Some in Ky. worry about changes to Obamacare, Medicaid; others dislike insurance mandate and say coverage unaffordable

By Melissa Patrick
Kentucky Health News

As Republicans in Washington grapple with how to repeal and replace the Patient Protection and Affordable Care Act, Kentuckians are speaking out for and against it in interviews with state and national journalists.

Mathew and Clare Johnson told Deborah Yetter of The Courier-Journal that they were delighted to get coverage under the state’s expansion of Medicaid soon after they moved to Louisville for his job as a Baptist pastor, a job with no health benefits.

“It was like a miracle,” Claire Johnson said. The family was on Medicaid for a year until getting commercial coverage through her employer.

Under the reform law, Kentucky expanded Medicaid to those who earn up to 138 percent of the federal poverty level ($16,394 for an individual and $33,534 for a family of four).  Until then, the income limit was 69 percent or less of the poverty line.

Dr. Barbara Casper, a physician at the University of Louisville, told Yetter that she treats many low-income patients, most of them working and many covered by the expansion, and some have made “dramatic strides toward better health” because they now have coverage. “I don’t want to see us go back to the way it used to be,” she said.

Mathew and Claire Johnson and kids
(Courier-Journal photo by Matt Stone)

Mathew Johnson told Yetter that it’s upsetting to hear comments, like those made by Republicans in Frankfort, suggesting that people on Medicaid are looking for a handout or unwilling to work.

“I’ve talked about it in my sermons,” he said. “I thought it was important that we come out as someone on Medicaid. . . . There’s an assumption that if you’re on Medicaid, you’re lazy, and a taker, and don’t want to work. It’s really shocking that elected officials don’t have a basic knowledge of how these programs work that they’re trying to get rid of.”

Yetter notes that more than half the 440,000 people added to Medicaid through the expansion work at jobs that don’t provide health coverage, such as food service, construction or farming, according to a study by the Kentucky Center for Economic Policy.

Republicans in Washington  are working to repeal the law and find a replacement. One broad proposal calls for turning Medicaid into a block-grant program, which would provide a set amount of money to states. Critics say this would eventually cause dramatic cuts to already scarce resources, and people on the program worry.

“We’re watching every move they make, and it’s scary,” Diane Cahill, a Lexington mother whose disabled adult son relies on Medicaid for his health care, told Yetter.

Others are worried about losing the reform law’s protections for pre-existing health conditions. Clare Johnson told Yetter that she was refused health coverage in North Carolina because she had asthma. Instead, she was placed in an expensive high-risk pool that provided few benefits, and Matthew and their son had to get a separate, high-cost plan.

PBS NewsHour also explored how Kentuckians felt about the reform law, with a trip to Corbin. Several believe strongly that it shouldn’t require people to buy health insurance or pay a fine, even after being told that health insurance systems require both healthy and unhealthy people to enroll if the goal is to keep costs down.

Paul Salmon interviewed Perry Partin, Elisabeth Easton, Bobbie Smith and (not pictured) Kathy Oller.

“It was forced on me, shoved down your throat, whether you wanted it or not,” said Perry Partin, a security guard who said he voted for President Donald Trump.

Agreeing with him was Bobbie Smith, who bought subsidized health insurance on the federal exchange in 2016 after being diagnosed with breast cancer in 2015, when she lacked coverage because she missed the enrollment deadline. “I think if I were to walk around here with no health insurance, and that’s what I choose to do, then that’s my right,” she said.

Kathy Oller, who helps enroll people in Obamacare coverage, said enrollment had slowed down, probably because people expect the requirement to buy insurance, called the individual mandate, will be repealed. Experts say enrollment is down because coverage is more expensive, deductibles are higher and fewer insurance companies offer plans on the exchanges.

Anthony Flannery, a health-care worker, reminded PBS of how expensive premiums and other costs can be: “I was looking at like $280 with a $6,000 deductible that would then pay 60 percent of any medical expenses I may incur. And I was like, no, I’m not doing it. So I will pay the penalty. So, last year come tax time, I owed $652.”

Elizabeth Easton, who said she didn’t vote in the election she was “high and suicidal,” now has coverage through the expansion, which covers mental-health and addiction treatment: “It saved my life,” she said. “It’s — yes, it’s great.”

Republicans have called for the repeal of “Obamacare” since it became law in 2010, but now that they are in charge, they worry that eliminating or reducing coverage could hurt them politically.

Cornell University economist Robert Frank told PBS that people react badly when they have something taken away: “Millions have coverage now for the first time. And if they take people’s coverage away from them with this new repeal measure, you’re going to see a political firestorm unlike anything we have seen in recent history.”

Republican Gov. Matt Bevin supports repeal and block grants, and is pursuing a proposal he made before the election, to require many if not most Medicaid recipients to work and pay premiums based on income. The Trump administration is expected to approve the plan.

“That’s ridiculous,” Ewell Scott told Yetter, who writes that he is “a retired Morehead physician who aid the additional money the Medicaid expansion has pumped into Kentucky — an estimated $3 billion — has revitalized struggling regional hospitals, including the St. Claire Regional Medical Center at Morehead, and created scores of new jobs.”

Yetter notes that a Foundation for a Healthy Kentucky study found that uncompensated care at Kentucky hospitals dropped from $2.4 billion in 2012 to $552 million in 2015, a decline of 77 percent.

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