Study of Indiana’s Medicaid Program a Warning Against Kentucky’s Plans to Charge Premiums

A recent evaluation of Indiana’s Medicaid waiver program should stand as a warning for Kentucky policymakers attempting to similarly charge premiums in our own Medicaid program. While proponents of Kentucky’s Medicaid waiver proposal say charging premiums wouldn’t be a barrier to coverage and care for low-income Kentuckians, the findings of the study of Indiana’s waiver suggest otherwise.

One aspect of Indiana’s Medicaid waiver program, “Healthy Indiana Program 2.0,” (HIP 2.0), is a requirement that enrollees make monthly contributions to a type of Health Savings Account called a POWER Account. The consequences of not making these contributions differ based on income:

  • Members with income above the poverty line are disenrolled from Medicaid altogether and locked out of the program for six months.
  • Members with income below the poverty line are moved from the standard policy, HIP Plus, into HIP Basic, a much more limited plan with co-pays.

The recent evaluation sought to find out how well Hoosiers were making their mandatory monthly POWER Account Contributions (PACs), and what was happening to those who didn’t. Here’s what the study found and the implications for Kentucky:

Many low-income Hoosiers were left without coverage because they didn’t pay in.

During the first 21 months of the waiver program, 324,840 (55 percent) of the 590,315 people eligible to pay PACs didn’t make a required payment at some point. All of them were then kicked off of Medicaid or were left with inferior coverage:

  • Among Medicaid enrollees above the poverty line, 13,550 were disenrolled and 46,176 who qualified and applied for coverage were not enrolled because they did not pay. Combined, this rejected group represents 29 percent of those who qualified and applied for Medicaid with incomes above the poverty line.
  • Among Medicaid enrollees below the poverty line, 286,914 were given HIP Basic coverage because they didn’t make a PAC. Of these, 40,756 made at least one PAC, but missed a payment and as a result were moved from HIP Plus to HIP Basic coverage.

People didn’t make their PAC for many reasons, but the most common were that people could not afford the contribution, were confused about the payment process or didn’t know they were required to make a payment.

Among Medicaid enrollees above the poverty line who were kicked off of coverage because they didn’t make a PAC:

  • 44 percent said they couldn’t afford the contributions.
  • 17 percent said they were confused by the payment process.
  • Around one percent said they didn’t know a payment was required.

Among Medicaid enrollees above the poverty line who qualified for HIP Plus coverage but were never enrolled because they failed to make a PAC:

  • 22 percent said they couldn’t afford the contributions.
  • 22 percent said they were confused by the payment process.
  • 8 percent said they didn’t know a payment was required.

Among Medicaid enrollees below the poverty line who were moved to HIP Basic coverage because they missed a PAC:

  • 34 percent said they couldn’t afford the contributions.
  • 17 percent said they were confused by the payment process.
  • 25 percent said they didn’t know a payment was required.

The number of people either moved to HIP Basic or left without coverage might have been even higher except that employers and non-profits stepped in and paid for 5,770 people’s PACs, or roughly 2.5 percent of the HIP Plus enrollees. This practice, which will be allowed under Kentucky’s proposed changes to Medicaid, may mask the true affordability of premiums for some low-income persons.

Some people who were kicked off HIP coverage or who qualified but were never enrolled due to PAC non-payment were able to get some form of insurance: 47 percent of people kicked off and 41 percent of people who were never enrolled had coverage when surveyed. But that means that 53 to 59 percent were without health care coverage of any kind.

People who were kicked off coverage or never enrolled found it harder to get to the doctor.

Both HIP Basic and Plus members were more likely to have received routine care, have seen a specialist, or have had a prescription filled than people who were kicked off coverage or never enrolled.

Source: Lewin Group, “Healthy Indiana Plan 2.0: Power Account Contribution Assessment,” March 21, 2017.

This stands in stark contrast to the common claim that people who have Medicaid coverage are less likely to be able to access health care. It also shows people were less likely to get needed health care because of failing to pay their PAC.

