Two dozen people spoke against Gov. Matt Bevin’s proposed Medicaid overhaul at a public hearing on Wednesday. Bevin’s plan to drop Medicaid coverage for dental and vision care unless participants perform community service or other tasks to win “reward points” proved especially unpopular.
“What I think you are doing is putting fiscal responsibility over what is good and right,” former Medicaid recipient A.J. Jones of Louisville told several of Bevin’s aides, who faced a packed hearing room in the Capitol Annex.
“I don’t think it’s dignified to have to pick up trash on the side of the road to have a tooth pulled,” Jones said. “And I don’t think that you think it’s dignified to do that. If you did, then you would be picking up trash on the side of the road to get your tooth pulled.”
Jones was responding to a comment made earlier by Bevin’s deputy chief of staff, Adam Meier, who said the governor’s plan would let Medicaid recipients earn the right to dental care. For example, Meier said, filling out a detailed personal health questionnaire online “would be enough to pay for three fillings and a tooth extraction.” The remark drew loud groans from the audience.
Bevin, a Republican, hopes to ask the federal government by Aug. 1 for a waiver so he can modify the Medicaid expansion that Kentucky adopted under his predecessor, Democratic Gov. Steve Beshear. Tuesday’s hearing was one of three scheduled around the state to gather public comments on his waiver request. A Tuesday hearing in Bowling Green also drew about two dozen opponents to the microphone.
Medicaid expansion under the federal Affordable Care Act added roughly 440,000 Kentuckians, which means that 1.32 million people — 30 percent of the state’s population — are now enrolled in the health benefits program for the poor and disabled.
This has dropped Kentucky’s uninsured rate from 20 percent to 7.5 percent. However, Kentucky already struggled to cover its Medicaid costs, and Bevin says there is no realistic way to pay for this growth. He says the state’s share will be $1.2 billion over the next five years, even with the federal government picking up most of the tab.
We have not moved the needle. Our health has not improved.
Health and Family Services Secretary Vickie Yates Brown Glisson
Despite the massive increase in health care spending, Kentuckians aren’t much healthier today, Health and Family Services Secretary Vickie Yates Brown Glisson said at Wednesday’s hearing. The state still has high rates of obesity, smoking and drug addiction, and data indicates that many of those who gained a Medicaid card haven’t used it for wellness check-ups, Glisson said.
“We have not moved the needle. Our health has not improved,” Glisson said.
The more significant changes in Bevin’s waiver plan focus on roughly 400,000 “able-bodied” adults enrolled in Medicaid, excluding children, pregnant women and the disabled. He would eliminate some of their current coverage, such as dental and vision care, although they could earn those benefits back by getting a job, volunteering in the community, taking a class or filling out a health assessment.
Bevin’s waiver would at first encourage, and then require, Medicaid recipients to switch to a health insurance plan offered by their employer, with a state subsidy to assist with premiums and deductibles if necessary.
However, state officials acknowledge that they don’t know how many recipients have access to workplace health insurance. Some of the biggest enrollment numbers for expanded Medicaid came in sectors, such as construction, food service and retail, where insurance often is not offered to workers.
Bevin also would charge a monthly premium to Medicaid recipients, from $1 to $15 a month, based on their income. For those just above the poverty line, monthly premiums gradually would rise over the next five years to $37.50. Failure to pay a premium within 60 days of the due date would lead to a temporary loss of coverage.
The Bevin administration estimates its waiver could reduce the state’s projected Medicaid enrollment by about 85,000 in five years, although the number of people in the program would rise slightly even with the waiver in place.
We are concerned that these changes will limit patient access and will actually increase cost when patients miss their preventative care.
Richmond optometrist Matt Burchett
Critics at Wednesday’s hearing said it’s unlikely the federal government will approve Bevin’s request as it’s presently written. No state has been allowed to impose work requirements on Medicaid recipients through a waiver, said Emily Whelan Parento, a Georgetown University law professor in Washington who previously was a health policy adviser to Beshear.
Steadily raising monthly premiums on people just above the poverty line is likely to be seen as an unfair penalty on the working poor, Parento added.
Several dentists and optometrists spoke against the plan, complaining that it’s illogical to categorize their services as an “extra” benefit that can be won as a reward, alongside discounts on gym membership. Dental and vision exams can catch chronic diseases before they become an expensive and potentially fatal ailment, the doctors said.
Fifteen percent of diabetics “were first diagnosed in an optometrist’s chair,” said Richmond optometrist Matt Burchett.
“We are concerned that these changes will limit patient access and will actually increase cost when patients miss their preventative care,” Burchett said. “Quite simply, the highly preventative health care provided by these services should not be lumped into the same incentive categories as gym membership fees. It makes no fiscal sense and it carries heavy risks.”
Make your comment
The third and final public hearing to discuss Gov. Matt Bevin’s Medicaid proposal will be held July 6 from 11 a.m. to 1 p.m. in Room 208 of the Jolly Classroom Center at Hazard Community and Technical College in Hazard.
Comments also can be sent by email to firstname.lastname@example.org or by mail to Commissioner Stephen Miller, Department for Medicaid Services, 275 E. Main St., Frankfort, Ky. 40621.