FRANKFORT — An emotional Gov. Steve Beshear announced Thursday that Kentucky will expand the federal and state Medicaid program to provide coverage to an estimated 308,000 Kentuckians without health insurance.
At a news conference at the Capitol, Beshear called the decision to expand Medicaid for the poor and disabled "the single most important decision in our lifetime" to improve the health of Kentuckians — who traditionally rank near the bottom nationally in nearly every health indicator.
Expanding Medicaid could add 17,000 jobs and pump more than $15.6 billion into the state's economy in the next six years by putting more money into the state's medical infrastructure, Beshear said.
That data came from analysis conducted by University of Louisville and Price Waterhouse Coopers on the potential financial impact of expanding the program that accounts for roughly 14.8 percent of the state's current two-year budget.
Medicaid already provides medical coverage to more than 800,000 Kentuckians.
With Beshear's announcement in the Capitol, Kentucky becomes the 21st state to expand Medicaid, a key provision of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare since President Barack Obama initiated it.
A 2012 U.S. Supreme Court decision upheld the law but left the expansion of Medicaid up to states. Twenty states — mostly with Democratic governors — and the District of Columbia had already opted to expand.
Beshear's voice cracked several times during the announcement, which attracted a large crowd, including Lt. Gov. Jerry Abramson and several Cabinet members.
He was adamant in his decision. By expanding Medicaid, every Kentucky citizen will have access to affordable health care, Beshear said. "No one will fall into a coverage gap," he said. "That is huge."
Beshear also had strong words for "naysayers" opposed to the expansion. He said they "express vague and broad anxieties about costs, fears which the facts refute, and they fall back on partisan politics."
The Democratic governor said the opposition contends Kentucky will be supporting Obama, who is unpopular in the state, if Kentucky expands Medicaid.
"Well, to them, I say to them, get over it," Beshear said to loud applause.
Tea Party activist David Adams of Jessamine County, who has filed a lawsuit challenging Kentucky's role in implementing Obamacare, later told reporters, "I look forward to making him eat those words."
Adams called the expansion "the mother of all unfunded liabilities" and disputed Beshear's numbers.
House Minority Leader Jeff Hoover, R-Jamestown, said the expansion will have "a drastic impact on the financial stability of the Commonwealth. It may not be immediate, but certainly I believe it will in a couple of years."
He predicted that the legislature will either have to cut state spending further or raise taxes. "I can assure you that I do not intend to raise taxes."
Senate President Robert Stivers, R-Manchester, said the legislature should have been involved in deciding whether to expand Medicaid.
Beshear said the cost to state government over eight years beginning in 2017 should be about $473 million. The federal government will pay for 100 percent of expansion costs for the first three years, and then will gradually decrease funding to 90 percent in 2020.
States can change their expansion plan at any time; if circumstances change and expansion is no longer a benefit to Kentucky, the state can pull back that expansion, he said.
House Speaker Greg Stumbo, D-Prestonsburg, said Beshear's decision is "not only the right thing to do, it makes economic sense."
Stumbo said he would challenge any public official opposing the move "to surrender his or her own health care coverage.
"I think it is hypocritical of those with excellent, taxpayer-supported benefits to criticize others who will now have accessible and affordable health care."
The expansion of Medicaid will include people whose income is at or below 138 percent of the poverty level.
Beshear said that means someone who makes $15,415 a year or less, or a couple making $20,879 a year or less, would be eligible for Medicaid beginning Jan. 1.
"The bottom line is that it is the right thing to do," said Beshear, noting that many people with jobs will benefit from the expansion.
He introduced Steve and Jana Bailey of Berea with their four young children: Sawyer, Cassidy, Briyley and Kinsley.
Steve Bailey works full-time,and Jana Bailey works part-time, Beshear said.
Jana Bailey said her husband has health care but she does not.
"With this expansion, it will allow me less stress and let me concentrate on my family, now that there will be health care for my family," she said.
Health care advocates, many hospitals and medical associations have pushed for the expansion, saying it will help the state's finances and its overall health rankings.
But Kentucky Republicans have repeatedly tried to block key portions of the Affordable Care Act, including the creation of a health benefits exchange, an online insurance marketplace for people who don't have health insurance.
The Republican-controlled Senate also passed legislation in the most recent session that would have required Beshear to get legislative approval before an expansion could occur. That bill died in the Democratic-controlled House.
Kentucky Republicans have questioned how much the Affordable Care Act will eventually cost the state, which already spends $6 billion in federal and state money on Medicaid.
Senate Health and Welfare Chair Julie Denton, R-Louisville, said her committee will review the expansion.
The big question, she said, will be how to pay for this and its administrative fees.
U.S. Rep. Brett Guthrie, R-Bowling Green, said he wants people to be covered by health insurance, "but most people think Medicaid is unsustainable as is and will continue to put pressure on state budgets."
But Beshear said Thursday that after months of study, he thinks state coffers and Kentucky businesses and hospitals would be hurt if the state does not expand Medicaid.
"We have now done the exhaustive research, and our conclusion matched what most other states have found. By expanding Medicaid, Kentucky will come out ahead in terms of both health outcomes and finances. In fact, if we don't expand Medicaid, we will lose money."
Without expansion, the cost to the state could be an estimated $40 million by full implementation in 2021, Beshear said.
Beshear said that if Kentucky did not expand Medicaid so more people would have coverage, there would be more than 206,000 people in Kentucky who would not be eligible for subsidies to buy health insurance on the health benefit exchanges. That means many people — mostly the working poor, who work minimum-wage jobs but have no insurance benefits — would continue to be without health insurance.
Many social justice groups and health care advocates applauded Beshear's decision.
Dr. Michael Karpf, executive vice president of health affairs at the University of Kentucky, said uninsured patients delay treatment or use emergency rooms for primary care. Expanding Medicaid will improve treatment and decrease costs, he said.
"Uninsured individuals often utilize emergency rooms for conditions which could be more appropriately and inexpensively treated by a primary care provider," Karpf said.
"Expanding Medicaid coverage will create opportunities to improve access to care and improve the ability of organizations such as UK Health Care to more effectively manage both acute and chronic conditions of our most vulnerable patient populations."
The Rev. Patrick Delahanty, executive director of the Catholic Conference of Kentucky, said: "We believe that health care is a basic human right.
"Opening up access to that care by providing health insurance to hundreds of thousands of Kentuckians who are now without it is the right thing to do."
Kentucky Voices for Health, a coalition of more than 250 health care advocacy groups and persons, said in a statement: "Today is a great day for Kentuckians currently living without the security of health care coverage."