Has Bevin swung on Medicaid?

In urging Congress to repeal the Affordable Care Act “in its entirety,” Gov. Matt Bevin has put himself at odds with some of his fellow Republican governors and also with his own former position.

House Majority Leader Kevin McCarthy asked governors to share their ideas for achieving the Republican goal of repealing and replacing the ACA.

USA Today reports that Bevin, in a Jan. 6 letter, advocates repealing the ACA’s Medicaid expansion and its popular consumer protections without advocating any major replacement ideas.

Early in his dark-horse campaign, Bevin vowed to repeal Kentucky’s Medicaid expansion but moderated that stance after winning the nomination, calling instead for cost-saving changes modeled on what Indiana had done under Gov. (now Vice President) Mike Pence.

Bevin’s administration devoted much of last year to developing a plan to tweak Medicaid, which covers about 1.3 million Kentuckians, in ways that Bevin said would make the federal-state program sustainable going forward.

Emails to Bevin’s spokespeople asking whether he still supports his Medicaid plan, known as a waiver, or again wants to repeal the expansion, produced no replies on Wednesday.

Some Republican governors, including Ohio’s John Kasich and Michigan’s Rick Snyder, are urging Congress to save Medicaid expansions.

In a Jan. 18 letter to House Majority Leader Kevin McCarthy, Kasich said, the 700,000 Ohioans “who became eligible for coverage through the expansion reported that it was easier for them to keep or find work, and most reported better health and financial security as a result of obtaining coverage.”

Kasich and other Republicans also are calling on Congress to continue ACA provisions that protect sick people from being rejected by insurers and let young people stay on their parents’ insurance until age 26. Bevin’s letter mentioned neither.

Bevin did raise the idea of reviving Kentucky’s high-risk pool for people who have pre-existing medical conditions. Many Kentuckians who had been rejected by insurance companies could not afford the premiums for the high-risk pool, which never covered more than 5,000 people.

Around 80,000 Kentuckians have private health insurance through the ACA and another 420,000 have coverage through the ACA’s Medicaid expansion, which also increased access to drug abuse treatment and brings $3 billion a year to Kentucky’s health-care providers. Under the ACA, states must provide 10 percent of the cost of the Medicaid expansion.

Bevin’s plan would impose premiums and co-pays to slow increases in Medicaid enrollment and in hopes of instilling “personal responsibility.”

He can’t implement the changes without approval from the Centers for Medicare & Medicaid Services. Considering that President Donald Trump’s pick to head that agency, Seema Verma, worked as a consultant on Bevin’s plan, winning approval shouldn’t be a hurdle — if Bevin still supports his own plan.

This story was originally published January 25, 2017 at 5:42 PM with the headline "Has Bevin swung on Medicaid?."