Op-Ed

Kentucky health gains are real, worth defending

Emily Whalen Parento
Emily Whalen Parento

The Foundation for a Healthy Kentucky recently released a quarterly update of its ongoing evaluation of the impact of the Affordable Care Act in Kentucky. The data are compelling evidence that health-care reform is working and that we are beginning to overcome the barriers to good health that have held us back for generations.

The data also strongly suggest that Kentucky’s approach to reform — both Medicaid expansion and the state-based health-benefit exchange Kynect — produces the best results, particularly when compared to neighboring states:

A lower uninsured rate. The report confirms that the commonwealth has made tremendous improvements in reducing the rate of its uninsured. The 2015 uninsured rate of 7 percent was lower than the overall U.S. rate of 10.6 percent. Moreover, Kentucky has succeeded in reducing uninsured rates across the board, beating the national average at every income level.

Not a single surrounding state has a lower uninsured rate, and Kentucky’s rate is significantly lower than four of its seven neighboring states (Illinois, Tennessee, Indiana and Virginia, which range from 9 percent to 10.5 percent), as well as Arkansas at 9.9 percent.

Increased consumer choice. Kentuckians continue to see markedly increased choice of plans, a direct result of the effective work of the team at Kynect, in working with insurers. The report documents a 50 percent increase in the number of plans offered on Kynect between last year’s open enrollment period and the most recent one: from 40 to 60 plans.

More affordable premium costs. Kentucky’s success at promoting choice and competition has resulted in the lowest median premiums among surrounding states (plus Arkansas) for silver-level family plans, the most widely selected level of plan. The average premium in those states was nearly 10 percent higher — approximately $642 per month compared to Kentucky’s rate of $585 per month. And some states were considerably higher; West Virginia’s comparable premium was $703 per month, and Missouri’s was $684.

Among all of those states, Kentucky is the only one with a state-based exchange. The others operate entirely or partly under the auspices of healthcare.gov, the federal health insurance exchange.

While this report does not conclusively demonstrate that Kentucky’s decision to operate its own exchange is the cause of its lower premiums, all Kentuckians should be concerned that Gov. Matt Bevin’s decision to dismantle Kynect will lead to higher costs and less choice.

In fact, if Kentucky’s premiums were to increase only to the average of our surrounding states following a transition to the federal exchange, families would be faced with an increase in premium costs of $685 per year, on top of the estimated $23 million in taxpayer dollars that will be needed to dismantle the exchange that even critics admit has been hailed as a national model.

That’s a lot of taxpayer money to spend on a political point.

Bevin has stated that Kynect is “redundant” and adds no value relative to the federal exchange, and that Medicaid expansion must be “transformed” to be sustainable. He has given no evidence to back up his claim. And the evidence that is available — including the data in the Foundation for a Healthy Kentucky report — strongly suggests he is wrong.

The truth is that health-care reform has worked for Kentucky, and the lives of hundreds of thousands of people are better for it. After decades of being at the bottom of the pack on virtually every health metric, we are now leading all of our surrounding states in reducing the rate of uninsured and offering affordable health insurance. That is progress worth defending.

Bevin’s partisan decisions to undo this good work are not yet a done deal, and Kentuckians who want to preserve these hard-fought gains must stand up and make their voices heard.

Emily Whelan Parento was executive director of Kentucky’s Office of Health Policy in 2013-2015. She is now associate professor of law and the Gordon D. Schaber Health Law Scholar at the University of the Pacific McGeorge School of Law.

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