Kentucky’s premiums are similar, so we can expect similar results.

Proposed changes to Kentucky’s Medicaid program, through a similar waiver process, include premiums for most enrollees. These premiums are based on income for all enrollees, and also on the length of time enrolled in Medicaid for enrollees above the poverty line. Much like HIP 2.0, Kentucky HEALTH, as the waiver is called, would drop people into more limited coverage if they are below the poverty line and fail to make premiums. Those above the poverty line would be locked out for six months unless they paid back three months’ worth of premiums and took a financial or health literacy class. The Kentucky waiver is even harsher than HIP 2.0 in that people earning above the poverty line would face rising premiums over time.

Given the findings of the HIP 2.0 evaluation, we can expect large numbers of Kentuckians to be left without coverage if the waiver is approved by the federal Department of Health and Human Services. The assessment of the Indiana waiver confirms that both the cost and process of paying premiums is a barrier to coverage for low-income people. It also shows us that when Medicaid-eligible people are left without coverage they don’t see the doctor or get prescriptions filled as often. If we really care about people being insured and getting healthier, Indiana is a perfect example of what not to do..

Hey, Moms, You’re on Your Own

How At-Risk Federal Discretionary Funds Are Important to Kentucky

Click to view as PDF.

Similar to President Trump’s initial budget blueprint, or “skinny budget,” his full budget proposal slated for release next week is expected to include cuts to non-defense discretionary (NDD) program funding in order to pay for increased spending for defense and border control — and pave the way for tax cuts for the wealthy. These NDD programs are separate from mandatory federal programs like SNAP (formerly known as “food stamps”) that are also expected to face major, damaging cuts in the president’s plan. 1

Cuts to NDD programs would be harmful to Kentucky as they provide more than $2 billion a year, the equivalent of 20 percent of our state’s General Fund, in critical funding for improving education, supporting children and families, making our communities safer and healthier, providing assistance for the state’s most vulnerable, developing our workforce and economy, and increasing cultural enrichment opportunities. Such federal budget cuts would occur in the context of our state already experiencing declines in federal funding in recent years, and struggling under state budget cuts.

Here are some highlights of what federal NDD funds do in Kentucky and what would be at risk with cuts.

Improvements in Education

Cuts to federal grants that provide funding to improve education would be harmful in Kentucky, where educational attainment levels are not where they need to be and state budget cuts are already being deeply felt. Just half of Kentucky kids are considered to be ready when they enter Kindergarten; achievement gaps persist in our K-12 system; more than 344,000 Kentuckians have no high school diploma or GED credentials; and we are far from reaching our state’s higher education goals. 2

Meanwhile, K-12, adult and postsecondary education are all struggling under frozen funding levels and state budget cuts in recent years. Cuts make it hard for our schools to address achievement gaps, for adult education programs to improve access to a GED credential and for tuition at the state’s public universities to be affordable. 3

Here are some of the NDD programs that provide funding to help improve education in Kentucky:

