More than seven in 10 residents of Kentucky want their new governor, Matt Bevin, to keep the state’s expanded Medicaid program as it is, according to a new poll from the Kaiser Family Foundation. And more than half of respondents described Medicaid as important for themselves and their families, underscoring the program’s substantial reach in the state and the challenges Bevin may face if he seeks to scale back or modify it.
Bevin, a Republican who took office Tuesday, is an opponent of the Affordable Care Act who earlier this year called for reversing the Medicaid expansion on the grounds that it was unaffordable for the state. He has since backpedaled to say he will seek changes requiring Medicaid enrollees to have “skin in the game,” such as by charging them monthly premiums.
“I do not intend to re-enroll people at this same level going forward,” Bevin said in a news conference after his election.
Yet the Kaiser poll, conducted Nov. 18 through Dec. 1, found that 63 percent of Kentuckians have a favorable opinion of their state’s Medicaid expansion. Support for the expanded Medicaid program was significant even among Republicans, of whom 54 percent said they would prefer to keep Medicaid as it is rather than scale it back to cover fewer people. Of respondents who voted for Bevin last month, 43 percent said they preferred keeping the program as it is now.
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Even in a Southern, anti-Obama state, the message seems to be that it’s going to be very hard and very unpopular to take away coverage people now have.
Drew Altman, the president and chief executive of the Kaiser Family Foundation, a nonpartisan health research group
“This is a very poor state and people here can’t even afford to buy food,” said one respondent, Daryl Tackett, 57, a Republican in Harrodsburg, who said he did not vote in the election. “I don’t want him to take the Medicaid away because there’s too many people that needs it.”
Drew Altman, the president and chief executive of the Kaiser Family Foundation, a nonpartisan health research group, said the message of the polled seemed to be: “ ‘We may not like Obamacare very much, but don’t take my brother’s or sister’s or niece’s Medicaid coverage away.’ It’s like there’s an ideological side of people’s brains but a practical side, too, that values the health benefits and the coverage.”
The Affordable Care Act gave states the option of expanding their Medicaid program to include all people under 65 with income at or below 138 percent of the federal poverty level, or $16,243 for a single person. Before the law’s passage, enrollment was limited almost exclusively to children, pregnant women and the disabled.
Kentucky’s former governor, Steven L. Beshear, a Democrat, expanded the program by executive order in January 2014, and since then, an additional 425,000 residents have joined the Medicaid rolls, most of them adults. By contrast, only 89,000 people have bought private coverage through Kynect, the state’s health care exchange.
In all, 30 states have expanded Medicaid under the health law. Some Republican-led states, like Indiana, have won permission from the federal government to experiment with alternative ways of expanding the program, typically adding premium requirements and other rules that they describe as promoting personal responsibility. In his inaugural address, Bevin said he intends to “copy the best parts” of Indiana’s program.
On the Affordable Care Act over all, respondents were far more divided, with more negative than positive leanings. Forty-nine percent said they viewed the law unfavorably, while 41 percent had a favorable view. Their opinions split sharply along party lines, mirroring national polls on the law.
Opinions were also divided on whether the law had made health insurance more affordable: 36 percent said it had, but about a third said it had made coverage less affordable.
Asked about the poll findings, Jessica Ditto, a spokeswoman for Bevin, said: “Obamacare is not working in Kentucky, and Governor Bevin is committed to finding a practical and efficient solution that will improve health outcomes. The administration will take deliberate and prudent steps to develop a health care plan that Kentucky can afford.”
Over all, 72 percent of poll respondents said Bevin should keep Medicaid as it is, while 20 percent said he should scale it back so that fewer people are covered. Ballard Ashlock, 43, a farmer in Crestwood, said he believed Bevin should scale back the program to exclude people who are capable of working but choose not to.
“I’m not a believer in people who get a free ride,” said Ashlock, adding that he voted for Bevin despite being a Democrat. “I’m sorry, but get a job.”
Altman said the level of support for the Medicaid expansion was striking especially given that most respondents incorrectly assumed Kentucky is paying most of the cost or splitting it with the federal government. In fact, the federal government currently pays 100 percent of Medicaid expansion costs, a share that will gradually drop to 90 percent in 2020 and beyond. The Beshear administration estimated the state’s share of covering the new Medicaid enrollees would total $257 million over the next two budget years.
Altman added that while the leading Republican presidential candidates have uniformly called for repealing the Affordable Care Act, the poll results are a reminder of just how politically risky it could be to actually do so. “Even in a Southern, anti-Obama state,” Altman said, “the message seems to be that it’s going to be very hard and very unpopular to take away coverage people now have.”
Bevin, who defeated his Democratic opponent by nine points, seems to have grasped the political complexities of changing aspects of the law; after backing away from his initial call to reverse the Medicaid expansion, he softened his language in discussing it.
“There is tremendous need; we know that,” Bevin said in his inaugural address on Tuesday, referring to Medicaid recipients.
The poll found less robust support for keeping the online insurance exchange that Kentucky built under the health law: 52 percent of respondents said they wanted to keep Kynect, while 26 percent said they wanted Kentucky to switch to the federal insurance exchange and 19 percent said they did not know. People whose income is too high for Medicaid can buy private coverage through these exchanges, and apply for federal subsidies to help with the cost.
People can also apply for Medicaid through Kynect, which the state built with $283 million in federal grants.
Bevin wants to dismantle Kynect and transition Kentucky to the federal insurance exchange, which 38 other states already use. Most of those states have Republican leaders who oppose the health law and rejected federal funds to build their own exchanges.
Fifty-six percent of the poll respondents said they personally knew adults who had gotten health insurance coverage through Kynect, but most said the coverage was Medicaid, not a private plan.
Underlying the support that the poll found for the expanded Medicaid program is the personal connection that many say they have to it. They include Janice Singleton, of Science Hill, who said her partner, a trucker, learned he had colon cancer after signing up for Medicaid last year.
Without the coverage, she said, “He wouldn’t have gone to the doctor and he wouldn’t be here now.”
Singleton, a 52-year-old Republican, said that she, too, had qualified for Medicaid and would be willing to pay a monthly premium if she could afford it. The Medicaid expansion was a lifeline for many and should not be scaled back, she said, even though it would cost the state money over time.
“Sometimes they spend money in places it doesn’t need to be,” Ms. Singleton said. “But this is good spending.”
Interviews for the poll were conducted by landline and cellphone among a total sample of 1,017 adults across the state, with a margin of sampling error of plus or minus four percentage points.