Op-Ed

Medicaid expansion healing very sick Kentucky: Don’t stop now

Improving health takes time. Almost everyone has struggled to improve their health — whether it’s trying to achieve a healthier weight, recover from a serious illness, reduce anxiety and stress, or overcome an addiction — and we don’t expect overnight results.

But when we find something that truly helps, we know we ought to stick to it and see it through to real results.

Expanding the Medicaid program in Kentucky to cover more low-income, and predominantly working, people is truly making a difference in our population’s health, and we ought to stick to it.

I’m pleased that Gov. Matt Bevin is planning to keep expanded Medicaid while also trying to make the program more cost efficient, and hope federal law will continue to allow newly insured Kentuckians to retain their Medicaid coverage. Kentucky needs to see this effort through.

The commonwealth faces unique health challenges, in part because of high poverty rates.We have the nation’s highest cancer death rate and among the worst rates of heart disease, diabetes, poor mental health and drug overdoses.

More Kentuckians are obese, and more smoke, than residents of almost every other state. Our life expectancy is not improving at the same pace as other states; eight Kentucky counties had the largest decreases in longevity in the nation from 1980 to 2014.

After Medicaid expansion, however, the needle is beginning to move.

The rate of uninsured Kentuckians dropped by more than half, from 13.6 percent to 6.1 percent, after expansion went into effect in January 2014, according to independent research commissioned by the Foundation for a Healthy Kentucky. We now have one of the lowest uninsured rates.

What’s more, the number of Kentuckians reporting that they have a usual source of health care jumped more than seven points to nearly 90 percent from 2012 to 2015. Fewer Kentuckians say they have delayed or gone without needed medical care due to the cost.

Our study found that expanded Medicaid has covered hundreds of thousands of health screenings — such as tests for breast cancer, colon cancer and diabetes — for low-income Kentucky adults who otherwise likely couldn’t afford them, helping prevent chronic disease and allowing for earlier treatment.

The screenings save lives. They also save money for Medicaid and the rest of the health-care system that would otherwise pay the price of late-stage and crisis care for people who were forced to put off medical visits until they got too sick to delay any longer.

Our research shows that one group that benefited most from the upgraded Medicaid program has been younger adults, 19 to 34. Despite being generally healthy, without insurance they often don’t use preventive services. Thanks to Medicaid, they have a better chanceto prevent and, when needed, manage chronic disease and disability.

Medicaid also has been found to protect people from bankruptcy, and research shows that lacking coverage and access to care has a negative impact on life expectancy. Losing coverage can force Kentuckians into a life-or-death situation.

Hospitals also are benefiting, by their own reporting, through reductions in charity and self-pay charges for patients without health insurance. Uncompensated care dropped 67 percent after Kentucky overhauled Medicaid, representing nearly $800 million in avoided losses as of 2015. This is enough to make the difference for many institutions between staying open and collapsing in bankruptcy.

Finally, there is the issue of substance use. Few Kentucky residents in the 67 hardest hit counties remain untouched by a friend’s or loved one’s struggle with addiction.

Our health care system is also dealing with the secondhand impacts. Kentucky is first in the nation for new hepatitis C cases and a 2016 Centers for Disease Control and Prevention report found that Kentucky is at risk of an HIV outbreak sparked by intravenous drug use.

The inclusion of substance-use treatment under Medicaid is essential. Treatment services increased by 740 percent in the first 30 months of the expanded Medicaid program. Access to professional rehabilitation for those struggling with a substance use disorder represents our best opportunity to end this destructive epidemic.

While it is too soon to see improvements in Kentucky’s health outcomes, Medicaid is truly making a difference in the measures that, according to research, will lead to better population health if we stick to it. Our goal must be to continue to improve and optimize Medicaid so we can realize the benefits of a healthier Kentucky.

Ben Chandler is president and CEO of the Foundation for a Healthy Kentucky, which addresses unmet health needs of Kentuckians.

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