  • Head Start. This program provides low-income Kentucky children across the state with early childhood education and care that has significant short- and long-term benefits, including improving the likelihood that participants graduate from high school, attend college and receive a postsecondary degree or credential. 4
  • Special Education. Federal NDD funds help to educate children with disabilities — including early intervention services for infants and toddlers, preschool children and older school-aged children.
  • Adult Education. Federal funds support local adult education centers that provide free adult education services across the state. Earning a GED credential improves employment opportunities and more than a third of Kentuckians earning GED diplomas go on to postsecondary education. 5
  • College Work-Study. By providing mostly on-campus jobs for qualifying students, federal college work-study funding helps more Kentuckians be able to afford college — and research has shown work-study students are more likely to graduate than those in non-work-study jobs and more likely to be employed after graduating than students who do not work during college. 6
  • School Improvement Grants (SIGs). These funds help to raise achievement of students in low-performing schools. A SIG grant, for instance, was a critical part of Leslie County High School’s dramatic jump from scoring poorly on standardized tests prior to receiving school improvement funds, to scoring in the 94th percentile in Kentucky a few years later and being designated as a distinguished school 2 years in a row. 7 Twenty-five schools in Kentucky are currently receiving SIG funds. 8
  • 21st Century Community Learning Centers. These federal funds are used to design and implement effective after school programs. They enable schools to provide students with homework assistance and an array of activities that complement their regular academic programs; funding can also be used to offer literacy and other educational services to the families of participating children. As an example, through 21st Century Community Learning Centers funding South Livingston Elementary School offers an after-school computer coding program. 9 President Trump’s “skinny budget” proposal recommended completely eliminating this program.
  • Supporting Effective Instruction. This grant provides funding to increase student academic achievement; improve the quality and effectiveness of teachers, principals and other school leaders; and provide low-income and minority students greater access to effective teachers, principals and other school leaders.
  • Rural and Low-Income Schools Program and Small, Rural School Achievement Program. These two federal programs provide assistance to rural school districts that often lack adequate resources due to a weak local tax base.

Help for Kids and Families

Children and families in our state already face many challenges and additional cuts to federal funding would be detrimental in particular to at-risk children. Our state’s child welfare system is already overstretched and child abuse and neglect is unfortunately on the rise. 10 In addition, Kentucky’s child care assistance program is already relatively weak compared to programs in other states in terms of eligibility limits, parent co-payments, reimbursement rates to providers and how much leeway parents have when looking for a job. 11

These are some of the federal NDD programs that support children and families in Kentucky:

  • Child Welfare Services. The Stephanie Tubbs Jones Child Welfare Services program provides states with funds to provide preventive intervention, to place children in foster care when they cannot stay safely at home and to provide family reunification services to enable the safe return of children to their homes when possible. These funds can also be used for child protective services — including investigations of child abuse and neglect, counseling and emergency assistance. Kentucky received funding in 2016 for protective services, foster care maintenance payments and administrative costs. 12
  • Community-Based Child Abuse Prevention. Kentucky receives funding through this program to develop, operate, expand and/or enhance community-based prevention-focused programs and activities.
  • Healthy Start. This program helps to reduce the rate of infant mortality and improve perinatal outcomes in high-risk communities. In Kentucky, there is a Healthy Start program in Louisville to address high infant mortality rates in several of the city’s zip codes where babies are more than twice as likely to die before their first birthday than in the Louisville Metro area as a whole. 13 The program provides home visits and other outreach methods to make sure women begin getting prenatal care early on and continue to get consistent care through pregnancy and after delivery.
  • Child Care and Development Block Grant. These funds make child care assistance available for low-income families and children. In Kentucky, they are an important source of funding for Kentucky’s popular Child Care Assistance Program (CCAP), which provides important support to more than 26,000 low-income Kentucky families struggling to afford care while they work. 14

Healthier and Safer Communities

Despite important health improvements likely resulting from the Medicaid expansion, Kentucky still ranks toward the bottom on many health indicators compared to other states. Kentucky has the highest rate of cancer and cancer deaths in the nation, and more than one in four Kentucky adults reports having a chronic health condition. 15 Our state has also been hit particularly hard by the opioid epidemic and has the third highest rate of death due to drug overdose, alongside Ohio. 16 In addition, Kentucky faces many environmental concerns, including water pollution that degrades our drinking water, and state budget cuts have weakened environmental enforcement. 17

Federal NDD programs are a critical source of funding for health services in our state, including the following:

  • State-Based Comprehensive Breast and Cervical Cancer Early Detection
  • Mental Health Block Grant
  • Substance Abuse Prevention and Treatment Block Grant
  • Family Planning Services
  • State Offices of Rural Health
  • Universal Newborn Hearing Screening
  • Preventive Health Block Grant, Preventive Health Services, Preventive Health – Rape Prevention and Education

Other NDD programs that improve health and safety in Kentucky include:

