Thursday's U.S. Supreme Court ruling upheld the nationwide tax credit subsidies to help people buy health insurance through the Affordable Care Act.
So what impact does the ruling have in Kentucky, and what's happening with the state's version of the ACA known as Kynect?
The ruling comes at time when the future of health care reform in Kentucky is a hot-button issue in the race for governor.
Republican candidate Matt Bevins says he wants to end Kynect, and, ultimately, he'd like to see the entire Affordable Care Act disappear. Democrat candidate Jack Conway is straddling a middle ground, saying some things about Kynect need to change, but it's too soon to tell how the program will work in the long run.
Several health experts helped explain Kynect and its future. They include: Audrey Haynes, secretary of the Cabinet for Health and Family Services; Glen Mays, a professor of health services at the University of Kentucky; Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation; and Robin Rudowitz, associate director for the Kaiser Commission on Medicaid and the Uninsured.
The following is a summary of their answers and a brief recap of Thursday's ruling:
Question: What was the U.S. Supreme Court ruling about?
Answer: Here's some background: States could create their own program for selling health insurance mandated by the Affordable Care Act. Twenty-one states, including Kentucky, created a state-based program or created a program in partnership with the federal government. These are called state exchanges.
In states that did not create programs, residents use the federal program, known as the federal exchange. State and federal exchanges alike provide subsidies that help make insurance more affordable. The lawsuit that the U.S. Supreme Court ruled on claimed that federal exchanges were not eligible for the subsidies. The court denied this argument.
Q: So what does that mean in Kentucky?
A: It means that Kentucky's state exchange, Kynect, will continue as it has since its beginning in 2013. The subsidies are available to people buying private insurance, depending on their income.
Q: Candidate Bevins says he wants to end Obamacare. Is that the same as Kynect?
A: The Affordable Care Act is widely referred to as Obamacare, most often in a negative way. The law required every American to have health insurance. Kynect is the commonwealth's method of fulfilling that mandate so, yes, Kynect is part of Obamacare.
Q: Can a governor really end Obamacare?
A: No. A governor doesn't have the power to overturn a federal law. But a governor could withdraw support for Kynect and push Kentuckians to get their health care through the federal exchange.
A governor could support efforts to roll back expanded Medicaid eligibility, which allows folks who make as much as 138 percent of the poverty level to apply for Medicaid, the tax-funded health insurance program for the poor.
Q: What would that mean for Kentucky residents?
A: People who received Medicaid because their income fell under the expanded guidelines would lose Medicaid and would be required to buy private insurance. In Kentucky, at least 350,000 people have received Medicaid under the expanded income guidelines. Kentucky is second only to Arkansas in reducing the number of uninsured. Kentucky has reduced its uninsured rate by 10.6 percent. Arkansas has an 11.4 percent reduction.
Q: Can Kentucky afford to pay for Kynect?
A: State officials say yes. The expansion of Medicaid has been subsidized by the federal government, and the state will begin taking over a percentage of Medicaid payments in 2017. That percentage will rise incrementally until 2021. The state estimates that the positive financial impact of Kynect to the state, including jobs, increased taxes and increased payments to hospitals for people who previously received charitable care, would be $30 billion through 2021 and will cover those costs.
Q: What happens if you don't have insurance?
A: If you didn't have insurance in 2014, the penalty was $95 per person in a household, or 1 percent of the household income, whichever is higher. The penalty number rises substantially for taxes due for 2015. If you don't have health insurance in 2015, the penalty is $325 for each adult and $162.50 for each child in a household, or 2 percent of the household income. That penalty will be due next tax season.
Q: Well, how can I get insurance to avoid the penalty for 2015?
A: If you qualify for Medicaid, you can sign up for health insurance at any time. If you are paying for private insurance, you can't sign up for private insurance for 2015 unless you have a life-changing event, such as divorce, death or birth. Open enrollment for 2016 will begin in the fall.