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DON’T THROW OUT THE BABY
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
I
mmediately after his election, Gov. Matt
Bevin vowed to “dismantle Kynect by the
end of 2016.” He said that “It’s redundant
and adds no value” to the federal program
and that the Commonwealth cannot afford
to continue it. He may not do that (after all,
he said in his campaign he would release his
tax returns, but now refuses to do so). He
has said he may try to work with the federal
government to change eligibility thresholds
(so far no state has succeeded in that) and
to add copays, penalties and premium supplement payments for the person insured,
citing the Indiana version of the health insurance exchange.
Since his pronouncement, people who
work in health care policy both here and in
Washington have estimated the cost of killing off Kynect. The original estimate of $23
million has been derided by many as failing
to consider realistically the Feds’ response
to ending the program. The federal government contributed at least $136 million
to help set it up, and another source at the
Kaiser Family Foundation said that Kentucky spent $283 million in federal funds
to implement it. Will the Feds ask for repayment? Any funds to “decommission”
our state exchange must come from the
General Fund (all our tax-paying pockets)
and certainly the cost could soar far above
$23 million, and succeed in dismantling a
lot of lives, as well. Right now our uninsured
rate has dropped from over 20 percent to
about 9 percent; our ACA-related Medicaid
expansion now covers 400,000 Kentuckians
with another 100,000 enrolled through other insurance plans on the exchange.
The cost that Gov. Bevin says that we
cannot afford is the growing proportion
through 2020 that we pay, with the federal
government walking down its contribution,
to the eventual 90 percent from the current
100 percent for the Medicaid expansion.
That means that we will need to budget an
extra $250 million that includes 2017, and
an extra $400 million for the 2020 one.
Indiana in early 2015 did join in the Medicaid expansion program, after working to
gain approval from the Feds for novel proposals designed to encourage more accountability to “plan, use and pay for health care”
in a financially responsible way. Hoosiers
using their state’s version of the ACA Medicaid plan can lose their coverage for six
months if they fail to pay a given portion
of the premium (ranging from just over $4
per month for one per