  • Black Lung Clinics Program. Kentucky receives grant money to seek out and provide health services to current and former coal miners. There are currently two Black Lung Clinics in our state. 18
  • Office of National Drug Control programs. The High Intensity Drug Trafficking program provides federal funding to address drug trafficking and production in 32 Kentucky counties. 19 The Drug Free Communities Support Program helps prevent and reduce youth substance use/abuse; in 2015, 21 projects in Kentucky received funding through this grant program. 20 In the upcoming budget proposal, the Trump administration is expected to slash funding for the Office of National Drug Control Policy by about 95 percent, eliminating these two federal grant programs, among others. 21
  • Poison Control Center Program. This program provides funding to improve access to quality poison control treatment and prevention services.
  • Environmental Protection Agency (EPA) grants. These funds help provide clean water, pollution control and the safe management of hazardous waste in Kentucky. Currently about a third of the Kentucky environmental protection staff is paid for with federal EPA funds. 22

Assistance to Vulnerable Kentuckians

As a high-poverty state with one of the nation’s fastest growing aging populations, Kentucky has large numbers of people in need of assistance with housing and aging supports. Like other areas of the state budget, these services have experienced cuts in recent years and additional cuts to federal programs that serve our most vulnerable Kentuckians could cause harmful reductions in critical services.

The following federal NDD programs help some of the most vulnerable Kentuckians:

  • Battered Women’s Shelters
  • Developmental Disabilities
  • Enhanced Mobility of Seniors and Individuals with Disabilities
  • Homeless Mental Health
  • Services for Older Blind Individuals
  • Mental Health Block Grant
  • Emergency Food and Shelter Program
  • Public Housing
  • Refugee Assistance
  • Sexual Assault Services
  • Runaway and Homeless Youth
  • Low Income Home Energy Assistance (slated for elimination in President Trump’s “skinny budget”)
  • Community Development Block Grant (can be used to fund Meals on Wheels as well as a wide range of other community development needs, including repairs to a historically African American community center in Mount Sterling) 23
  • Administration on Aging Support Services; Administration on Aging Home Delivered Meals; Administration on Aging Congregate Meals

Workforce and Economic Development

Kentucky also faces serious needs for worker training and job creation. The state’s unemployment rate has improved but is still higher than it was in 2000. The economic challenges are particularly deep in the eastern part of our state. In 62 of the state’s 120 counties the unemployment rate is higher now than in 2007. 24

  • Workforce Innovation and Opportunity Act (WIOA) funds provide employment and training services for adults, dislocated workers and youth through formula grants to states. WIOA also funds adult education and literacy programs and vocational rehabilitation state grant programs that assist those with disabilities in obtaining employment.
  • The Appalachian Regional Commission (ARC) makes important investments in economic opportunities, workforce development, infrastructure, natural and cultural assets, and leadership and community capacity in Kentucky (as well as other states in the region). The “skinny budget” proposed completely eliminating this agency. 25
  • The POWER (Partnerships for Opportunity and Workforce and Economic Revitalization) Initiative has recently provided funding through ARC and a number of other federal agencies and offices to address the economic crisis faced by communities and workers reliant on the coal economy. In 2016, Kentucky received 4 of these grants, totaling around $14.8 million. 26 One of these projects provides training and employment opportunities in Information Technology (IT) careers to young adults who are out of school and older adults who are unemployed, laid-off or underemployed; this workforce development initiative will train 200 new workers, create 160 jobs and bolster sectors that require a skilled IT workforce in 23 eastern Kentucky counties. Another project provides retraining and entrepreneurial assistance to dislocated coal workers, creating 200 new jobs and 100 new enterprises as well as serving 500 existing businesses and bringing $12 million in leveraged financing to a 54-county region in Eastern Kentucky.

The “skinny budget” proposed rolling back funding that benefits coal miners and their communities, which according to a recent policy brief “would stunt economic revitalization where it is needed, and additional cuts to other assistance programs would compound the economic challenges facing coal communities and the families who call them home.” 27

Cultural Enrichment Opportunities

State budget cuts have already limited funding for the state’s libraries and the arts. Additional federal budget cuts in these areas would only worsen the situation.

