For Courtney McDowell of Bowling Green, life is pretty good right now, but recent years have been a struggle. Last December, at the age of 32, she earned a college degree. Before then, money was tight.
"I was one medical catastrophe away from complete and total bankruptcy," McDowell told WKU Public Radio. "I’m just glad I didn’t have any major illnesses or injuries during that period because it’s a real risk.”
When Kentucky created an online health insurance exchange known as Kynect and expanded Medicaid under the Affordable Care Act, McDowell qualified for coverage through Medicaid and remained on the government program until she graduated and began working full-time.
McDowell currently does IT work and has private health insurance through her employer, but the upcoming election makes her nervous for others who aren’t so fortunate.
The state of healthcare in Kentucky could look very different depending on who wins the governor’s race on November 3.
Kentucky could become the first state to repeal the expansion of its Medicaid program. In a September speech to the Kentucky Rural Health Association, Republican nominee Matt Bevin said the state can’t afford to have a fourth of its population on Medicaid.
"When you’re spending other people’s money, it’s easy to be successful," suggested Bevin. "We say by any measure it’s been a success. For crying out loud, it’s been 100% under-written and subsidized by other people’s money. We’re part of those other people. Federal dollars are our own dollars coming back to us.”
Currently, the federal government is picking up the entire tab for the expansion. Starting in 2017, the state must begin bearing a share of the cost estimated to be anywhere from 250 to 400 million dollars. Democratic gubernatorial nominee Jack Conway, who supports the Medicaid expansion, says an improving economy would trim the Medicaid rolls.
"I agree we have too many of our citizens on Medicaid, but you fix that by growing the economy, creating better paying jobs, bringing wages up, and then people eventually roll off Medicaid," Conway remarked in an interview with WKU Public Radio.
Conway says if the state determines in the future it can’t sustain the Medicaid population, adjustments will be made."If we get six years down the road and we can’t afford something, I think the federal government would be willing to work with Kentucky and we may have to scale back or change some things," he added.
When Bevin announced his candidacy, the GOP nominee said he would reverse the Medicaid expansion immediately, if elected. Conway called the proposed move "callous," but Bevin denies he would “kick people off of Medicaid.”
"I don’t even have the authority or the ability to just oust people from Medicaid. It doesn’t work that way," stated Bevin. "We have these folks currently on Medicaid and we have to come up with a way to provide the health care to them that we owe under the current obligation that we have that they are already enrolled.”
Bevin, however, has stated emphatically, that if elected governor, the state would not continue to enroll or re-enroll people at 138 percent of the federal poverty level. Kentucky has added more than 400,000 recipients to the Medicaid rolls through the expansion. Bevin has said he would apply to the federal government for waivers as other states have received. The waivers would allow the state to customize a health care plan for Medicaid recipients while expecting them to bear a small portion of the costs.
"Up to 100% you get ‘x’, 100-110% you get ‘y’, 110-125% you get ‘z.’ At each increasing level, there will be different expectations," noted Bevin. "The higher up you go, the more expected skin in the game people will have because when you rob people of any vested interest in their own success you rob them of any reason to care.”
Kentucky has seen one of the largest drops in the percentage of uninsured since the federal Affordable Care Act was implemented.
Calling it a level of redundancy, Bevin has said he would dismantle Kynect and put enrollees on the federal exchange. Conway maintains that, if elected, he would continue the state run exchange, saying Kentuckians get better rates through Kynect than on the federal version.
"If we were to get rid of Kynect, it would cost the state $23 million dollars we don’t have," noted Conway. "None of our general fund tax dollars are going to Kynect. It’s actually a one percent assessment on the insurers who go on there and the assessment on the federal exchange is actually three percent.”
Conway recently declined Bevin’s invitation to debate what he called “the costly flaws of Obamacare” just days after the Kentucky Health Cooperative announced it would no longer offer health plans during this year’s open enrollment period which begins November 1. The non-profit insurer operated in all 120 counties and covered more than 50,000 Kentuckians. Conway argues the co-op’s demise is not a reflection on the Affordable Care Act.
"The co-op’s failure was really due to mismanagement and not maintaining adequate reserves, Conway suggested. "Market forces pushed them out and the Republicans on Capitol Hill defunded the grants that supported the co-op. I think it’s disingenuous to say it’s a failure when they defunded the program.”
Independent candidate Drew Curtis has largely stayed out of the health care debate, but says if elected governor, he would continue Kynect and the Medicaid expansion in their current form.
"The thing I like about it is that it does appear to pay for itself," Curtis remarked. "The five percent we have to pony up in three years and the ten percent we need to pony up in six year, it looks like it’s on track to being paid for by additional revenue that’s coming from increased health care spending.”
Curtis is referring to a consultant’s report commissioned by the state earlier this year that projected the Medicaid expansion would create 40,000 jobs and add $30 billion dollars to Kentucky’s economy by 2021, a claim which Republican gubernatorial nominee Matt Bevin strongly disagrees.
Curtis says he would call for an audit of how the state’s health care system is functioning and how it might be improved.
Voters on Tuesday will decide between three candidates and the direction of health care in Kentucky.
