Bevin letter says he will repeal Medicaid expansion; spokeswoman says he will find another solution

A mid-August fund-raising letter from gubernatorial candidate Matt Bevin says he would “repeal” the state’s Medicaid expansion if elected, returning him to essentially the same stand he took early this year.

The Republican’s campaign said he plans to replace the expansion with a different program approved by the federal government, but his vision of that appears to conflict with the federal health-reform law, which pays almost all the cost of the expansion only if states make eligible people with household incomes up to 138 percent of the federal poverty level.

“We will not continue to enroll people at 138 percent of the federal poverty level,” Bevin told Ronnie Ellis of CNHI News Service. “They will continue to be on it until we come up with a solution. But we are not going to re-enroll people at 138 percent.”

Bevin’s newly named communications director, Jessica Ditto, issued a statement saying “Matt has been consistent on the issue of Medicaid expansion from day one. Kentucky simply can’t afford to have a quarter or more of our citizens on Medicaid. What he has called for is repeal of Obama’s Medicaid expansion by applying to CMS for 1115 waivers (as other states have successfully done) in order to better customize a solution to address the healthcare needs of the commonwealth.”

The federal government pays the entire cost of the expansion through next year. In 2017, the state begins paying 5 percent, rising to the federal health-reform law’s cap of 10 percent in 2020.

A Deloitte Consulting study, funded by the state, says that the expansion will pay for itself throiugh 2020 by adding regular patients to the system, expanding jobs in health care and increasing income taxes paid by those workers. Bevin has called this report “nonsense.”

At the Kentucky Chamber of Commerce‘s Business Summit and Annual Meeting in July, Bevin said he would not immediately end the expansion, contrary to what he said for months. “That’s not what I’m calling for, at all,” he said, adding that he favors a modified plan based on the experience of other states like Indiana, which received federal waivers to create a program in which Medicaid beneficiaries have co-payments, can pay premiums for better benefits and get partial refunds if they don’t use the benefits.

Bevin told the Chamber that it was important for consumers to have some “skin in the game” when asked why he liked the Indiana plan, describing his belief that it is important for clients to have a “sense of ownership” in their healthcare and that charging them a co-payment is a way to treat people with “dignity and respect, and giving them the belief that they have control over their own situation and people are seizing that.”

The Kentucky Center for Economic Policy disagrees and says that the Indiana model “could prevent low-income people from getting the care they need, making health problems costlier down the road and creating barriers to sustaining the health coverage gains Kentucky has made in recent years, ” Ashley Spalding writes for the center.

In a Sept. 15 debate, Bevin said he would “tweak” the program, “largely
gliding past his February declaration that he would end the expansion ‘immediately’,” Lexington Herald-Leader political reporter Sam Youngman notes, adding that the letter is “a far cry
from a ‘tweak,’ and the closer we get to Election Day, the less clear
Bevin’s position on the issue has become. But the assumption that
most voters will check out the facts and look closely at the veracity
of what was said is a fool’s bet, and Bevin’s apparent strategy of
trying to muddy the waters on the issue might help him survive his many
contradictions.”

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