Bevin's election puts Ky. health care in cross hairs

LOUISVILLE, Ky. — Republican Matt Bevin’s election Tuesday as governor has placed Kentucky’s widely lauded health insurance expansion under the Affordable Care Act squarely in the crosshairs, with the governor-elect having pledged to eliminate or at least scale back the plan also known as “Obamacare.”

More than a half-million Kentuckians now get health coverage through the federal law implemented under executive order of Gov. Steve Beshear. That includes more than 400,000 low-income Kentuckians covered through the Medicaid expansion and another 100,000 who have purchased private plans, many with federal subsidies to offset the costs.

Those enrollees helped drive down Kentucky's rate of people with no health insurance from 20.4% to 9%, one of the biggest drops in the country.

And Kentucky's health exchange, kynect, where Kentuckians can shop for health insurance or find out if they are eligible for Medicaid, has been hailed as a national model, successfully launched in 2013 even as the federal government exchange foundered.

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On Wednesday, kynect call centers were inundated by residents asking whether they should still enroll, state officials said.

Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said the public should continue to enroll. Coverage gained now will last at least until the end of 2016, she said.

“People are afraid they’ll get insurance, they’ll lose it, and won’t have a way to pay for their health care,” she said.

Bevin ran a campaign in which he denounced Obamacare and initially said he would abolish the Medicaid expansion in Kentucky. Later in the campaign he said he plans to scale back the Medicaid expansion but would not disrupt coverage for the more than 500,000 people covered through Medicaid or kynect.

"I am going to get rid of kynect," he said in an interview with The Courier-Journal prior to the election. "We don't need a state exchange."

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Bevin has said he plans to shut down kynect next year, by the fall of 2016, and transfer people to the federal exchange — a process health policy experts say could be costly and disruptive to people who use it to manage their health insurance coverage.

"Kynect is working, and it's working well," said Jennifer Tolbert, director of state health reform with the Kaiser Family Foundation in Washington.

Decommissioning kynect could take months and cost millions of dollars — money Kentucky would have to repay the federal government, which financed the startup of the exchange, according to a presentation state officials made to a legislative committee in August.

The technology costs alone could run as high as $23 million, Haynes told the human resources budget subcommittee.

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Furthermore, the federal government, which paid Kentucky $283 million to create its exchange, requires a one-year notice before decommissioning it, Haynes said Wednesday.

Bevin also said he wants to scale back the Medicaid plan that now covers people who earn up to 138% of the federal poverty level, or about $33,000 a year for a family of four. He has said he would seek a waiver, or permission from the federal government, for an alternative plan, as other states done.

"We're not going to enroll new people at 138% going forward," he said in last month's interview.

Diane Rowland, executive vice president at the Kaiser foundation, said some states have obtained waivers from the federal government for Medicaid expansion. But none has been allowed to change eligibility from 138% of the poverty level.

Kentucky could seek a waiver for its own Medicaid expansion plan but it could take months and would require extensive negotiations between state and federal officials, she said. Utah, she said, has been seeking permission for a Medicaid expansion waiver for two years.

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Some other states, including Montana and Indiana, have gained approval for their own versions of the expansion that include cost-sharing by members through small co-payments or premiums.

Most Medicaid services are free to consumers.

Bevin's incoming administration should consider the value of federal funds that cover 100% of the Medicaid expansion until 2017, Rowland said. The state share will gradually increase to 10% by 2020.

"In a poor state like Kentucky, this provides a lot of federal money to cover a lot of people," Rowland said.

Medicaid has now grown to serve nearly 1.2 million residents, or a quarter of Kentucky's population — about one-third of them added through the expansion under the federal health law.

About 500,000 of the Kentuckians covered by Medicaid are children.

Bevin's election came just days Beshear kicked off the third enrollment push under the 2-year-old program, which lasts until Jan. 31. A recent Kaiser Family Foundation report found that 43% of nearly 285,000 still uninsured people in Kentucky were eligible for Medicaid.

Repealing Obamacare has been a rallying cry for Republicans for years. As a result, many are watching to see whether Bevin can roll it back in Kentucky.

A recent Bluegrass Poll found that 54% wanted to keep the Medicaid expansion, while 24% said they wanted the next governor to reverse it. The rest were undecided.

Emily Beauregard, executive director of Kentucky Voices for Health, said there was “a lot of concern, but also a lot of confusion” given that “none of us really understand what Bevin is proposing or how that’s going to look.”

“The main concern is that whatever is proposed would include more barriers to access. That’s where we’re all holding our breath,” she said.

But a top Republican in the General Assembly, Senate President Robert Stivers, said he doesn't think proposed changes mean people will lose coverage.

"I think what you’re going to see is a transition to a different type of coverage," Stivers said. "As Matt Bevin grew as a candidate, he realized that there would be this transition period, but there could be a product delivered to these individuals that would give them coverage."

Greg Stumbo, the speaker of the Democratic-controlled state House, told media outlets on Tuesday night he foresaw a “big battle” over kynect in the next legislative session.

The Foundation for Healthy Kentucky, a nonprofit group tracking the progress of the federal health law in Kentucky, said it will be monitoring any changes with its main interest making sure people don't lose access to health care.

"We believe Kentucky is better off when Kentuckians have access to affordable care," said Susan Zepeda, foundation president.

Kentucky is one of the nation’s poorest and unhealthiest states, and the only Southern state to fully embrace Obamacare despite the deep public antipathy toward the president. Bevin did well in eastern Kentucky, which enrolled large numbers of residents.

The uncertainties are causing worry among people who have insurance for the first time or depend on Medicaid for themselves and their children.

“This is going to be chaotic,” said Regan Hunt, the former director of Kentucky Voices for Health. “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.”