  • Federal NDD programs include National Endowment for the Arts, National Endowment for the Humanities, the State Library Program and the Historic Preservation Fund.

Upcoming Budget Proposal

President Trump’s previously released “skinny budget” for 2018 proposed cuts to NDD programs — an approximately 15 percent cut in NDD programs outside of Veterans Affairs and Homeland Security — and even the elimination of many programs entirely to offset a $54 billion increase in defense spending. 28 The President’s full budget proposal is expected to be released next week and will likely include funding levels for defense and non-defense programs overall for years beyond 2018. Although some of what was outlined in the “skinny budget” will change, big cuts to NDD funding are expected. Harmful cuts to important mandatory safety net programs are also expected be included in the full proposal, as well as further details on the President’s tax plan, which would give massive tax cuts to the wealthiest Americans.

Click to see a list of discretionary federal grants received by Kentucky in 2015.

 

  1. Paul M. Krawzak, “Trump Wants $800 Billion, 10-Year Cut in Entitlement Programs,” Roll Call, May 15, 2017, http://www.rollcall.com/news/policy/trump-wants-800-billion-10-year-cut-entitlement-programs.
  2. Kentucky Department of Education, “Readiness Results Highlight Need for Quality Early Learning,” News Release, December 7, 2016, http://education.ky.gov/comm/news/Documents/R16-159%20Kindergarten%20Screener_final.pdf. Prichard Committee for Academic Excellence, “Excellence with Equity: It’s Everybody’s Business,” August 2016, http://prichardcommittee.org/wp-content/uploads/2016/08/2016-Achievement-Gap-Study-Group-Report.pdf. High school diploma/GED attainment data is from the Working Poor Families Project.
  3. Ashley Spalding, “Tuition Ceilings Announced,” Kentucky Center for Economic Policy, March 31, 2017, http://kypolicy.org/tuition-increase-ceilings-announced/.
  4. Diane Whitmore Schanzenbach and Lauren Bauer, “The Long-Term Impact of the Head Start Program,” The Brookings Institution, August 19, 2016, https://www.brookings.edu/research/the-long-term-impact-of-the-head-start-program/.
  5. Kentucky Center for Education and Workforce Statistics, “New Report Shows Benefits of Kentuckians Earning GED Diplomas,” News Release, September 19, 2016, https://kcews.ky.gov/Content/News/New%20report%20shows%20benefits%20of%20Kentuckians%20earning%20GED%20diplomas.pdf.
  6. Judith Scott-Clayton and Veronica Mina, “Should Student Employment Be Subsidized? Conditional Counterfactuals and the Outcomes of Work-Study Participation,” National Bureau of Economic Research, July 2014, https://www.insidehighered.com/sites/default/server_files/files/NBER-workstudy.pdf.
  7. Greg Anrig, “Lessons From School Improvement Grants That Worked,” The Century Foundation, July 23, 2015, https://tcf.org/assets/downloads/Anrig_LessonsFromSchoolImprovementGrants.pdf.
  8. Kentucky Department of Education, “School Improvement Grants (SIG),” http://education.ky.gov/federal/progs/sigi/Pages/default.aspx.
  9. Mike Marsee, “Making Coding More Friendly,” Kentucky 21st Century Community Learning Centers, September 9, 2016, http://ky21cclc.org/.
  10. Deborah Yetter, “Feds Rip Kentucky Child Protection System,” Courier-Journal, February 23, 2017, http://www.courier-journal.com/story/news/politics/2017/02/23/feds-rip-kentucky-child-protection-system/98306250/. John Cheves, “Child Abuse and Neglect up 55 Percent in Kentucky Since 2012,” Lexington Herald-Leader, February 3, 2017, http://www.kentucky.com/news/politics-government/article130535059.html.
  11. Karen Schulman and Helen Blank, “Red Light Green Light: State Child Care Assistance Policies 2016,” National Women’s Law Center, https://nwlc.org/wp-content/uploads/2016/10/NWLC-State-Child-Care-Assistance-Policies-2016-final.pdf.
