After hearing about the work, volunteerism and education requirements and the My Rewards Account incentives that would have to be documented and tracked under Gov. Matt Bevin’s Medicaid proposal — not to mention the premiums, co-pays and penalties that would need to be collected and recorded — KET’s “Kentucky Tonight” host Bill Goodman asked, logically enough, if the mechanisms for all that paperwork are already in place.
The answer is no, none of them.
Bevin’s Medicaid plan requires designing and building a red-tape machine of new administrative regulations and systems, including one for subsidizing employer-sponsored health insurance in hopes that individuals earning less than $16,000 a year will move onto private plans.
In order to build and operate the new bureaucracy, taxpayers would end up paying more per person to buy less health care for the low-income Kentuckians who gained access to preventive care under the 2014 Medicaid expansion — about $192 more a year per person, according to the Bevin proposal.
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Bevin is seeking authorization to try his plan for five years under a federal law meant to encourage innovation that expands coverage to more people and services or makes Medicaid more efficient.
Bevin’s plan does neither, which is why officials with the U.S. Department for Health and Human Services have made clear that parts of the Kentucky plan cannot be approved.
Other Bevin proposals — especially the request to expand Medicaid-funded addiction treatment — are much needed and would expand care.
It’s encouraging then that the administration has decided to take more time to refine the plan in response to feedback received. Bevin had set an unrealistically ambitious deadline of Aug. 1 for submitting it to the federal government.
The plan is built on some assumptions that we think are faulty: Namely, that providing free health care to working-poor Kentuckians discourages them from moving into higher-paying positions and robs them of their dignity.
Losing health care can only make someone less fit to work. Many struggling Kentuckians already hold down more than one job and others can’t find even one job where they live. They are eager for vocational training and to work their way into better-paying positions. There’s no need to motivate them by holding their health hostage.
But, for argument’s sake, let’s say that there are benefits from requiring someone earning $3,000 a year to pay a $1 monthly premium or lose their health care.
At what cost are we willing to provide that hypothetical benefit? The cost of collecting premiums and co-pays from low-income patients would far exceed what could be recouped, while it’s likely that individual health crises resulting from delayed care would increase costs to the public.
The unfavorable cost-benefit ratio convinced Arizona, Arkansas and Virginia to nix Medicaid cost-sharing requirements similar to Bevin’s proposal.
Kentucky’s health challenges are daunting. Bevin has plenty of opportunities to leverage better outcomes from Medicaid without creating new red-tape machines.