Health advocates, providers and faith leaders voice concerns about Medicaid plan; one says it’s based on false assumptions

By Melissa Patrick
Kentucky Health News

FRANKFORT — Health advocates, providers and faith leaders spoke out against Gov. Matt Bevin’s proposed changes to the state’s Medicaid program at a news conference July 20, saying it creates barriers to access, is too complex and is based on false assumptions.

“The proposed changes to Medicaid by Governor Bevin and his staff will impact the health and economic wellbeing of hardworking, low-income Kentuckians, families and our most vulnerable citizens across the Commonwealth,” said Rich Seckel, executive director of the Kentucky Equal Justice Center.

The news conference was sponsored by KeepKYCovered, a campaign coordinated by Kentucky Voices for Health, an umbrella organization for groups focused on sustaining access to affordable health coverage in Kentucky.

Col Owens, a director of KVH and a retired Legal Aid lawyer, was one of the most vocal opponents of the Medicaid proposal, saying it is based on inaccurate assumptions.

He said the notion that low-income workers don’t sign up for health insurance because they don’t know how it works is false. He said it “has little to do with understanding insurance and virtually everything to do with affordability.” He noted that the costs of health insurance and health care are rising faster than wages, which have remained stagnant for decades, and that fewer employers than ever are offering health insurance: 56 percent, down from 70 percent in 1980.

As for the idea that people need “skin in the game,” as Bevin contends, Owens said, “Low-wage workers do not earn enough money to achieve economic stability for their families, and it is simply untrue, demonstrably untrue, that they have enough sufficient disposable, discretionary income in order to pay co-pays, deductibles or premiums.”

As for the work requirements, he said, “It is a great fallacy to believe that low-income people must be forced to work by holding out goods or services for things that they need. … The truth about Medicaid is quite the opposite: it is what allows people to work.”

The Kentucky Center for Economic Policy found that more than half of Kentuckians who gained Medicaid through the 2014 expansion by then-Gov. Steve Beshear are working.

Bevin’s proposed work and volunteer requirements were particularly upsetting to entrepreneurs and farmers, jobs that require long hours and often the need to work a second job to make ends meet.

“The work requirements of the new proposal feel like a slap in the face to hard-working families like mine,” Oldham Coutny farmer Bree Pearsall said in a prepared statement. “To assume that because I am low-income that I have an inferior investment in my family’s health is an insult. I would like to see the governor act with compassion, instead of creating a culture of shame for families who receive health care coverage through Medicaid.”

Tyler Offerman, 27, of Lexington, who recently started an outdoor-adventure company while working full-time in a restaurant, said the expansion of Medicaid “allowed me to follow the American dream, and it supports other young entrepreneurs in doing the same. To assume people like me are lazy or are mooches to the system is totally offensive. I am an entrepreneur. I am trying to create jobs, to create a living for myself, and the kind of  rhetoric that is coming out of the Bevin administration is very offensive.”

Under Bevin’s plan, Medicaid recipients would be required to pay premiums, which initially range between $1 and $15. Non-payment would result in a six month lock-out for those who are above the federal poverty level, though they can re-enroll if they get current on their payments and take a financial- or health-literacy class. Those below the poverty level or who are medically frail and don’t pay premiums would shift to a co-payment system and have $25 deducted from their rewards account, which is then suspended.

Father Dan Noll of the Catholic Conference of Kentucky said that the complexity of the plan would discourage access, and strongly opposed the premiums.

“Kentucky cannot sacrifice people because they are poor,” Noll said. “Many more lower income individuals and families in Kentucky will lack the resources to meet the financial burdens of their healthcare under Governor Bevin’s health-care plan. To these families, an increase in premiums, cost-sharing charges and a lock-out period will be significant barriers to obtaining coverage or seeing a doctor, much less a dentist or eye-doctor.”

Dr. Eli Pennington Pendleton, a family practice physician in Louisville who cares for the poor, said he was “deeply troubled and dismayed” by the plan.

“I had people come to me with tears in their eyes, overjoyed that they were finally able to take charge of their health problems. I had people quit smoking, get their blood pressure and diabetes under control, get much needed glasses, and finally address long-standing dental issues. Many of these patients were able to then enthusiastically rejoin the work force,” he said.

“I worry that Gov. Bevin’s plan will erase all of this progress and more. We know that premiums tend to decrease overall coverage; we know that co-pays decrease frequency of visits and discourage people from seeking immediate care; lock-outs compromise the management of complex chronic disease and decrease downstream cost, both for the patient and the system as a whole; and impoverished patients… are not helped by complex requirements for extended coverage.”

Deacon William Grimes, who runs the New Hope Clinic in Bath County, one of the state’s poorer counties, said many of his patients have no income and don’t have enough money to pay for a $4 generic prescription.

“If they can’t pay a $4 generic, how are they going to pay a co-pay, how are they going to pay premiums, how are they going to pay for anything?” he asked. “Yes, there are some people who this ‘skin in the game’ might help, but the people I deal with can’t afford it.”

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