  12. Administration for Children and Families, “Stephanie Tubbs Jones Child Welfare Services: 2016 Planned Use of Funding by State and Service Category,” https://www.acf.hhs.gov/sites/default/files/cb/cfs101_report_congress_2016_attach_c.pdf.
  13. Louisville Metro Health Start, “Healthy Start,” https://louisvilleky.gov/government/health-wellness/healthy-start.
  14. Kentucky Center for Education and Workforce Statistics, “2017 Early Childhood Profile,” https://kcews.ky.gov/Content/Reports/ECP/ECP_2017_FullReport.pdf.
  15. Kaiser Family Foundation, “Health Status,” State Health Facts, http://kff.org/state-category/health-status/. State Health Access Data Assistance Center, “Final Report: Study of the Impact of the ACA Implementation in Kentucky,” February 2017, https://www.healthy-ky.org/res/images/resources/Impact-of-the-ACA-in-KY_FINAL-Report.pdf.
  16. Centers for Disease Control and Prevention, “Drug Overdose Death Data,” https://www.cdc.gov/drugoverdose/data/statedeaths.html.
  17. James Bruggers, “Kentucky Braces for Big Trump EPA Cuts,” Courier-Journal, March 3, 2017, http://www.courier-journal.com/story/tech/science/environment/2017/03/03/kentucky-braces-big-trump-epa-cuts/98650188/.
  18. Health Resources and Services Administration, “Active Grants for HRSA Program(s): Black Lung/Coal Miner Clinics Program,” 2016, https://ersrs.hrsa.gov/ReportServer/Pages/ReportViewer.aspx?/HGDW_Reports/FindGrants/GRANT_FIND&ACTIVITY=H37&rs:Format=HTML4.0.
  19. National HIDTA Assistance Center, “HIDTA Counties by State,” http://www.nhac.org/news/HIDTA_Counties.htm.
  20. Substance Abuse and Mental Health Services Administration, “SAMHSA – Fiscal Year 2015 Discretionary Funds,” https://www.samhsa.gov/grants-awards-by-state/details/Kentucky.
  21. Alan Rappeport, “White House Proposes Cutting Drug Control Office Funding by 95%,” The New York Times, May 5, 2017, https://www.nytimes.com/2017/05/05/us/politics/white-house-proposes-cutting-drug-control-office-funding-by-95.html.
  22. James Bruggers, “Kentucky Braces for Big Trump EPA Cuts,” Courier-Journal, March 3, 2017, http://www.courier-journal.com/story/tech/science/environment/2017/03/03/kentucky-braces-big-trump-epa-cuts/98650188/.
  23.  Jose A. DelReal, “Trump Asked African Americans What They Had to Lose. For This Rural Kentucky Community, the Answer Is Tangible,” The Washington Post, April 7, 2017, https://www.washingtonpost.com/national/trump-asked-african-americans-what-they-had-to-lose-for-this-rural-kentucky-community-the-answer-is-tangible/2017/04/06/0bf500fe-1a61-11e7-bcc2-7d1a0973e7b2_story.html.
  24. Anna Baumann and Jason Bailey, “The State of Working Kentucky 2016,” Kentucky Center for Economic Policy, August 2016, http://kypolicy.org/dash/wp-content/uploads/2016/08/State-of-Working-KY-FINAL.pdf.
  25. Renee’ Marcum-Losey, “Trump Budget Beats Up on Appalachia,” Courier-Journal, March 17, 2017, http://www.courier-journal.com/story/opinion/contributors/2017/03/17/trump-budget-beats-up-appalachia-losey/99297824/.
  26. The White House, “Fact Sheet: Administration Announces New Economic and Workforce Development Resources for Coal Communities through POWER Initiative,” August 24, 2016, https://www.arc.gov/images/grantsandfunding/POWER2016/POWER2016_Awards_WHFactSheet_8-24-2016.pdf.
  27. Ashley Spalding, “Important Federal Investments in Kentucky’s Coal Communities at Risk,” Kentucky Center for Economic Policy, April 28, 2017, http://kypolicy.org/important-federal-investments-kentuckys-coal-communities-risk/. Luke Bassett and Jason Walsh, “The Trump Budget Cuts Hit Coal Communities and Workers Where It Hurts,” Center for American Progress, April 24, 2017, https://www.americanprogress.org/issues/green/reports/2017/04/24/430842/trump-budget-cuts-hit-coal-communities-workers-hurts/.
  28. Jason Bailey, “Trump Budget Eliminations Would Be Major Hit to Kentucky,” Kentucky Center for Economic Policy, March 21, 2017, http://kypolicy.org/trump-budget-eliminations-major-hit-kentucky/.

