Kentucky Health News
The major-party campaigns for governor disagree on all of Kentucky’s major health issues, sharply on such topics as the Medicaid expansion, the Kynect health-insurance exchange and a statewide smoking ban.
Those differences and others were explored Friday in Bowling Green, at a forum sponsored by the Kentucky Rural Health Association, by Republican candidate Matt Bevin and Democrat Sannie Overly, Attorney General Jack Conway’s running mate for lieutenant governor.
The questions were composed from a list of questions from the audience, most of whom had attended the annual KRHA conference prior to the forum. Conway was scheduled to attend, but sent Overly, citing a scheduling conflict.
Overly, who spoke second, said on more than one occasion during the forum that the candidates’ views on Medicaid expansion under federal health reform was their main difference on health care. Bevin says the expansion is unaffordable and he would replace it with a different program that he has yet to nail down. Conway says that would be premature.
The expansion of Medicaid eligibility, to people in households earning up to 138 percent of the poverty level, has added about 400,000 Kentuckians to the federal-state program. Overly cited the state-funded study by Deloitte Consulting that predicted the expansion would pay for itself, by bringing more people into the health-care system, creating jobs and tax revenue.
The study says the expansion would put $820 million into the state’s economy through 2020, but would not pay for itself in 2021. Overly said, “We just simply believe that you don’t throw 500,000 Kentuckians off their insurance today because of something that may or may not happen in six years,” she said.
The federal government is paying the full cost of the expansion through next year. In 2017, the state would pay 5 percent, rising in annual steps to the law’s limit of 10 percent in 2020.
Bevin, who spoke first, said he expects that states will have to pay more than the law now calls for because “the federal government is broke.” He said Kentucky won’t be able to afford the 10 percent, let alone a higher figure.
He said Gov. Steve Beshear spent $144,000 on the study “to delude us into thinking that we are actually making money from this.” He added, “We are not. . . . You don’t make money by spending other people’s money.”
Bevin declared, “We will not, and I can’t be more clear about this,we will not continue to enroll or re-enroll people at 138 percent of the federal poverty level. We can’t afford to. To do otherwise is to lie to them, is to mislead them, is to put too much cost on the taxpayer, to preclude us from being able to provide for those who most desperately need it.”
Asked what would happen to the 400,000 Kentuckians covered by the expansion, he offered a lengthy explanation.
Bevin acknowledged that he would have no authority as governor to “oust” the “initial folks” from Medicaid and said that we needed to “come up with a way to provide health care to them.” He acknowledged, “Nobody likes the idea of getting less than anything than they currently have.”
He said he would apply to the Centers for Medicare and Medicaid Services (CMS) for waivers under Section 1115 of the Social Security Act “to customize something that allows us to provide for these same folks.” In July, he said he would use examples from other states, such as Indiana, which requires Medicaid patients to make co-payments.
Bevin said people need to have “skin in the game,” because “When you rob people of any vested interest in their own success you rob them of any reason to care.”
He added, “There is nobody who is getting it that doesn’t have some element of need. There is no question about that. But I grew up well below the poverty level, we never had access to it, I managed to turn out. That isn’t to say that that is the answer, it is not. I know it is not easy. I know it is a struggle. But it is not as if these people will suddenly be destitute in the street if they don’t have everything that they currently have today.”
Bevin said getting federal Medicaid money in a block grant could allow the program to help people between 138 percent and 200 percent of the poverty level. “Maybe they have a health savings account where they get a certain allocation of CMS dollars through this 1115 waiver where they have their own account and so that they have some incentive, if they have prescriptions, to not get the $100 prescription if they can get the $20 generic, because they have power over that and they have an allocated amount of money that has been given to them.
“If we implement things like this, and we can and we should, then ultimately we are going to find that we are covering more people with better access and empowering them in ways that actually help them to streamline themselves back into society in ways that are good.”
Bevin said the Kynect exchange has been a success only because it was built on “other people’s money,” meaning federal grants, and reiterated that he plans to shut it down and move Kentuckians to the federal exchange because Kynect “is a level of redundancy frankly that does not serve us well.”
He said that the argument that Kynect only costs insurers 1 percent, compared to the 3.5 percent charged by the federal exchange is like comparing “apples and oranges” because the 1 percent is a fee on all health-insurance policies sold in the state, while the federal exchange’s 3.5 percent fee is levied only on policies sold through that exchange.
Overly reiterated that she and Conway plan to keep Kynect.
“We’ve been hailed as a national model for how to take the federal law and implement it here in Kentucky,” she said. “That doesn’t mean it’s perfect, and we will continue to work with folks in this room as we need to make additional changes to continue to improve Kynect, but I think we’ve done a pretty job of implementing it to this point.”
Bevin says bans on smoking should be local decisions, though he does support government buildings being smoke-free.
Overly said, “Jack and I are supportive of a statewide smoking ban,” noting that she had voted for it in the House during this last session.
After many complaints from hospitals and other health-care providers, the Cabinet for Health and Family Services changed its contracts with managed-care organizations that oversee Medicaid patients’ care.
Bevin said the changes have not gone far enough. “At a bare minimum, we need to ensure absolute strict compliance with streamlining this to the degree possible, but we would do well to simplify it even further,” he said.
Bevin said he absolutely supports tort reform and would be “very intentional” about moving it forward if elected. “If this race comes down to nothing else in your minds, the odds that you will have any kind of tort reform in this state in the next four plus years if Jack Conway is the governor of this state is zero.”
Bevin said he also supports medical review panels for malpractice and other lawsuits against health-care providers, but says they should be set up in a way to promote “thoughtful, intentional, self-evaluation” that doesn’t create a situation where the information disclosed can be used against you.
Overly, like Conway a lawyer, said, “I very strongly believe that we must keep our court system open for each and every Kentuckian. Having said that, Jack Conway has said that he would consider some amendments to tort reform here in Kentucky. We would take those on a case by case basis and where they make sense we would be willing to look at implementing those.”
Quality and quantity of health care
Bevin said to improve quality and quantity of health care, we must “sit down and have a modern, up-to-date, frank conversation about things like certificate of need, things like scope of practice, things like reimbursements and whether or not the number of MCOs we have is appropriate. . . . Everything should be on the table. . . . The heart of the answer to that question is the fact that we need to empower those at the point of contact.”
Overly said, “We have put forward a jobs plan, we have put forward an education plan and a number of components of those plans are things that will improve the lives of rural Kentuckians,” noting their commitment to bringing broadband to all of Kentucky. She also said that she and Conway would make sure rural health issues would “have someone at the table in Frankfort.”