Commentary: Kentucky should keep the Medicaid expansion as it is; say no to KyHealth alternative

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By Col Owens
Special to KyForward

I am a recently retired senior attorney from the Legal Aid Society of Southwest Ohio. During my career I concentrated on health care issues of our low-income clients, primarily Medicaid issues. Many of our clients relied on Medicaid. Others went without access to care — until the Medicaid expansion.

Ohio adopted the Medicaid expansion in 2013 with the strong support of Gov. Kasich. The Republican-dominated legislature opposed it but finally acquiesced. Since its implementation over 600,000 Ohioans have received health care, many for the first time. Ohio is now seeking a waiver to redesign its program, at the behest of the legislature.

Gov. Beshear expanded Medicaid in Kentucky via executive action. Since its implementation over 400,000 Kentuckians have received care, and health conditions among recipients have improved greatly. Most people agree that the expansion is a good thing – a Kaiser Family Foundation poll found in December 2015 that 72 percent of Kentuckians wanted to keep the expansion without changes.

Gov. Bevins won election on a promise to take the expansion down. He has instead also developed a waiver proposal to redesign the program. His proposal is based on several assumptions: that 1) low-income Kentuckians do not understand private insurance, 2) they do not adequately appreciate the coverage they receive, 3) they do not work unless required to, and 4) they need to have “skin in the game” by paying co-payments, deductibles and premiums, to achieve dignity.

These assumptions are demonstrably inaccurate. Here’s why.

First, not taking advantage of employer insurance. The failure of many low-income workers to take advantage of employer insurance, where offered, has little to do with understanding insurance. Studies show, and experience validates, it is a matter of affordability. Costs are rising much faster than wages. As well, employer-sponsored insurance is declining, from 70 percent in 1980 to 56 percent today. It is thus less of an option for workers generally, much less low-income workers, and is increasingly unaffordable.

Second, “churning.”

“Churning,” recipients going on and off the program because of failing to renew on a timely basis or other administrative failure, is not due to a lack of appreciation for the program or coverage. It is much more related to the overall complexity of the program, and the application and renewal processes, as well as the instability of many low income people’s lives.

Continuous and predictable coverage over time helps to decrease churning.

Third, work requirement. It is a great fallacy that low income people must be forced to work. This assumption inverts the real truth of Medicaid – that it supports working. Most low-wage jobs do not offer benefits. Taking those jobs leaves workers and their families vulnerable to any health care issue or crisis that might arise, such as an accident, illness, injury, or chronic illness.

Many low income people face major obstacles to working, including education and/or skills deficits, health issues, lack of transportation, or simply the lack of jobs. Notwithstanding these challenges, data show that most non-disabled low-income adults eligible for the Medicaid expansion are working.

Fourth, “skin in the game.” This is perhaps the most easily disproved of all these assumptions. Self-sufficiency studies show the living costs for varying-size families in specific communities or counties. They take into consideration all basic living costs, such as housing, food, utilities, health care, child care, transportation, etc.

They routinely show that while many low-wage jobs, especially those near the minimum wage, pay below-poverty wages, the needs of almost all families lie somewhere near 200 percent of the poverty level.

Low-wage workers do not earn enough money to achieve economic stability for their families. It is simply untrue that low-income people have sufficient discretionary income with which to pay co-payments, premiums or deductibles.

Conclusion: Low income people, like all people, need health care. Medicaid provides that. Low income people want to work, if they are able, to provide for themselves and their families. Medicaid helps them to do so. Low income people, like all people, want dignity. Medicaid helps them achieve that.

Finally, low income people want to get ahead economically, so they can assume greater responsibility – and ability – to “pay their way.” Medicaid helps with that.

The Medicaid expansion has achieved significant gains for hundreds of thousands of Kentuckians. This is an amazing accomplishment in the first years of implementation. Over time it will more than pay for the state’s investment, by reducing health care conditions and costs, by increasing employment, by creating health care jobs, by reducing uncompensated care costs that get inefficiently, dishonestly and unfairly re-distributed to the rest of society, and by increasing revenue from a healthier, more stable and productive workforce.

Kentucky should keep the Medicaid expansion as it is.

Col-Owens-Resized-Photo-300x300

Col Owens is retired senior attorney from the Legal Aid Society of Southwest Ohio and a member of the Kentucky Voices for Health board of directors. He lives in Northern Kentucky.

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