Op-Ed: ACA Repeal Would Be Devastating in Ky.

This column originally ran in the Courier-Journal on Jan. 31, 2017. It ran in the Kentucky Gazette on Feb. 1, 2017. The Richmond Register published it on Feb. 2, 2017

Communities thrive when they have a strong foundation made up of things like good schools and quality healthcare. The Affordable Care Act empowered Kentucky to bring healthcare to half a million of our citizens, protect ourselves from harmful insurance practices and boost our economy.

Repeal would undo all of that progress.

First and foremost, an estimated 486,000 Kentuckians would lose insurance coverage from ACA repeal. Because we were so successful at signing people up for coverage, we would have the third largest increase in the rate of uninsured of any state if the law went away.

When it comes to the protections we would lose as Kentuckians, a few critical ones stand out:

  • 1.9 million privately insured Kentuckians, as well as 863,000 seniors on Medicare, could lose free preventative care.
  • 1.4 million Kentuckians, including children, could see lifetime or even annual caps placed on their insurance coverage.
  • Women could be charged premiums as high as 57 percent more than men.
  • All insured Kentuckians could lose protection from being overcharged by insurance companies.
  • Disabled and older Kentuckians would pay more for prescription drugs, or else forgo them entirely.

And what about the popular guarantee of coverage for preexisting conditions in the ACA? If it is repealed, 1.9 million Kentuckians with conditions like asthma, diabetes, cancer and even pregnancy could see their premiums dramatically increase, or simply be denied insurance coverage altogether. But keeping the preexisting coverage protection without requiring everyone to be insured will touch off what’s called an insurer “death spiral,” leading to skyrocketing premiums or insurers pulling out of the individual market altogether. This would be devastating for Kentuckians who buy coverage directly from an insurance company.

Finally, the billions of dollars the federal government has pumped into Kentucky have been a major boost to our economy. If repeal moves forward and that money suddenly evaporates, every part of the commonwealth will feel it.

  • 45,000 jobs would be lost by 2019.
  • Over five years beginning in 2019, Kentucky would lose nearly $41 billion in business output.
  • Kentucky would see $718 million less in state and local tax revenue in the midst of a health crisis and a massive pension liability that has already pushed lawmakers to undermine critical state services.

Taken together, this is not the formula for a thriving community. It would, however, wreak havoc on our healthcare system and reverberate throughout the commonwealth. People would be left without access to needed treatment, healthcare providers would see their revenues shrink and possibly close their doors and state government would be forced to further cut vital services as it deals with a smaller state coffer.

Kentucky’s representatives in Washington should be aware of the harm that would cause back home before making such a reckless decision.

Targeted Refugee Groups Make Important Contributions to Kentucky’s Communities and Economy

Two recent reports from the Center for American Progress (CAP) explore the contributions immigrants and refugees make in our communities and local economies – including Syrians and Somalians, two groups targeted by President Trump’s executive order – and find high levels of economic participation.

Many Syrian Immigrants Are Building Lives in Kentucky

According to CAP, among states Kentucky resettled the 16th most Syrian refugees between January 2014 and December 2016 (Kentucky has the 26th largest population of all states). Since the crisis began in 2011, Kentucky has resettled 450 Syrian refugees according to the lengthy vetting process that is already required by federal law.

Using Census data, CAP explores Syrian immigrants’ integration into American communities and finds that they are well-educated, have good-paying jobs and are more likely than native-born residents to own businesses. They are eventually likely to speak English very well, own their homes and become naturalized citizens. Of particular note:

  • 11 percent of Syrian immigrants in the U.S. labor force own businesses, compared to 4 percent of all immigrants and 3 percent of native-born residents.
  • Syrian business earnings are also higher than U.S-born business owners’: $72,000 on average compared to $51,000, respectively.
  • 9 out of 10 Syrian immigrants eventually become naturalized U.S. citizens.

In addition to building strong ties in their local communities and economies, more established Syrian immigrants can serve as an essential part of the receiving community for more recent Syrian refugees.

Evidence from Four Large Refugee Groups Suggests Large-Scale Integration and Contribution

Another report from CAP analyzes Census data on select refugee groups including Somalis and finds similarly high levels of integration into our local communities and economies. Kentucky and some of our metro areas rank high among states and cities for our large resettled share of refugees from these countries, with the 14th largest Somali population in the nation residing in Louisville and the 7th largest community of all 4 groups (including Somali as well as Burmese, Hmong and Bosnian refugees) as a share of immigrants in Bowling Green.

Refugees from these 4 groups comprise 20 percent of all refugees who have resettled in the U.S. over the last 3 decades. Their high rates of employment, business and home ownership, educational attainment, and eventual English proficiency and naturalization suggest that refugees as a whole do well in the U.S.

The President’s Executive Order Disrupts Resettlement and Integration

President Trump’s executive order bans refugee admissions from all countries for 120 days, but from Syria indefinitely. Counting refugees from all countries of origin, Kentucky resettles more than twice the national average. Kentucky Refugee Ministries (KRM) previously anticipated that Kentucky would resettle an estimated 2,000 refugees in 2017, and it is unclear how the executive order will ultimately reduce this number.  Just this week, 45 refugees were prevented from traveling to Louisville alone.

