It is no surprise that Governor Bevin has attempted to implement major changes to our state’s Medicaid laws. One major change is that the state is now requiring recipients to work or pay for health coverage. Since inception with the prior administration, the new law has dropped the uninsured rate from about 20% (2013) to 7.5%.
Under the ACA, the feds pay the full cost of the health insurance expansion (which in Kentucky is Medicaid), until 2017. At that point, the State’s must begin to participate in cost sharing. Over a 3 year window (by 2020), Kentucky would have to fund about 10% of the raw cost of the health insurance expansion.
People get sick, and they get injured. The cost to a civilized society for health care is there whether we choose to believe it or not. Whether it is indigent care or managed care, people will use community health facilities and services. Bevin has concluded Kentucky cannot afford the status quo with the looming cost shift. Governor Bevin has proposed that the non-disabled work, or face or loss or lock out of coverage, and/or pay some nominal premium, maybe $1.00 to $15.00 per month.
The legal thorn here is directly linking Medicaid coverage to a work requirement. The fed’s CMS (Center for Medicare and Medicaid Services) must grant some kind of waiver. Absent a waiver, the proposed changes will likely fail a legal challenge, in which case two alternatives have been discussed: it either leave it alone (which Bevin believes Kentucky cannot afford); or end Medicaid as it currently exists and go back to the drawing board. While Medicaid insured about 1.3 million in Kentucky, caught in the crossfire here is a group of about 500,000 vulnerable Medicaid recipients.
The poor and working poor are a vulnerable group. As a disability lawyer, I have seen firsthand the benefit of this expansion. Claimants can see a doctor and get treatment, which generates medical proof. The medical proof usually does one of two things: (1) demonstrates the merit of the underlying case ad we win; or (2) with the benefit of treatment, the claimant gets better and goes back to work (or the case is simply denied). Professionally I am a fan of the current law because it can reduce the guesswork in the SSA disability vetting process. Ultimately, medical proof allows the SSA to make a better informed decision, which in many cases, is ultimately the right decision.
However, budgets are what they are, and with the loss of what is really a federal subsidy, if Kentucky truly lacks the money to continue, what compromise can be reached? These stakes are high and half a million Kentuckians are caught in the crossfire. I hope that greater minds then my own can solve this one. Should we incentivize the working poor? Should we make cuts elsewhere and keep this Medicaid program, or kill it and start over?
Comments are invited!
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