Linda Blackford

Kentucky is paying $270 million to kick people off Medicaid. Where’s the dignity in that?

Brandi Button works three part-time jobs that she loves: as an adjunct professor at Western Kentucky University, a Montessori teacher in Glasgow and at a non-profit called Sustainable Glasgow.

None of them offer healthcare, so Kentucky’s Medicaid expansion allowed her to cover her husband and two children for the first time.

“We were in the in-between group, not far enough below the poverty line to get Medicaid, but we didn’t make enough to buy insurance,” Button said. “For a long time I felt the pressure to do something I don’t love, work that I’m not passionate about, just so I could afford health insurance, but with the expansion, I can do the things I’m passionate about.”

Button is one of thousands of success stories that came out of the Medicaid expansion adopted by former Gov. Steve Beshear in 2013. The expansion covered the “working poor,” people who earned up to 138 percent of the federal poverty level.

There are personal stories like Button’s, and larger policy successes, like the University of Kentucky study which found that more people in Eastern Kentucky were getting colon cancer screenings, which in turn led to lower colon cancer deaths. The number of people with a personal doctor rose by 26 percent while emergency room visits fell by 30 percent, according to one study. Between 2013 and 2017, the uninsured rate dropped 62 percent. The Kentucky Center for Economic Policy estimates that in 2020, every dollar invested through the Medicaid expansion will generate between $1.3 and $1.8 billion of economic activity in the state.

Currently, Kentucky is reimbursed for much of those costs by the federal government. Those costs will eventually go down because healthier people who have access to preventative care and don’t use an emergency room as their main medical provider cost the medical system less money. Most other developed nations recognize that healthcare is a crucial part of a workable, humane society, where people like Button can pursue meaningful work that may not pay much, but improves their communities.

But current Gov. Matt Bevin and the rest of the Republican Party see expanded Medicaid as a handout abused by layabouts, despite a recent Kaiser Foundation study that found most Medicaid recipients already work. Republicans would rather hand out tax breaks to millionaires and billionaires than help people achieve stability and mobility in their lives because they don’t have to worry if they have to give up food for medication.

Bevin, with the ardent support of the Trump administration, pushed Kentucky to add work requirements to Medicaid, a move known as the Medicaid waiver. It would require 80 hours a month of “community engagement” including a job, school or community service, in order to keep their coverage. It’s already been rejected in state and federal court, and last Friday, the Washington, D.C. Court of Appeals judges seemed concerned that neither the federal nor state governments had taken into account that a lot of people will be kicked off Medicaid, not necessarily because they don’t work, but because this requirement adds a whole new level of bureaucracy.

How much, you ask? Well, the day before the court hearing, the General Accounting Office released a study that estimated Kentucky’s administrative costs to set up the new work requirement will be $272 million. According to reporter John Cheves, that’s twice the amount of other states that are adopting the waiver, and doesn’t even include the $100 million the state has already spent trying to implement the waiver.

And how are these waivers working in other states? Well, in Arkansas, tens of thousands of people lost Medicaid, not because they weren’t working, but because many of them couldn’t keep up with the onerous reporting requirements.

Angela Cooper, state outreach director for Kentucky Voices for Health, recounted the story of one man in Arkansas who had a full-time job, but didn’t properly fill out some of the online requirements. Because of that, his pharmacy wouldn’t fill his prescription for a lung condition. He got sick and lost his job.

“That’s exactly the kind of thing that will happen in Kentucky,” Cooper said. “The state has not taken into consideration that all of this is done online, and in parts of the state you don’t have reliable internet access.”

Medicaid coverage is already complicated and time-consuming, noted Button, who has a masters degree.

“When people criticize people on Medicaid, like it’s the easy way out, I just laugh,” she said. “There’s a ton of paperwork to fill out, you have to make sure not to miss deadlines, and I have to prove my income over and over again.”

Bevin talks a lot about the dignity of work and earning what you receive. What really provides dignity is knowing that you can work at a job you love and not worry about whether you can afford to go to the doctor. Kentucky is one of the most unhealthy states in the nation, and expanded Medicaid has been working to turn those numbers around. More than tax breaks. More than not-yet-built, Russian-funded aluminum mills.

Republicans like Bevin don’t really care about dignity, they care about strangling public programs that make the government in their eyes too big and expensive. It’s selective, of course, because they don’t seem too worried about a trillion dollar deficit that emerged after tax breaks for the rich. It’s just the government programs that help people. Those are the ones that have got to go.

Linda Blackford writes columns and commentary for the Herald-Leader.