Bevin dismantling one of Ky.’s best achievements

It is essential to empower Kentuckians to be self-sufficient and accountable, but I disagree with Gov. Matt Bevin’s vision for achieving this goal.

Bevin is dismantling one of the most successful health-care programs Kentucky has ever seen. Unlike Bevin’s Medicaid waiver, Kentucky’s original implementation of the Affordable Care Act saves money, jobs and lives.

First, the number of uninsured Kentuckians dropped by 63 percent between 2013 and 2015, making it the third most successful case of Medicaid expansion, behind Arkansas and Nevada. Second, the uninsured portion of the Appalachian community is medically underserved and accounts for approximately 100,000 (a fifth of the total) recipients of Medicaid under the expansion. While low-income Kentuckians in central and northern parts of the state may be able to get through this period, our Appalachian brethren cannot.

Take as an example one of Kentucky’s hardest hit places, Clay County. More than 37 percent of the county’s population lives in poverty. This number is egregious when compared to a national poverty rate of 12.7 percent. Until 2013, roughly a third of Clay County residents were insured by Medicaid, but after Medicaid expansion, more than 60 percent had coverage and the number of uninsured non-elderly residents decreased by two-thirds.

As Medicaid is the primary health insurance coverage for those living below or near the poverty line, shrinking the Medicaid expansion program, as Bevin plans, will contribute to the ongoing health crisis. In Clay County, 14.1 percent of people suffer from diabetes, which affects the poor at much higher rates than the wealthy. Most of the afflicted suffer from type 2 diabetes, a condition whose likelihood of occurrence is heightened by poor access to preventative health care.

Based on Centers for Disease Control estimates, as many as 1 in 3 Kentucky adults (37 percent or 1.1 million) have prediabetes but only 8.4 percent (240,000) report having been diagnosed. With the rate of diabetes this high and barriers to preventative health care already present, further reducing access to the health-care system will worsen poverty and joblessness.

Left untreated, diabetes can lead to heart attacks, strokes, blindness, kidney failure and problems with the feet and nerves. In a region where job offerings are slim, and primarily involve physical labor, disorders like these frequently prevent working-age people from obtaining employment.

While Bevin has been quick to point out the importance of self-sufficiency, he may have overlooked the collateral damage his Medicaid expansion work requirements will cause. Clay County is already characterized by low high school retention with only 63 percent of students receiving a diploma, among the lowest five four-year graduation rates in Kentucky,

The burden diabetes places on students whose parents suffer from the disease is considerable. Permanent disabilities like diabetes affect entire households. Students feel more pressure to stay home and care for their sick parent, or alternatively get full-time employment to make up for the parent’s lost income. Without access to regular primary care visits, early diabetes diagnosis is unlikely, resulting in enormous costs not only for families, but for hospital emergency rooms, as well.

The high diabetes and poverty rates in Clay County are matched by an equally alarming rate of food insecurity, as preventable diseases like diabetes are often contracted due to nutrition deficits. Clay County has the second-highest rate of food deficiencies in Kentucky, with more than a fifth of residents unable to maintain a nutritious diet. Bevin’s Medicaid waiver’s requirement that recipients work 80 hours per month is infeasible in rural counties where employment rates and morale are low.

The short-term savings from restricting government benefits will result in long-term health-care costs for the state. Without preventative services and access to primary care, disadvantaged Eastern Kentuckians will find themselves making more frequent trips to hospital emergency rooms, costing hospitals and taxpayers millions. The Medicaid expansion cut the number of uninsured Kentuckians by two-thirds. Foregoing this great success in health care policy for political gain will neither benefit Bevin nor his constituents.

If our bodies are broken and our wallets are empty, how can Bevin ask us to be self-sufficient? We all want Kentucky to achieve high rates of employment and a high standard of living. Attacking one of the most successful structural health-care programs the state has ever seen will only put those goals farther out of reach.

This story was originally published April 27, 2018 at 9:15 PM with the headline "Bevin dismantling one of Ky.’s best achievements."