The numbers differ in recent estimates of how the U.S. Senate bill to replace the Affordable Care Act would affect Kentucky, but the studies reach the same over-arching conclusions: Kentucky would lose billions of dollars in federal aid and the number of people without insurance would go up dramatically.
For instance, the left-leaning Center for American Progress estimated 231,400 fewer Kentuckians would have insurance in 2026 under the bill.
The non-partisan Urban Institute projected an even bigger impact: 541,000 more non-elderly Kentuckians without insurance in 2022 under the Senate bill than under the ACA, the law now in place that is commonly called Obamacare.
That would push the number of uninsured people in Kentucky from 6.3 percent of the population to 21 percent, the study said.
A cut in federal funding for Medicaid would be the key driver of that increase.
By 2022, the Senate bill would cut federal aid coming to Kentucky for Medicaid, and for tax-credits and cost-sharing to help people buy insurance, by 58.5 percent, or $6.26 billion, compared to what the state would get under the ACA, the Urban Institute study said.
That was the biggest projected drop in the nation. Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) in Kentucky would fall 51.6 percent under the Senate bill, the study said.
Former U.S. Rep. Ben Chandler, president and chief executive officer of the Foundation for a Healthy Kentucky, said a significant reduction in Medicaid would be a setback for health in Kentucky.
The foundation commissioned a study that showed “broad improvements” in measures of health coverage in Kentucky since eligibility for Medicaid was expanded under the ACA, including increases in the number of people with a regular source of care, fewer people putting off needed care because of the cost, and a big decline in people who said they had trouble paying for medical care.
The law also has brought in money for medical providers, and holds the potential to cut health costs in the long run by getting people into preventive care and heading off problems that are expensive to treat, Chandler said.
“Medicaid expansion has been valuable for Kentucky in several ways,” Chandler said Friday. “Our position is simple: the more people covered, the better.”
Reductions in Medicaid spending would have an outsized impact in Kentucky because the state saw one of the biggest increases in the nation in the percentage of its population covered under the program for low-income and disabled people. Former Gov. Steve Beshear embraced the expansion of Medicaid under President Barack Obama without legislative approval.
Only 6 percent of Kentuckians lacked health insurance in 2015, a drop of 8.3 percentage points since 2013, according to the U.S. Census Bureau.
The Medicaid expansion also has meant greater access to substance-abuse treatment, so there is a concern that a cutback would worsen the state’s climbing drug-overdose death rate, Chandler said.
Critics, though, argue that spending under Obamacare has added to the federal deficit and is unsustainable, and that the law has driven up premiums and caused insurance companies to pull out of markets, leaving people with little choice of carriers.
“The health insurance market has been ripe with uncertainty and instability since the implementation of Obamacare,” Kentucky Department of Insurance Commissioner Nancy Atkins said Friday in a news release announcing higher insurance premiums this fall. “Year-after-year, Kentuckians are experiencing the fallout from bad policy, and the rate increases reflected in this year’s filings are, unfortunately, commonplace for most states.”
Atkins said insurance companies in the Kentucky marketplace have proposed year-over-year rate increases ranging from 6.5 percent to 47.7 percent. In addition, only one option is available for individual coverage in some counties.
Many could see increased premiums
Insurance premiums won’t necessarily decline, though, if the Senate bill becomes law.
An analysis by the Kaiser Family Foundation projected a 74 percent increase in the cost of the average monthly premium, after tax credits, for the benchmark insurance plan available through marketplace exchanges under the Senate bill. That was a nationwide number.
The study said most people who bought insurance through the exchanges would pay more.
Older and lower-income people would see the biggest increases while many younger people would see insurance premiums decline. People age 55 through 64 would pay 115 percent more, for instance, the Kaiser study said.
Studies of an earlier bill approved by the House of Representatives, called the American Health Care Act, also projected significant impact on Kentucky because of cutbacks in Medicaid spending and other factors.
For instance, a study by the non-partisan Commonwealth Fund and George Washington University said that the number of health care jobs in Kentucky would initially go up under the law in 2018, but then drop.
The study estimated the state would lose 16,500 health care jobs by 2026 because of coverage reductions — many of them in rural communities where jobs are relatively scarce — and that the amount of uncompensated care Kentucky hospitals absorb would increase by 165 percent.
Under the ACA, uncompensated charges at Kentucky hospitals dropped by 67 percent from 2012 and 2015, according to a study by the Foundation for a Healthy Kentucky.
“The ACA has helped rural hospitals stay afloat,” Chandler said.
A rising number of uninsured
The Senate bill has different provisions than the House bill and will likely supersede it, but the Senate plan also could change in coming days.
Senate Majority Leader Mitch McConnell pulled the bill back from a planned vote this week after some in his own party objected to the initial draft.
That was after an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation. Their report estimated the Senate bill would cut the cumulative federal deficit by $321 billion from this year through 2026. The bill would cut spending by a trillion dollars but the deficit reduction would be much smaller because it would also reduce money coming in to the government by $701 billion, in part through tax cuts for wealthier people.
The biggest savings would come from reduced spending on Medicaid and changes in subsidies for individual health insurance under the ACA, the report said.
The CBO estimated that 15 million more people would be uninsured in 2018 under the Senate bill, mostly because it would end the Obamacare penalty for not having insurance.
In later years, lower spending on Medicaid and smaller subsidies to help people buy coverage would also increase the number of uninsured Americans, according to the analysis.
By 2026, an estimated 49 million Americans under age 65 would be uninsured, compared with 28 million who wouldn’t have insurance under the current law, the CBO said.
McConnell defends GOP plan
Critics of Obamacare have focused on its costs and problems, such as premium increases, rather than the potential for people to lose coverage under a replacement.
McConnell, R-Louisville, said in a Senate speech that Obamacare has caused premiums to increase by an average of 105 percent in most states in the federal exchange, and that more increases are projected.
He told the story of a small business owner from Lancaster who said she had decided her plan under Obamacare was useless because she paid a large price and had a $6,000 annual deductible, but the plan did not cover office visits or other important items.
The woman, whom McConnell did not name, said she “decided it was utter nonsense to buy insurance that covered nothing,” McConnell said.
In a statement to the Herald-Leader, McConnell said two insurers in the individual market in Kentucky requested sizable rate increases for next year — 34.1 percent for Anthem and 20.8 percent for CareSource.
“Too many Kentuckians have learned firsthand that the so-called Affordable Care Act has really been anything but affordable,” McConnell said.
He said the Senate bill will preserve access for people with pre-existing health conditions, allow children to stay on their parents’ insurance until age 26, reduce costs and give states tools to drive down premiums, while ending “onerous mandates” for required coverage that employers and individuals face under the ACA.
“Under Obamacare, choices have diminished, even disappeared, in states across the country,” McConnell said. “The Obamacare status quo is unsustainable and unacceptable and Republicans believe we can do better — and we fully intend to do so.”