Kentucky leading the way in Medicaid expansion compared to neighboring states
Published 12:05 am Sunday, February 7, 2016
Kentucky is leading the way in Medicaid expansion when compared to neighboring Tennessee and Virginia, which didn’t expand Medicaid as part of the Affordable Care Act, according to a Families USA teleconference Wednesday.
“In 2014 with the expansion we saw the uninsured rate plummet. The majority of people who became insured were workers,” said Cara Stewart, health law fellow for the Kentucky Equal Justice Center. “Anywhere there were minimum wage workers we saw a consistent reduction. It’s fantastic that someone looking for coverage that they’re going to get it with Medicaid.”
Although Kentucky Gov. Matt Bevin plans to change the Medicaid expansion program, Stewart isn’t worried.
“I embrace the idea of transformation,” she said. “It looks like we’re going to keep our population covered.”
Medicaid expansion states saw an average of 25 percent decrease in uninsured workers while non-expansion states saw a decrease of only 13 percent, according to a report by Families USA, the national organization for health care consumers.
“Thirty-one states and the District of Columbia have Medicaid expansion. Nineteen states do not,” said Dee Mahan, Families USA director of Medicaid Advocacy. “States can take up the expansion at any time.”
Medicaid expansion puts states “on a path toward building a healthier, more productive work force,” Mahan said.
“Ages 18 to 64 are most likely to benefit,” she said. “That’s not only good for workers, it’s good for economies, too.”
Although one or two years don’t give the complete picture, people with illnesses such as substance abuse and cancer benefited from the expansion, Stewart said.
“In the first year, we saw a reduction in smoking, obesity and cancer deaths. There was access to preventative care such as screenings,” she said. “We’re keeping people healthy. If you’re getting treated, you’re going to have healthier workers. Neighboring populations are missing out.”
One of those neighboring states is Tennessee, which state Sen. Dr. Richard Briggs, a heart and lung surgeon, was not happy about.
“I’m not pleased that my state is one of 19 not to extend Medicaid expansion. It never got out of the committee. It failed miserably,” he said. “Some people thought it would increase the debt. It’s not going to cost the state or taxpayers any money.”
Tennesseans are suffering, said Briggs, a Knoxville Republican.
“We still have a large number of people who have no access to health care,” he said. “Our state is 45th in the nation in general health parameters. It affects economic development. It affects how children do in school.”
Briggs gave a hypothetical example of a cardiac patient who has to come in to get a stent. The patient may need medication to keep the stent from clogging that costs $200 to $300, an amount the patient may not be able to afford. Some time later, the patient comes in having a major heart attack. Instead of facing a large bill, the patient could’ve gotten the necessary screening to keep everything from happening in the first place.
“I think that’s a perfect example,” he said. “The patient may have major surgery and never go back to work.”
Ray Scher, treasurer of the Virginia Organizing State Governing Board, saw similar situations happen in Virginia.
“I sympathize with Dr. Briggs. His experience mirrors ours,” he said. “We’ve given them the moral, logical and ethical reasons to expand Medicaid. Virginia does not take care of its own.”
Thanks to the Affordable Care Act, Virginia was able to enroll about 360,000 people, but it wasn’t enough.
“We had good employers to give employees an extra half a shift to qualify for the marketplace. Over a quarter we had to turn down because they didn’t qualify for marketplace subsidies. We had to explain not only were they not making enough money, but there was no help for the people below that,” Scher said. “It was embarrassing. It brought tears to our eyes. People could not get health care of any fashion – young people, working people, veterans. No health care was being offered.”
The report, “Medicaid Expansion States Help More Working People Get Health Coverage,” used Census data to compare uninsured workers in all 50 states between 2013 and 2014, the first year Medicaid expansion was offered, according to a press release.
Beginning in 2014, Medicaid expansion offered states the chance to extend Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty, or $27,724 for a family of three in 2015, according to the news release. In most states that have not extended Medicaid coverage, non-disabled adults without dependent children with incomes below poverty are not eligible for Medicaid and make too little to qualify for tax credits to purchase marketplace coverage. Most of these individuals are left with no option for affordable health insurance. The federal government pays 100 percent of the expansion costs through 2018. Beginning in 2017, the federal share gradually declines until it reaches 90 percent in 2020, where it stays.
— Follow features reporter Alyssa Harvey on Twitter at twitter.com/bgdnfeatures or visit bgdailynews.com.