The order also bans travel from a list of seven countries including Somalia to the U.S. for 90 days. KRM reports that since 2011, Kentucky has resettled 4,000 refugees from Iraq, Iran, Somalia, Sudan and Syria, five of the seven countries under the travel ban (Libya and Yemen are also targeted).

In addition to preventing refugees from making their way to a new and safer home in Kentucky, these actions preclude refugees’ contributions to our communities and economy. And local support for refugees – the voluntarism and philanthropy their resettlement prompts among families, faith and community groups – also creates valuable social capital in Kentucky.

Kentucky Would Have the Second Highest Rate of Job Loss With Healthcare Law Repeal

If the Affordable Care Act is repealed, Kentucky’s rate of job loss would be the second worst of any state with the elimination of an estimated 55,949 jobs or nearly 3 percent of the state’s workforce, according to a new analysis by the Economic Policy Institute.

Kentucky’s job loss as a share of its employment would be higher than any other state except New Mexico.

The report also shows that repeal would take away $4.1 billion in federal spending from Kentucky’s economy while the tax cuts that would also be part of ACA repeal would only put back $677 million into the Commonwealth, largely benefitting a small number of extremely wealthy people. The report estimates the net loss of $3.4 billion would be worse for Kentucky than any other state relative to the size of the population.

Our state’s decision to expand Medicaid and cover more people resulted in a huge increase in federal funding and the evaporation of those dollars is the primary cause of the job loss. The $4.1 billion we receive in federal monies through Medicaid and premium and cost-sharing subsidies under the ACA is equivalent to over 2 percent of Kentucky’s GDP, a larger share than any state but New Mexico. Those dollars don’t just stay in the healthcare industry, but help pay construction workers, for example, who expand hospitals and clinics. That money also makes its way to industries like retail, food, and other services where nurses, doctors and other healthcare sector workers spend their salaries.

Here’s a look at job losses from ACA repeal across the country:

Talk of Obamacare Repeal Alarms Kentuckians

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130,000 Kentuckians in Individual Market Would Lose Coverage from Health Reform Repeal

A partial repeal of the Affordable Care Act would likely result in close to half a million people becoming uninsured in Kentucky, including those who buy health coverage directly from an insurance company. According to the Urban Institute, 130,000 Kentuckians who are individually insured would lose coverage. Because the ACA requires everyone to have insurance or face a penalty, a larger, healthier and younger pool of plan-holders has made it possible for insurance companies to cover people who have conditions that make them more expensive to cover like asthma, diabetes, and even pregnancy. Repeal would undo that and create what’s called a “death spiral.”

Source: Urban Institute analysis using HIPSM 2016.

What Is a “Death Spiral?”

The Affordable Care Act (ACA) has been very successful in getting Kentuckians insured through the expansion of Medicaid and by offering subsidized insurance plans to low-income Kentuckians. Uninsured rates have also gone down thanks to the ACA ban on insurers denying coverage based on preexisting conditions and the requirement that everyone have insurance coverage or else face a penalty. These two provisions are related – it’s only with healthy, less medically expensive people gaining coverage that insurers could afford to cover sicker people with higher medical expenses. As a result of this relationship, removing the individual mandate, as well as the loss of federal subsidies for Qualified Health Plans through the marketplace, would trigger what is known as a “death spiral,” Here is how the death spiral would work:

 

Although some have claimed that the ACA is already in a death spiral, evidence has not shown this to be true. According to the American Academy of Actuaries and Standard & Poor’s, you would expect to see declining enrollment in the ACA marketplaces or continually escalating premiums. But nationally, marketplace enrollment has grown each year since 2014. And the sharp rise in insurance premiums this past year was a “one time pricing correction” not likely to be seen again in coming years.

As Kentuckians have taken advantage of federally subsidized Qualified Health Plans since 2014 through the ACA, the individual insurance policy market has expanded. Furthermore, because the share of employers offering insurance as a benefit has been falling — from 54.4 percent in 2012 to 47.8 percent in 2015 – there has been an increasing reliance on individual insurance policies.  More broadly the economy was nearing recovery in 2015 from the hit it took during the Great Recession. All of these factors combined so that people felt they could start buying insurance again. With repeal, that’s not likely to continue.

The ACA Repeal Would Hurt All Kentuckians

The ACA had a wide-ranging impact on the healthcare of Kentuckians. Besides the roughly half million Kentuckians enrolled in either the  Medicaid expansion or  Qualified Health Plans whose coverage would be jeopardized from a repeal of the Affordable Care Act, chaos in the individual insurance market, loss of patient protections and loss of billions in federal funding would be felt in every corner of the commonwealth. Even before Congress finalizes legislation to repeal parts of the law, President Trump can shock the healthcare sector, specifically the individual insurance market, through actions like the executive order he signed just after his inauguration. It did not detail what exactly what parts of the ACA would or wouldn’t be enforced, but that very ambiguity is enough to give insurers a second thought about participating in the individual market this coming year.

