balance personal responsibility with the obligation to care for the
poor,” Laura Ungar and Chris Kenning report for The Courier-Journal.
to $27,” Ungar and Kenning note. “Those who don’t pay can be disenrolled, and anyone below the
poverty level who fails to make payments is put into a ‘basic’ plan that
has fewer benefits and requires co-pays for care. It also includes
financial disincentives to repeated use of hospital emergency rooms,
among other provisions. . . . The jury is still out on whether the approach saves money, promotes more responsible behaviors or adds barriers to accessing care, said Indiana University health researcher Kosali Simon.”
lowest-income people can affect access to care,” Emily Beauregard,
executive director of Kentucky Voices for Health, a coalition of pro-Obamacare groups, told The Courier-Journal. Other experts told the Louisville newspaper that “small co-pays and premiums typically don’t add up to meaningful
revenue in state coffers – and may not even offset the cost of
collecting them – with any savings likely coming from deferred care or
fewer signing up for Medicaid,” Ungar and Kenning write.
big impact on beneficiaries,” Dr. Benjamin Sommers of the Harvard School of Public Health. Just what sort of impact is open to debate. Bevin says, “Having skin in the game is a big, big differentiator between whether or
not the person has the dignity that goes with making decisions for
themselves.” Health-reform advocates say complicating the system makes it harder to navigate, discouraging use of it, and becoming the main source of saving for the taxpayers.
But Darrell Patton, a Prestonsburg insurance agent who has helped people in Floyd County sign up for Medicaid, told The Courier-Journal that “skin in the game” is a good idea: “While some of Patton’s clients couldn’t afford even small premiums,
he said, too many work for cash and qualify for Medicaid while driving
$40,000 trucks.” Patton told the paper, “If you don’t have any kind of responsibility,
sometimes you’ll seek the most convenient care – which is in a lot of
cases the most expensive care,” such as the emergency room.
“Others say it’s not right to impose more costs on the neediest residents in a county where nearly one in three lives in poverty,” Ungar and Kenning report. “Laneta Auxier, clinic coordinator at Mountain Comprehensive Care Center
in Prestonsburg, said she agrees people should take responsibility for
their care, but some patients can barely afford gas to get to the
doctor, let alone co-pays.”
“If Kentucky adopts an Indiana-style Medicaid expansion, Miller said,
collecting co-pays will prove a challenge, based on his experience with
the one Medicaid company he deals with that charges them. Doctors must
document that they tried to collect, and the cost of sending out letters
to those who can’t afford a $2 co-pay can be $5 or $10.”