Most Kentuckians want Medicaid to cover as many people, and say Bevin should leave Kynect alone; advocates hopeful

By Melissa Patrick
Kentucky Health News

A recent poll found that a majority of Kentucky adults want new Gov. Matt Bevin to keep Medicaid as it is rather than change it to cover fewer people, as he has vowed to do.

All graphics from Kaiser Family Foundation report

The Kaiser Family Foundation poll found that 72 percent of Kentuckians said Bevin should keep Medicaid as is, and 20 percent said it should be scaled back to cover fewer people.

A majority of Democrats (89 percent), independents (75 percent) and Republicans (54 percent) said the Medicaid expansion should be kept as it is. Even among those who said they voted for Bevin, 43 percent said they wanted to it to cover as many people.

Kentucky was the only Southern state to fully embrace the federal health reform by creating its own health-insurance exchange and expanding Medicaid to those who make up to 138 percent of the federal poverty line. About 425,000 Kentuckians have signed up for insurance since the expansion, most of them for Medicaid. Overall, the poll found that 63 percent of Kentuckians have a favorable opinion of the state’s Medicaid expansion to households with incomes up to 138 percent of the federal poverty level.

Bevin has said the state can’t afford the expansion and has promised to scale it back, but that doesn’t necessarily mean that it will cover fewer people.

In his inaugural address, Bevin said Kentucky would “copy the best parts” of Indiana’s plan, which, through a federal waiver, created a modified expansion program that requires varying premiums and has provisions to remove those who don’t pay them. Both of these features are in line with Bevin’s desire to make sure this population has some “skin in the game.”

Outgoing Gov. Steve Beshear maintained until his last days in office that the expansion is affordable, citing a state-funded Deloitte Consulting study that says it will pay for itself through 2020 by generating health care jobs and tax revenue. However, the total health-job gain since the expansion began appears to be about two-thirds of the number the study predicted at this point, and not all those jobs can be attributed to the expansion.

Bevin has also said he will dismantle the Kynect exchange, where Kentuckians buy federally subsidized insurance, and shift its users to the federal exchange. Kynect was built with $283 million in federal grants and its Beshear-appointed administrator estimated that it would cost about $23 million to dismantle.

The poll found that 52 percent of Kentuckians want to keep Kynect; 26 percent support a switch to the federal marketplace; and 19 percent weren’t sure.

This support for Medicaid expansion and Kynect is good news to health advocates who hope to persuade Bevin to change his mind, Deborah Yetter reports for The Courier-Journal.

“I hope Gov. Bevin is paying attention to these findings and listens to the people,” Bill Wagner, executive director of Family Health Centers in Louisville, told Yetter. “I hope we won’t blindly follow the Indiana model. I think it’s a race to the bottom.” Wagner said he would rather Kentucky design its own program if Bevin’s administration insists on changes.

More than half of Kentuckians (56 percent) said Medicaid is either “very important” or “somewhat important” for them and their family, with 46 percent of that group saying they felt so because they know someone who has received health care through the program. Even more Kentucky adults, 65 percent, said they know an adult with Medicaid coverage.

The poll also found that most Kentuckians still don’t understand Medicaid and Kynect.

For example, only 16 percent of respondents were aware that the federal government pays for nearly all of the Medicaid expansion cost, with about a quarter (24 percent) of them thinking the state pays for most of it and 39 percent thinking the federal and state government share the cost equally.

In fact, the federal government pays for the expansion in full through 2016. In 2017 and 2018, Kentucky will be responsible for 5 and 6 percent, respectively, with its cost rising in two more steps to the reform law’s cap of 10 percent in 2020.

Senate President Robert Stivers said at a Republican caucus retreat in early December that the Senate does not plan to block the estimated $257 million needed to cover the state’s part of the expansion in the two-year budget that begins July 1.

Kentuckians also don’t know much about Kynect, with only 12 percent saying they know “a lot” about it; 22 percent “some;” 31 percent “only a little;” and 34 percent “nothing at all.”

In addition, 37 percent said they believe the reform law and Medicaid expansion have caused people to lose health insurance. While some people had to get new policies to replace those that didn’t meet the law’s requirements, Kentucky’s uninsured rate has dropped from 20.4 percent to 9 percent since the implementation of health reform, the largest drop in the nation.

Although most Kentuckians have a favorable view of Medicaid expansion and Kynect, about half (49 percent) say they have an unfavorable view of the law, often called Obamacare, while 41 percent have a favorable view. These opinions were split along party lines.

Almost one-fourth (24 percent) of Kentuckians want health care to be the top priority of policy makers, with health-care costs and keeping the reform law, Kynect and the Medicaid expansion listed as their top two priorities.

The poll surveyed 1,017 Kentucky adults via both landline and cellphones between Nov. 18 and Dec. 1. The margin of error is plus or minus four percentage points.

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