Ky.'s share of people with health insurance goes up again, giving state most-improved status, but future remains uncertain-HEALTHYLIVE

By Melissa Patrick
Kentucky Health News

In the third full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance continued to shrink, giving the Bluegrass State a larger drop in its uninsured rate than any other state.  So says a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

Map is from U.S. Census report
Kentucky's uninsured rate dropped to 5.1 percent in 2016, down from 6.1 percent in 2015 and 8.1 percent in 2014. In 2013, the year before the ACA was implemented, the rate was 14.3 percent.

Put another way, 95 percent of Kentuckians had health insurance in 2016, compared to 86 percent in 2013.

That gain came mainly because then-Gov. Steve Beshear expanded Medicaid under the ACA to those who earn up to 138 percent of the federal poverty line, adding about 470,000 Kentuckians to the free health-insurance program.

“It’s clear beyond a shadow of a doubt the Affordable Care Act is working. It has helped Kentuckians get the care they need to improve their health, work and take care of their families. It has created jobs in our state and kept many more Kentuckians from being an illness or accident away from financial ruin,” Kenny Colston, communications director for the liberal-leaning Kentucky Center for Economic Policy, said in a news release.

The survey also found that 96.7 percent of Kentucky's children had health insurance in 2016, up from 93.6 percent in 2013. Kentucky Youth Advocates estimates this represented an increase of 37,000 children. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program K-CHIP.

Medicaid and K-CHIP funding uncertain 

The recent gains aren't guaranteed to continue, with changes looming on both the state and federal level for both the adult and children's insurance programs.

Gov. Matt Bevin has submitted a proposal to overhaul the state's Medicaid program that largely targets "able-bodied" adults without dependents who qualify for Medicaid under the expansion. Bevin says the state can't afford to pay for this expanded population; the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020.

Bevin's plan is designed to encourage participants to have a higher level of involvement in their care through premiums and work or volunteer requirements. If approved, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted by federal officials. They are expected to approve Bevin's request, and perhaps allow other changes.

The Bevin administration has said that the goal is for these able-bodied adults without dependents to move to higher-paying jobs that offer employer-provided health insurance. Opponents of the plan say these higher-paying jobs are scarce in Kentucky, and note that many in this group already work at low-paying jobs that don't offer health insurance -- or if it's offered, it's not affordable.

KYA Executive Director Terry Brooks said some of the recent changes in Bevin's proposal could create "very real barriers to coverage" for adults, which research shows could result in fewer children being covered. "We also know that kids are more likely to have health insurance when their parents do," he said in a prepared statement.

Bevin spokesman Woody Maglinger told The Associated Press, "It may be a fact of life in Terry Brooks' alternate universe, but it is not a fact in Kentucky," Maglinger said. He noted that Bevin's plan would not change Medicaid eligibility requirements for children.

Last-ditch ACA repeal pushed in Senate

In Congress, Republican Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, are pushing a last-ditch effort to repeal the ACA and redistribute its funding from states that expanded Medicaid to states that did not, Sarah Kliff of Vox reports. The bill would reduce federal funding of Medicaid in Kentucky by more than $3 billion over the next 10 years.

Cassidy told The Washington Post that the bill has "48 or 49" votes, and Senate Majority Leader Mitch McConnell told Kentucky Health News that the bill will come to the floor if his allies can find 50 votes, which would put Vice President Mike Pence in position to break the tie and pass it. "There’s a lot of discussion, but the time is running on that," McConnell said Thursday afternoon. "It could well come up. If we have 50 votes, we’ll go to it."

The bill must pass by Sept. 30 to be allowed under budget-reconciliation rules that would prevent Democrats from filibustering it. Those rules could pose other obstacles to it, and the Congressional Budget Office has not said how the bill would affect the federal budget or the insurance-coverage rate.

Congress also faces a Sept. 30 deadline to extend funding for CHIP, which provides health coverage for roughly 9 million children. The Senate Finance Committee has agreed on a plan to extend the program for five years, but phase out federal funding in 2021.


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