A nonprofit publication of the Kentucky Center for Public Service Journalism

Paul suggests tax increase necessary if Kentucky wants to keep its expanded Medicaid coverage


U.S. Sen. Rand Paul suggested Sunday that Kentucky and other states that expanded Medicaid under federal health reform should have to raise taxes to keep it expanded and not rely on the federal government to continue the benefit.

Paul appeared on CNN’s “State of the Union” to discuss his plan for replacing the law, which he said should be replaced the same day it is repealed.

“Paul’s plan did not directly address the future of states that signed on for expanded Medicaid offered as part of Obamacare,” Gregory Kreig reports for CNN.

Paul appeared on CNN's "State of the Union" to discuss his plan for replacing the law, which he said should be replaced the same day it is repealed (KHN Photo)

Paul appeared on CNN’s “State of the Union” to discuss his plan for replacing the law, which he said should be replaced the same day it is repealed (KHN Photo)

“That’s the big question,” Paul told host Jake Tapper. “And I don’t think that’s going to be in the replacement aspect.”

Paul said the Obama administration misled the public about the federal government’s ability to pay for the expansion, “So I’d say that if you want to have more Medicaid you should say we’re going to have to have higher taxes to pay for it.”

Those taxes could be considerable. Under the law, federal funds covered all the expansion cost through 2016. States are now paying 5 percent, and the law calls for that will rise in annual steps to its limit 90 percent in 2020. Kentucky’s share for 2017 and the first half of 2018 is estimated at $257 million.

The expansion covers people in households with incomes up to 138 percent of the federal poverty level (about $33,000 a year for a family of four). It added about 44,000 Kentuckians to the program and was largely responsible for cutting by more than half the percentage of Kentuckians without health insurance.

A spokesman for Senate Majority Leader Mitch McConnell, Kentucky’s other senator, asked to reveal McConnell’s plans for the Medicaid expansion, said in an email, “Sen. McConnell will have lots more to say about this issue in the coming weeks.”

Paul said his replacement plan would allow health-insurance companies to offer cheaper plans with less coverage.

“We’re going to legalize the sale of inexpensive insurance,” he said. “That means getting rid of the Obamacare mandates on what you can buy. We are going to help people save through health savings accounts, as well as a tax credit.”

“Under Paul’s program, the bargaining power created by the state and federal exchanges would be replaced with a provision that allows individuals and associations like small businesses to create their own markets,” Kreig reports. “He added that those negotiations with insurance companies could also be used to guarantee the availability of policies that “can’t cancel you and guarantees the issue of the insurance even if you get sick.”

Paul told Tapper, “Our goal is to insure the most amount of people, give access to the most amount of people, at least the amount of cost.”

However, Paul is just one senator.

“Republicans have been at loggerheads over the timing and execution of their promise to repeal Obamacare and replace it with a cheaper alternative that will not disrupt the insurance market and leave millions of Americans without coverage,” Kreig notes.

Supporters of Obamacare rally in Kentucky, protest repeal plans

“The event was billed as a public forum on the consequences of repealing the [Patient Protection and] Affordable Care Act and Kentucky Medicaid expansion. But at times it seemed more like a political rally,” Andrew Wolfson reports for The Courier-Journal.

“Several hundred people turned out for the session hosted by U.S. Rep. John Yarmuth, D-Louisville, at the Louisville Central Community Center.” Protests were also held in Lexington and around the nation, WKYT-TV reports.

State Rep. Darryl Owens, D-Louisville, claimed President-elect Donald Trump is “hell-bent on destroying the lives of Kentuckians and Americans,” and state Rep. Jim Wayne, “another Democrat who has worked 40 years as a psychotherapist, went further, describing the soon-to-be president as ‘evil’ for vowing to repeal the Affordable Care Act and return to a competitive system for health care that ‘didn’t maintain our country’s health’,” Wolfson reports. “Yarmuth said Republicans want to dismember the law that has provided health care to 22 million Americans without offering any details on how they will replace it.”

“They say they want a free market system, which sounds to me ominously like what we had before the Affordable Care Act – when insurance companies decided who lived and who died,” Yarmuth said. Wolfson notes, “Critics of the Affordable Care Act say it is too expensive and that the requirement to get coverage is an intrusion on individual liberty.”

Yarmuth said he expects federal officials to approve the Medicaid waiver requested by Republican Gov. Matt Bevin, which would charge small premiums based on income and the require work, school or similar activities by able-bodied adults who aren’t primary caregivers.

The future of the Medicaid expansion, and the rest of the law, are in doubt because there has been no agreement on a plan to replace the law but retain certain core elements such as coverage of pre-existing conditions, which Trump has said he wants to keep. Experts say that requires a mandate to buy insurance, a provision Republicans don’t like.

“Speakers beseeched Trump and Republican leaders to replace the law immediately and to keep the features that Yarmuth said provide ‘health security’ for all Americans,” Wolfson reports.

From Kentucky Health News


Related Posts

Leave a Comment