Rarely do the words “Medicaid” and “mystery” pop up in the same sentence, or even the same thought, but people are puzzling over whether Gov. Matt Bevin’s Medicaid revamp is an elaborate ruse that he knows the federal government will not approve.
Then, goes the speculation, Bevin will do what he promised early in his dark horse Republican campaign — end the Medicaid expansion, leaving more than 400,000 low-income Kentuckians without health care — and blame Democratic President Barack Obama.
The 2014 Medicaid expansion helped halve the rate of uninsured Kentuckians and made Kentucky a rock star of Obamacare.
When Bevin unveiled his proposal on June 22, he framed the choice as his plan or repeal, declaring, “It’s entirely the decision of the federal government.” In truth, Kentucky would have to end the Medicaid expansion.
Despite proposing changes that have been rejected in other states, Bevin’s people express confidence that the feds will OK the plan as is or very close.
Asked about that, a spokesman for the U.S. Department of Health and Human Services issued a statement last week that said, in part: “We have repeatedly been clear with the state about the principles of access to coverage and affordability of care by which we will assess any waiver. Among these principles, states may not limit access to coverage or benefits based on work or other activities, nor may they impose premiums or cost sharing that prevent low-income individuals from accessing coverage and care. We remain hopeful that Kentucky will ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards.”
So, it sounds as if Bevin has been been advised that his proposals to condition Medicaid eligibility on work and volunteerism requirements won’t fly. Ditto his plan to deny coverage for six months to low-income adults who fall behind on their new premiums.
U.S. Rep. John Yarmuth, D-Louisville, last week on CN2’s Pure Politics, said Bevin is intentionally sabotaging his plan with poison pills. “I think he just wants to blame the Obama administration for forcing him to roll back the Medicaid expansion. ... And this gives him a way to do it with less political push back. ... I hope that the people of Kentucky figure out what he’s doing and don’t let him get away with it.”
Yet it’s hard to believe Bevin would have devoted so much of his administration’s first 200 days to a ruse. Officials held overflowing public hearings in Bowling Green and Frankfort last week and will head to Hazard for the final hearing Wednesday.
In the days since the plan’s unveiling, a few things have come clear:
▪ The feds are under no deadline to give Kentucky an answer, contrary to what Bevin would have us think.
▪ Bevin officials say their plan will save the state $330 million over five years. That means Kentucky would forgo $1.87 billion in federal match for health care over the same period. Kentucky routinely gets a lower return than that on its tax breaks for businesses that open or expand.
▪ No federal OK is needed for most of the smart things Bevin wants to do. Promoting prevention, curbing overuse of emergency rooms, better chronic disease management can be achieved through contract revisions with the companies that manage Medicaid. But creating the complex administrative systems demanded by Bevin’s proposals that do require federal approval would suck the energy from real reform.
Here’s the mystery: Why doesn’t Bevin use his already considerable authority to advance policies that improve health outcomes — and save the political theater for something that isn’t a life-or-death matter for so many of the people he pledged to serve?