Kentucky Moms Deserve Better

More than 488,000 women in Kentucky are raising an estimated 919,711 children under the age of 18. These biological, step, adopted and foster moms, grandmothers and other relatives and their children would benefit from policies that better support employment, job quality and economic security for Kentucky women.

Supporting Pregnant and New Moms at Work

Pregnancy and childbirth are a normal part of life for women: national data show that more than four out of five become mothers. An estimated 55,759 Kentucky women gave birth over the last year, 63 percent of whom were in the labor force. That’s 10 percentage points higher than the labor force participation rate for all women (53 percent in 2016), reflecting the necessity in today’s economy for many married and single moms to work. To promote economic security for expectant and new moms, healthy families and a productive workforce, Kentucky needs policies that incorporate these facts of life into employment practices:

  • Pregnant workers rights: Today, some Kentucky mothers whose employers don’t provide pregnancy accommodations are forced to choose between getting paid or staying safe and healthy on the job. Legislation requiring employers to provide “reasonable accommodations” like temporary light duty and time and space to express breastmilk — so long as it does not impose an undue burden on the employer — can help moms continue working through pregnancy. Employers benefit from reduced turnover and increased productivity, and states benefit by reducing costs associated with public assistance when moms are forced to lose work. Bills were filed to address this issue in both the House and Senate in the 2017 session of Kentucky’s General Assembly, but neither were given a hearing.
  • Paid parental leave: Many new moms without the option of paid leave must choose between coming back to work earlier than is best or losing income. Paid parental leave is a commonsense policy that supports families’ economic security and health as they welcome new members and promotes labor market attachment, job satisfaction and productivity. The U.S. is behind the rest of the developed world in providing paid leave, and Kentucky should become one of the handful of states leading the charge. House Bill 303 in the 2017 session, which was not given a hearing, proposed to give access to six weeks of paid maternity leave to women who have been employed for at least a year by firms with more than 50 employees. Parental leave should include fathers as well.

These policy improvements would especially help women working in low-wage jobs where employers are less likely to offer accommodations and paid leave. Furthermore, because mothers are more likely than fathers to experience hiring discrimination, supporting their attachment to work through pregnancy and babies’ first months is especially crucial for families’ economic security.

Work and Care Supports

At 53 percent, women’s labor force participation has not recovered from the last two economic recessions (it was 58 percent in 2000), but has grown overall in recent decades from 48 percent in 1979. In contrast, men’s participation has declined from 77 percent in 1979 to 63 percent in 2016. More women are working as a result of changing gender roles, a lack of adequate job opportunities for men and stagnant wages and incomes for all but the wealthiest Kentuckians in recent decades — meaning more women are working out of necessity. For moms and dads to be able to work, high-quality, reliable care for their children is essential.

