Don’t cut Kentucky Medicaid, build on it

Dustin Pugel
Dustin Pugel

We all want to live in a thriving community where everyone has the chance to succeed. The building blocks of such a community include a good education, safe neighborhoods, reliable roads and healthy people — and insurance coverage is foundational for ensuring we are all healthy.

Thanks to the Medicaid expansion, more and more Kentuckians have a stake in their own health care and we all will benefit because of it.

In fact, if we’ve learned anything from the last two-and-a-half years of the Medicaid expansion, it’s that people are able to engage in their health care exactly because they are covered in the first place. Here are some examples:

▪  Preventative screenings for conditions like colorectal cancer, cervical cancer, high cholesterol and diabetes through Medicaid have all doubled.

▪  Regular dental check-ups have doubled.

▪  Tobacco-use counseling and interventions have nearly tripled.

▪  People are getting more regular care for chronic illnesses like asthma, hypertension and depression, and are less likely to skip taking prescribed medicine.

▪  Emergency rooms aren’t being used as a “usual source of care” as often.

▪  More people have a personal doctor and they’re going to annual check-ups more.

Already, according to an important new academic study, there’s been a 4.8 percent increase in low-income adults who report they have “excellent health” in Kentucky and Arkansas, which expanded Medicaid, compared to Texas, which did not.

Despite these gains, the Bevin administration is proposing to erect barriers to Medicaid coverage that will make such progress harder to continue. Past experiments show premiums, lockout periods and other barriers included in the administration’s plan result in loss of coverage. The administration’s proposal admits that at least 86,000 fewer Kentuckians will be covered if the plan is implemented.

The proposal incorrectly assumes that if you make it harder for people to get Medicaid they will somehow get good jobs that will allow them to obtain employer-sponsored health insurance. Such a claim is at odds with reality.

For the last few decades, wages have been stagnant, good jobs are scarce and employers are less often providing benefits. In 1980, 70 percent of Kentucky workers were covered through employer-sponsored health plans. Today that has fallen to 56 percent.

Most of those covered by the Medicaid expansion are working now — they just work in low-wage jobs in restaurants, construction, retail stores and other low-paying sectors.

Many parts of the state face a shortage of jobs because of fallout from the Great Recession or other transitions in the economy. Only 28 of Kentucky’s 120 counties have more jobs now than they did before the Great Recession. Also, other Kentuckians are caregivers for children and family members or face barriers to the labor force because of factors such as a lack of training, an inability to afford child care or a prohibitive criminal record.

One bright spot in our economy has been the healthcare sector, thanks in part to the federal dollars coming in because of Medicaid expansion. In the last two years, the state has added 9,000 jobs in hospitals and outpatient-care facilities.

If sustainability is truly a concern for Kentucky, then we should carefully consider what moving backward on our health care would mean: sicker people, fewer jobs and less money flowing into the state. The Medicaid expansion is already saving us money, but there are ways to make it work even better in the long run, both for those it covers and for the state budget.

Options include unfreezing the hospital provider tax that has been capped at 2006 levels despite the billions more dollars in revenue hospitals are receiving, and moving Medicaid reimbursements toward a model that focuses more on people getting healthy than on the number of treatments they receive.

We all do better when we all do better. Our commonwealth will thrive when building blocks like good health are in place. So far, the Medicaid expansion has us pointed in the right direction, and our investment is paying off. The administration should build on this progress and not move the state backward in the final proposal it sends to Washington.

Dustin Pugel is research and policy associate at the Kentucky Center for Economic Policy.