I worked hard as the taxpayer watchdog to root out corruption and inefficiency, to make Kentucky a place where we do big, important things while protecting every tax dollar. I believe that such an approach represents a better way for Kentucky. But now Gov. Matt Bevin wants to add new layers of bureaucracy and mandates to our health system.
His plan would hollow out Medicaid, replacing a simple, streamlined program with a hodgepodge of burdensome policies that restrict people’s ability to access care. It would jeopardize the health of our citizens and cost our state budget millions and our state’s economy billions.
Thanks to Kynect and Medicaid expansion, Kentucky’s uninsured rates have plummeted, and so has wasteful spending on emergency room visits for non-emergency care. It turns out that regular access to care makes a real difference. Fewer people are skipping their meds before payday, and more Kentuckians than ever have access to care that can keep them healthy.
The governor claims that he is developing “innovative” approaches that maintain and increase access. In, reality, Kentucky would offer coverage in name only. According to his own projections, the governor’s plan would kick 17,000 off their coverage this year, growing to 85,000 five years from now. To preserve the gains we’ve made , it’s time to hold Bevin accountable.
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Bevin claims that Medicaid expansion is a budget buster, but Deloitte projects our current system will yield almost half a billion dollars in savings over the next five years. That’s because when people have health coverage, Kentucky spends less on piecemeal programs providing emergency care to the uninsured.
Bevin’s math ignores those effects, and just looks at how much the legislature will contribute. Even if you do that, using his own data, Kentucky will pay an average of only about $500 a year per person gaining coverage through expanded Medicaid. Kentucky will pay at most 10 percent and the federal government 90 percent to continue investments in health, the state’s economy and well-being.
Economists also project that the state’s contributions to Medicaid will total less than what Kentucky hospitals will save in uncompensated care costs. These savings can help keep hospitals, especially rural hospitals, open for Kentuckians whether they’re getting coverage from Medicaid, Kynect, Medicare or their employer. Big pieces of Bevin’s proposal, like burdensome cost-sharing and employment restrictions that create red tape, will take us backwards.
Most people in the Medicaid expansion work low-wage jobs, which is why they had trouble affording private coverage in the past. Bevin has focused on the minority who don’t. Kentucky administers excellent programs that help people find and keep jobs. But Medicaid is not one of them, nor is it supposed to be. Bevin knows that the federal agency that administers Medicaid can’t let him tie job requirements to enrollment. By pretending otherwise, Bevin is setting himself — and Kentucky — up for failure.
Worse, the governor’s plan would take money from hardworking Kentuckians and send it to Frankfort. He’d force Medicaid beneficiaries to pay more in premiums and co-pays, even though many people are already struggling to pay their current bills. Data show that for lower-income people, even small increases in out-of-pocket costs can be the deciding factor on whether to go in for needed care. Bevin says he wants to make progress on Kentucky’s high rates of diabetes, depression and substance use disorders. But his plan would take Kentucky backwards on access to preventive services and regular treatment for chronic disease.
In 2015, Arkansas scrapped its plan to impose similar premiums after realizing that setting up the bureaucracy to collect the payments would cost the state more than the premiums would save. More important, when folks can’t afford the co-pays for medication that keeps them healthy or the premiums that let them go to the doctor instead of an emergency room, their health care bills go up in the long run — and taxpayers wind up holding the bill.
Today, thanks to a lot of hard work, Kentucky’s health care system stands for something big. The experts say we’ve implemented health reform better than just about anyone, and we did it in our own unique Kentucky way. Instead of letting Bevin destroy what we’ve built, join me in telling him: Don’t mess with success.
Adam H. Edelen. founder of Lexington-based Edelen Strategic Ventures, served as Kentucky’s auditor of public accounts from 2012 to 2016.