bill Wagner, executive director of Family Health Centers, credits Kentucky's embrace of the federal health law.

"It's completely reversed our financial fortunes," he said.

But he and other health advocates are alarmed that changes proposed by Gov.-elect Matt Bevin threaten to undermine major public health advances under the health law in a state with abysmally poor health rankings.

Kynect enrollment kicks off amid uncertainty

"We have a lot at stake," Wagner said. "I just hate to see all that rolled back to the way it was before."

Friday, Gov. Steve Beshear, a Democrat who implemented the federal health law in Kentucky by executive order,  plans to join the debate with a news conference in Frankfort to describe gains made under the law and offer details about costs and benefits.

"We are already seeing the benefits of it," Beshear said in an interview Tuesday with radio host Terry Meiners on WHAS.

Bevin, a Republican, swept into office on a pledge to scale back the Medicaid expansion under the federal health law that added about 400,000 more Kentuckians to the Medicaid rolls, providing them - many for the first time in their lives - with health coverage.

While a majority of Kentuckians support the Medicaid expansion, the health law remains a popular target for Republicans in a state where President Barack Obama remains unpopular.

Bevin also has vowed to dismantle kynect, the web-based system people can use to shop for health coverage or determine whether they are eligible for Medicaid. Kentucky is one of 16 states that created its own health insurance exchange rather than rely on the federal site, healthcare.gov.

Speaking at a news conference three days after he was elected on Nov. 3, Bevin said kynect "adds no value" and called it a "redundancy that we as taxpayers in this state are paying for twice." He proposes moving people to the federal exchange by the end of next year.

Beshear and others hope to change Bevin's mind, starting with kynect.

"Kynect is not redundant," Wagner said. "It is an enhanced value. I don't see any value of dismantling kynect other than to fulfill a political promise."

With Bevin, what's next for Ky. health care?

They hope to convince him by addressing misconceptions about kynect, including the oft-stated but false claim that taxpayers fund its operating costs of $26 million a year.

"It's not costing Kentucky taxpayers anything," Beshear said in Tuesday's radio interview.

Rather, operations of kynect are financed by a 1 percent surcharge on all insurance plans sold through the site. About 100,000 Kentuckians have purchased private health insurance plans through kynect.

The federal government did fund kynect's start-up costs of about $280 million but Beshear noted that money already has been spent. He said it appears shutting down, or decommissioning kynect, would cost Kentucky another $25 million to $30 million and would take a year to 18 months.

Matt Harrell, an independent insurance agent in Louisville, said costs for Kentucky consumers likely would rise if they are shifted to the federal plan, as Bevin proposes, because it charges a 3.5 percent surcharge instead of the 1 percent charged in Kentucky.

Also, supporters of kynect hope to persuade Bevin that kynect is more than "just a website," as critics claim - it's a full service education and information program with workers called "kynectors" who walk people through the process of applying for insurance.

Harrell and others worry that many consumers used to kynect wouldn't understand the switch to the federal site and might simply give up, especially if they encounter obstacles.

"People are going to become very disheartened," he said.

Beyond that, Harrell said he simply doesn't understand the point of scrapping a system that has won national attention as a model and has helped about a half-million Kentuckians sign up for health care.

"The impact to Kentucky will be devastating," he said. "Why get rid of something that is working and working well."

Wagner agrees dismantling kynect will be damaging and could reverse many of the gains Kentucky has made locating people with no health coverage and enrolling them.

Kynect operates a call center of 175 people based in Lexington to answer questions and funds a small corps of "kynectors" scattered throughout the state to  help people through the complexities of applying for and selecting an insurance plan or signing up for Medicaid.

The Family Health Centers employ a kynector at each of its seven clinics and have found them invaluable in helping people get insurance and learn how to use it, Wagner said. Often, patients come back to the kynector with questions or problems, viewing them as "trusted advisors," Wagner said.

Among such kynectors is Ashley Shoemaker, who works at Family Health Centers' Portland clinic, helping sign people up for health coverage.

Many patients walk in the door with no insurance and are amazed to discover they qualify for coverage, she said. Some people she helps aren't familiar with computers or don't have access to one to research health plans or apply on their own.

Though many of the patients she assists are employed, they hold low-wage jobs such as restaurant work or construction and have no health benefits.  Some have sought coverage but couldn't afford it or were rejected by Medicaid before it expanded to include anyone who earns less than 138 percent of the federal poverty level, or about $33,500 for a family of four.

Some are overwhelmed to learn they can get health coverage for themselves and their families, Shoemaker said.

"I've had people start crying," she said. "They are just so joyful when they leave."

Family Health Centers has enrolled 14,000 people in health coverage since 2014, the first year of coverage under the law. In Jefferson County, 100,000 people have been added to Medicaid, Wagner said.

Wagner said he hopes Bevin, a business executive, will be persuaded by the argument that improving public health through kynect and Medicaid means a better workforce, a point he said he and other health advocates plan to keep making.

"We're not waving the white flag," he said. "We're willing to keep talking with this administration as long as they're willing to listen to us."

Reporter Deborah Yetter can be reached at dyetter@courier-journal.com or (502) 582-4228.