The complexity and interdependent nature of the law makes it nearly impossible to remove parts of it without causing damage to the whole healthcare system, including people who buy insurance individually. This is not the time to move backward on the gains we’ve realized as a commonwealth. Congress can and should improve on the ACA, so that more Kentuckians have quality, affordable healthcare. Instead it is tilting full steam toward repeal.

 

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Mix of Criminal Justice Bills So Far in 2017 General Assembly

With Kentucky’s growing inmate population and high rates of recidivism, what we need in 2017 is legislation that will make these problems better, not worse. The criminal justice bills filed so far this session are a mix of both. While several bills could lead to fewer people being incarcerated or create more ways for Kentuckians with records to get a second chance, other bills would put more people in prison, particularly those struggling with addiction.

Here are some of the bills that could help to provide a second chance to former inmates, reduce recidivism rates and/or decrease criminal justice costs in our state:

  • Several bills would make it easier for Kentuckians with records to get jobs, which enables them to support their families and avoid returning to jail/prison.
    • Some bills build on last year’s important legislation that made it possible for some low-level nonviolent felony convictions to be expunged after a five-year waiting period. Four bills would reduce the filing fee for expungement from $500 to $200 (SB 37, SB 72, HB 17 and HB 86). HB 86 also makes it possible for those financially unable to afford to file for expungement to have the fee waived and adds several additional low-level (Class D) felonies to the list of those that qualify. In addition, SB 16 would add some additional low-level felonies to the list of those that qualify for expungement but make the waiting period for those felonies 10 years instead of 5.
    • HB 76 would “ban the box” on job applications, making it illegal for employers to consider or require the disclosure of prior criminal history as part of the initial job application for most positions.
  • HB 22 would help to reduce the number of Kentuckians in jail, prevent reoffending and result in savings to counties. The bill would create explicit authority in the law for some offenders to participate in a day reporting program rather than serve jail time. A day reporting program is a community-based, structured sentencing program operated by a county jail that combines supervision with resources and services. One such program that has been operating in Louisville provides electronic monitoring for participants on home incarceration who are required to report to the program for alcohol and drug testing as well as cognitive skills training. It has been effective at reducing repeat offending and also promoting employment. The program’s cost is $18 per day per participant, compared to the $65 per day cost for incarceration in Jefferson County jail. Jefferson County saved $2 million dollars from this program over several years.
  • HB 89 would result in fewer Kentuckians being saddled with a felony charge and its collateral consequences for relatively minor offenses. The bill would raise the threshold level for a number of nonviolent felony offenses — making the unlawful registration of a car for the purpose of tax evasion a felony only if the amount is $1,500 or higher, for instance; currently the threshold is just $100.

A number of bills, on the other hand, increase criminal penalties and would result in longer sentences and further growth in the state’s inmate population:

  • HB 70 would result in more Kentuckians serving very long sentences, including for some drug offenses. The bill would make the state’s current laws for repeat offenders even harsher than they already are, increasing the sentence to life without the possibility of parole for those with three or more convictions for high-level Class A or Class B felonies or capital offenses.
  • Several bills would result in more Kentuckians with drug addiction problems serving long sentences. While heroin and fentanyl addiction are very serious, harmful problems in our state, it is now widely understood that increased penalties are not effective at reducing addiction. Of particular concern with several of these bills are measures that would charge Kentuckians with addiction problems as drug traffickers.
    • SB 14 would make the exchange of any amount of heroin or fentanyl (an even more powerful, synthetic opioid) a Class C felony carrying a 5 to 10 year sentence even for first time offenders. Currently, the transfer of a small amount of these drugs (under two grams) is considered a Class D felony, with a 1 to 5 year sentence. Under Kentucky’s very broad definition of trafficking, one addict sharing drugs with another with no cash involved is considered to be drug trafficking.
    • HB 46 would make the transfer of any amount of fentanyl or carfentanil (an even more powerful synthetic opioid) a Class C felony for trafficking for the first offense. Currently these drugs do not carry with them harsher penalties than heroin.
    • HB 52 would also increase penalties for fentanyl. Similar to the above two bills, the exchange of any amount of fentanyl, a fentanyl derivative (including carfentanil) or analogue would be considered a Class C felony charge for trafficking for the first offense. Unlike the two previous bills, however, if a defendant is determined by a court to have a substance use disorder the charge would be reduced to a Class D felony for the first offense. The bill would also create the new offense of aggravated fentanyl trafficking for 10 grams or more of fentanyl or fentanyl derivatives or analogues, which would be a Class B felony for the first offense. A Class B felony carries with it a 10 to 20 year sentence.

Kentucky’s inmate population has already been on the rise, even with the important reform efforts passed in 2011. Legislation that promotes harsher penalties worsens this situation. Several of the bills proposed so far this session lock up more people who are struggling with addiction, which is costly to the state and has a negative impact on individuals and families across Kentucky badly in need of treatment. Efforts that instead increase access to second chances and substance abuse treatment would help to move the state forward.