New state senator, a former hospital boss, says health system needs fundamental repairs to increase access and affordability

By Melissa Patrick
Kentucky Health News

Four state legislators held to their party-line opinions about Obamacare on KET this week, but one said instead of creating another “piecemeal” replacement for the federal law, we should first address fundamental problems with the health-care system.

State Sen. Stephen Meredith

The 2010 law has “added millions of people to a fractured health-care delivery system that can’t sustain itself,” Sen. Stephen Meredith, a Republican from Leitchfield, said on “Kentucky Tonight” Jan. 30. “If you truly want to change health care, we’ve got to be more fundamental in our approach.”

Meredith, a retired CEO of Twin Lakes Regional Medical Center in Leitchfield, called for a reduction in bureaucracy and regulations, as well as tort reform and unspecified “radical incentives” for healthier lifestyles.

He said to improve access to health-care providers in rural areas, payment policies must be fair. He said rural providers make 25 to 30 percent less than their urban counterparts.

He also said it’s time to stop the “profiteering” in health care, calling this practice morally wrong. “We should not make a fortune off the misfortune of others,” he said. “We have to recognize that health care is not a commodity like anything else that is in our economy; it holds a special place.”

In addition to Meredith, the program’s guests included Sen. Reginald Thomas, D-Lexington, another member of the Senate Health and Welfare Committee; Rep. Addia Wuchner, R-Florence, chair of the House Health and Family Services Committee; and Rep. Mary Lou Marzian, D-Louisville, a member of that committee.

Repeal or tweak?

Host Renee Shaw asked the lawmakers if they agreed with Gov. Matt Bevin’s Jan. 6 letter to Congress that called for the repeal of the federal law “in its entirety.”

Rep. Addia Wuchner

Wuchner, a registered nurse and former hospital administrator, said she agrees with Bevin. She said the law is “very costly,” causing insurance companies to increase their premiums and deductibles or pull out of the Obamacare exchanges. She also said the state can’t afford to pay for its relatively small but growing share of Medicaid expansion costs.

Meredith, who said he has been against the federal law since its inception, also agreed with Bevin, saying, “It’s too expensive. It’s too much regulation. And all the things that we were promised would occur, have not occurred.” And while he acknowledged that it had given many people access to care, he asked, “But you have got to ask at what price can we do that?”

About 1.3 million Kentuckians are on Medicaid, with about 430,000 qualifying through the program’s expansion to those with adjusted income up to 138 percent of the federal poverty level. The federal government paid the full expansion cost through last year, but this year states are paying 5 percent, which will rise in annual steps to the law’s limit of 10 percent by 2020, unless those provisions are repealed. Bevin estimates Kentucky’s cost at $1.2 billion over the next five years.

Shaw noted that under the law, Kentucky’s uninsured rate dropped from 14 percent to 6 percent and that Kentucky hospitals have saved more than $1 billion in uncompensated medical care costs.

Thomas and Marzian said the law needs “tweaking” to address costs and regulations, but didn’t think it needed to be repealed “in its entirety.”

Rep. Mary Lou Marzian

Marzian touted the benefits of the law, including access to preventive care, mental-health and addiction-recovery care, the elimination of lifetime caps on insurance payments, allowing young adults to stay on their parents’ insurance until they turn 26, and requiring coverage of pre-existing conditions.

“Before the Affordable Care Act, when we just let insurance companies run things, which the state did, they cherry-picked,” Marzian said. “So you could get a low premium, but if you had to use it, then they dropped you … or it didn’t cover anything.”

Thomas said the law’s mandate that requires everyone to have insurance or be taxed is necessary to make the law work, because insurance companies must have a large enrollment of healthy people who don’t use many services in order to cover their costs for sicker people. “That is what makes insurance affordable,” he said.

Thomas said he didn’t like anything about U.S. Sen. Rand Paul’s replacement plan, which would eliminate the individual mandate; eventually revert back to the old system of allowing companies to deny coverage based on pre-existing conditions; roll back many of the required benefits; and expand the use of health savings accounts, with a $5,000 tax credit.

“Most poor people are not going to have money to put into a health savings account; they barely have money to live from day to day,” Thomas said. “So his $5,000 tax credit is nothing more than a tax benefit to highly paid and middle income people.”

Block grants

Shaw asked the lawmakers if they agreed with Bevin’s support for turning Medicaid into a block grant program, which would provide states with a set amount each year.

Thomas said, “The block grant program would be a horrendous step back for this state in terms of dealing with our medical care needs.” He said block grants would not keep pace with the growing need for services.

Sen. Reginald Thomas

He also said moving to a block grant program would create “death panels” because such a decrease in funding will require states to make hard decisions about who gets care and who doesn’t.

Wuchner disagreed, saying that block grants would allow states flexibility to spend their money where it is needed the most.

“Our population may have some particular needs that we’re dealing with, let’s say addiction, where Arizona’s population may be aging and long-term care,” she said.

Meredith said he supports block grants, but took it a step further and said they should be distributed at the county level, because counties know best what their citizens need. He said county-level grants would encourage providers to do perform better and be more innovative.

Ideas to cut cost, without decreasing access to care


When asked for ideas to cut costs while not decreasing access to care, Meredith said tort reform and getting rid of unnecessary regulations would help. He also suggested “radical incentives” to help Kentuckians get healthy, instead of putting penalties on providers.

In response to this question, Marzian suggested increased preventive care, teaching people how to use their health care, more wellness and chronic-disease-management programs and anti-smoking legislation. She also said that insurance companies should be required to reveal their “book of business” before being allowed to raise premiums, noting that some insurance executives are making as much as $45 million a year. “Is that fair?” she asked.

Wuchner said tort reform and allowing companies to sell policies across state lines would help reduce costs, as would insurance pools for small businesses.

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