Gov. Steve Beshear sharply criticized Matt Bevin, the Republican who hopes to succeed him, on Tuesday for calling Kynect "a disaster" and pledging to eliminate it if elected next week.
Speaking in Lexington, Beshear, a Democrat, said his decision two years ago to open the Kynect insurance exchange and expand Medicaid has provided health coverage for about 500,000 Kentuckians, "most of them for the first time, who didn't have it before. How much bigger a success can you have?"
"Anybody who today talks about dismantling Kynect and talks about repealing expanded Medicaid, they don't know what they're talking about," said Beshear, who leaves office in two months. "They're ignoring the facts. They're playing political games with the lives of our people. And I think on Nov. 3, the people of Kentucky are gonna rise up against that kind of — stuff. And I said 'stuff.' I was starting to say something else."
The Bevin campaign fired back with an attack on the Democratic nominee for governor, Attorney General Jack Conway.
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"Jack Conway wants to keep Obamacare going even though it is breaking down before our eyes," said Bevin spokeswoman Jessica Ditto. "Our state cannot afford another four years of failed liberal policies. A vote for Jack Conway is a vote for more of the same political games that got us in this mess."
Under the auspices of the federal Patient Protection and Affordable Care Act, Beshear established Kynect by executive order and expanded the federal-state Medicaid program to include people in households with incomes as much as 138 percent of the poverty line — $33,465 for a family of four.
Since then, Kentucky has seen the nation's steepest drop in the rates of uninsured residents, down to 8.5 percent, according to the U.S. Census. But the improvement hasn't come cheap. Most Kentuckians gaining insurance through Kynect enrolled in Medicaid, supported by taxpayers, not through a private plan. That has cost billions of dollars, and the federal government is picking up the entire tab through this fiscal year.
Over the next four years, as the federal government incrementally reduces what it pays for swollen Medicaid rolls, Kentucky's share could reach a cumulative $923 million, according to a report issued in February by Deloitte, a consulting firm. Deloitte predicted that Kynect ultimately will pay for itself, and then some, as the state shifts some health costs to the federal government and health care jobs are created by increased medical activity, sending more tax revenue to Frankfort.
It's possible that expanded Medicaid could become too costly in future years, so a governor might have to reduce the size of the eligible population, Beshear said. But that isn't currently necessary, he said.
"The good news for the next governor is, they should keep doing what I'm doing. Look at it every year. Let's find out what's going on. Let's see how the predictions are panning out in fact," he said.
"And if we ever reach a point — and I don't think we will — but if we ever reach a point where we can't afford to do this for our people, the governor has the discretion to pull back the program. And so we've got a safety net," Beshear said. "Right now, it is paying for itself. It is improving the lives of over half a million Kentuckians. How in the world can you be so callous as to make a decision right now to throw 500,000 people off of their health care coverage like Matt Bevin wants to do?"
Conway and Drew Curtis, an independent candidate for governor, both support Kynect.
Bevin, a Louisville financier, frequently says Kentucky cannot afford to support so many people on Medicaid. He has pledged to shut down Kynect and switch Kentuckians to the federal exchange, HealthCare.gov. He calls for repealing the Medicaid expansion and possibly seeking a waiver from the federal government, as Indiana has, that allows Kentucky to impose some costs and eligibility restrictions on Medicaid recipients.
Bevin says he doubts the Deloitte report's optimistic prediction about Kynect paying for itself.
"It's faulty; it's bogus," Bevin said Monday in a joint appearance with Conway on KET's Kentucky Tonight. "It assumes, among other things, that there's not a collapse of — oh, I don't know — the Kentucky Health Cooperative, which has 50-plus percent of the people who are participating in the actual qualified health plans."
The Kentucky Health Cooperative, a nonprofit insurer subsidized by the federal government, had about 51,000 customers in all 120 Kentucky counties when it announced this month that it will close Dec. 31 because it "came up short" financially. The cooperative was the biggest single source of coverage for the 88,904 Kentuckians enrolled in private plans through Kynect, almost 70 percent of whom received a tax credit to help offset their premium.
Beshear was at the Russell School Community Services Center in Lexington on Tuesday to promote open enrollment for Kynect, which begins Sunday and ends Jan. 31. Even with the loss of the Kentucky Health Cooperative, every county will have at least two competing insurance carriers in Kynect — Anthem and United Healthcare of Kentucky — and some counties will have as many as seven carriers from which to choose, Beshear said.
Kynect health plans for individuals were approved for an average 3 percent rate increase in 2016, although some will see larger increases and others will see none. The average monthly premium in 2015 for a Silver Plan for a 27-year-old Kentuckian was $137, with a $3,500 deductible, according to the Foundation For A Healthy Kentucky. For a 30-year-old couple with two children, it was $462 a month, with a $7,000 deductible.
Kynect will continue to sign up people through its website and at offices around the state staffed by "Kynectors," including one at Fayette Mall.
"It doesn't cost you a dime to go online or come in and find out what you might be able to get, and I can guarantee you, when you do, you're gonna like what you find. You're gonna find some great options available to you in terms of health care," Beshear said.