Bills to preserve Kynect and Medicaid expansion head for votes in Democratic House despite a likely death in Republican Senate

By Melissa Patrick
Kentucky Health News

Bills to continue the Kynect health-insurance exchange and the state’s current expansion of the federal-state Medicaid program passed out of the House Health and Welfare Committee March 17, starting a series of legislative votes on health reform that once seemed unlikely.

House Speaker Greg Stumbo said he expects the bills to pass the Democratic-majority chamber, even though Republicans in the fall elections could cast votes as support for “Obamacare,” the federal reforms under which then-Gov. Steve Beshear created Kynect and expanded Medicaid.

“There’s never really been a debate on this issue,” Stumbo said. “There’s not been a true letting of the facts, if you will.”

Six days earlier, Senate President Robert Stivers had more or less dared Stumbo to move the bills, whose sponsor had said he did not expect them to pass the Republican-controlled Senate, in order to “have a full, fair debate on the issue” and see where legislators stand on it.

House Bill 5 would require the state to keep operating Kynect, which Gov. Matt Bevin is starting to dismantle or transform. In his campaign, Bevin vowed to abolish the exchange, saying it did nothing that the federal exchange does not. Recently his administration announced that it would continue operating a state-based exchange but use the federal exchange for enrollments.

“They’re being pushed into what everyone calls Obamacare, and they don’t want that,” Stumbo told reporters.

House Bill 6 would keep the current expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. Bevin is negotiating with federal officials to change the program, saying it will not be sustainable once the state has to start paying part of the cost.

Rep. Darryl Owens

The committee approved the bills along party lines. Their sponsor, Rep. Darryl Owens, D-Louisville, said he filed them because “It is important for people to understand that there are those of us in this legislature that want to continue expanded Medicaid, that want to continue Kynect.”

The exchange is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which reform made unecessary. Approximately 1.4 million Kentuckians use Kynect, all but about 100,000 of them on Medicaid.

Kynect was started with federal grants. Rep. Robert Benvenuti, R-Lexington, argued that the state must include that $273 million when considering its cost. “I think most people in this room, most people in Kentucky, pay federal taxes as well, so this whole notion that there is a great federal money tree in which we can go pick off of and build things is just not correct,” he said.

Owens replied, “I’m not saying it’s a money tree, I’m just saying it’s a grant that the federal government gave the states if they wanted to develop their own system,” Owens said. “And I think the thing we miss when we talk about that is we have a great system; we have the best system in the country.”

Rep. Tim Moore, R-Elizabethtown, whittled the definition of Kynect down to a business that advertises and markets Medicaid and health insurance to Kentuckians, and asked, “How do you spend that kind of money to go out and build a marketplace for soliciting folks to do what would be in their own interest anyway?”

Cara Stewart of the Kentucky Equal Justice Center said the marketing has value because it has created a brand that Kentuckians recognize and trust, allowing them to know where to go to get health insurance. She said Kynect runs seamlessly to help Kentuckians shop and enroll in coverage for both Medicaid and federally subsidized insurance plans, unlike Bevin’s approach.

She said later that it now takes two minutes to reach customer service on Kynect and two hours on Benefind, which is operated by the state Department of Community Based Services. “We are radically changing the quality of service to Kentuckians,” she said.

Rep. Tim Moore

Moore said he was glad the bills would be voted on because Kynect and the Medicaid expansion had been created through “dictatorship,” not “the will of the people.” Beshear acted under a state law that requires the government to get as much federal money as possible for Medicaid, and he used his broad executive powers under the state constitution to transform the high-risk pool into Kynect.

Moore said Bevin’s election showed public opinion on the issue. However, a poll in November, after the election, showed Kentuckians supported the Medicaid expansion by 3½ to 1 and keeping Kynect by 2 to 1.

Democratic Rep. David Watkins, a retired physician from Henderson who voted for both bills, said, “It is kind of sad that our citizens don’t pay attention to what our politicians are saying because they do have consequences.”

Democratic Rep. Joni Jenkins of Louisville, chair of the House Budget Subcommittee on Human Services, said her panel’s hearings convinced her that the state needs to keep it. She said there is value in having one system for Kentuckians to access health insurance, and to have Kynectors, who not only help people access health insurance, but also help them access health services.

Emily Beauregard, executive director for Kentucky Voices For Health, said after the meeting that navigating health insurance is difficult, especially for those who have never had it. “We need to help connect people to a source of care and help them understand how to use their benefits and that’s what we’ve been able to do through Kynect,” she said. “Coverage alone is not going to solve Kentucky’s health issues.”

Benvenuti said after the meeting, “There are various ways to get people to health care and creating a huge governmental system that is duplicative of the federal system is simply not the best use of our dollars.”

As for Medicaid, Benvenuti said, “We’ve got to create a system where everybody who gets health care through an expansion population, or however you want to define it, has skin in the game and is responsible ultimately for their own health care.”

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