Gov. Matt Bevin has a deep-seated need to end Kynect.
Everyone gets that by now. In the spirit of acceptance, may we suggest: Rather than the Rube Goldberg-style shell game outlined recently by Health and Family Services Secretary Vickie Yates Brown Glisson, just rename it.
Rechristen Kentucky’s most visible symbol of President Barack Obama’s Affordable Care Act, then Bevin can declare victory and free his people to work on problems that are real.
Saying, “It's kind of like the best of both worlds,” Glisson recently described a hybrid in which the state would continue to oversee the health insurance marketplace while its electronic portal would be rebuilt at Healthcare.gov, the federal exchange.
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What she proposed sounds less like Bevin’s repeated vow to dismantle the exchange and more like changing addresses. We have not heard an explanation so must surmise that someone realized that dismantlement would create a disaster when the next open enrollment rolls around in November.
Bevin’s oft-stated reason for ending Kynect is redundancy with the federal exchange. But what could be more redundant and wasteful than reinventing something that cost taxpayers $290 million to build and that by many accounts is the best working in the nation.
Glisson and Bevin have yet to offer any documentation or independent assessments to back up their assurances that Kentucky can hybridize the system at almost no cost while gaining millions in future savings.
But Glisson was clear on one thing: Consumers would have to pay more. Kynect’s operating expenses are paid by an assessment on Medicaid managed care companies and a 1 percent fee on state-regulated health insurance policies (not paying the fee: privately-insured Kentuckians who are in large group plans regulated by the feds). Kentuckians enrolling through the federal exchange would have to pay 2 percent instead of the current 1 percent. Of that amount 0.5 percent would be a state fee to “cover outreach and plan-management functions,” according to Kentucky Health News’ account of Glisson’s appearance before lawmakers.
Confusing many is why Deloitte apparently lowered its $23 million cost estimate for switching over to Healthcare.gov. It makes sense, though. Deloitte, which built Kynect, no doubt learned some shortcuts while integrating Oregon’s disastrous enrollment system into the federal exchange. Deloitte also used expertise and computer code gained in Kentucky to create a new Medicaid enrollment system in Oregon.
Bevin should bring in the experts from Deloitte now to publicly detail the costs and benefits of his proposal, including setting up a new Medicaid enrollment system to replace the one that’s part of Kynect.
Bevin mercifully backed off his early vow to reverse the ACA’s Medicaid expansion, which has brought free health care to more than 400,000 working-poor Kentuckians. Kynect is the door through which they, along with almost another 100,000 who could afford to buy subsidized health insurance, gained access to preventive medical care, many for the first time.
Even if the complicated task of unspooling Kynect enough to satisfy Bevin can be accomplished as cheaply as claimed, Kentucky still is suffering an opportunity cost by expending so much time and political capital on something that serves no useful purpose. Let’s just slap a new name on it, declare Kynect dead and get back to improving the health of one of this nation’s sickest populations.