  • Child care assistance for low-income families helps make work a net economic benefit by making care more affordable. In 2016, Kentucky legislators gave a much-needed increase to the Child Care Assistance Program (CCAP) income threshold, from 150 percent of the 2011 poverty line to 160 percent of the 2016 FPL. However, CCAP reimbursement rates to providers are low and parent copayments are high, meaning that child care quality, availability and affordability are limited. In the 2018 session of the General Assembly, legislators should improve CCAP, including by appropriating more dollars to the program in the next state budget.
  • Paid sick and family leave can help parents weather illness, care for sick kids and meet other care needs without losing employment or income. Only a handful of states have enacted paid sick leave.
  • Healthcare is essential for moms’ and families’ economic security and health. Threats to coverage from the recently House-passed American Health Care Act and the state waivers it would encourage span across pregnancy, birth, family planning and women’s long-term health and affects those receiving coverage through Medicaid as well as private insurance. Federal and state lawmakers should build on strengths of the Affordable Care Act and reject proposals to reduce coverage, including for Kentucky moms.
  • Kinship Care is another program improving care options and economic security for Kentucky families. The program provides a stipend of $300 a month for low-income grandparents and other relatives raising children, but was closed to new enrollees in 2013 due to state budget cuts. According to Census data, more than 99,000 Kentucky kids are being raised by a grandmother or other female relative, either in a married or single, female-headed household. The share of Kentucky kids being raised by relatives has increased in recent years, and state support for these caregivers should rise accordingly.

Equal Pay, Better Pay

Supporting work through pregnancy, after childbirth and alongside ongoing childcare needs is essential, but making work pay is the other side of the coin. Kentucky mothers face a lack of pay equity between women and men as well as a lack of job quality for all Kentucky workers.

In 2016, Kentucky women making median wages brought home $15.64 an hour, just 88 cents on the dollar that men made ($17.84). Thanks to rising wages for women over time – but also due to eroding wages for men – the wage gap has shrunk: a decade ago women made 82 cents on the dollar men made and 20 years ago, 74 cents. Wide gaps persist when education levels are held constant, reflecting the fact that discrimination and undervaluing women’s contributions to the economy still play a big role. For example, as shown in the table below, women in Kentucky with an associates’ degree make $16.67 an hour on average compared to $20.74 for men (80 cents on the dollar). The data also shows that black Kentuckians make less than white Kentuckians. Though data limitations preclude an analysis of the wage gap by gender and race, it is fair to deduce that African American women face an even wider wage gap than white women.

Source: Economic Policy Institute analysis of Census data (CPS 2013-2016).
*Note: Sample size insufficient to produce estimate.

In addition to facing a gender wage gap, women are hurt by the same policies that hold down job quality for all Kentuckians. The Economic Policy Institute’s “Family Budget Calculator” estimates that a family of two (one adult, one child) living in Lexington, Kentucky, needs $42,004 a year to pay for housing, food, childcare, transportation, health care, taxes and other necessities. But at $15.64 an hour, a woman working full-time year-round for median wages brings home just $32,531.

Low pay means it is especially difficult for single female-headed households to make ends meet. More than half (55 percent) of Kentucky kids living with a single mom are in poverty, compared to one in four (26 percent) of all Kentucky kids.

The 2017 session of the General Assembly was a step backwards for job quality, with many bills passed that harm working moms. Kentucky legislators can reduce pay disparities and improve job quality in 2018, including by passing proposals that were filed in 2017 but never saw the light of day:

  • Equal pay: HB 179 defined equivalent jobs and work that is equivalent in skill and would have required equal pay for that work, regardless of sex, race and national origin.
  • Enforcement: Though not up for debate in 2017, in the 2018 budget session legislators will have the opportunity to improve funding for the Kentucky Commission on Human Rights which investigates discrimination based on sex, race, familial status and more. Between 2008 and 2018, state funding for the Commission has been cut by 19 percent, once inflation is taken into account. Also deeply cut has been the Kentucky Commission on Women.
  • Minimum wage: Federal and state inaction on the minimum wage has allowed it to erode to the point that a full-time minimum wage worker cannot keep herself and one dependent out of poverty. HB 178 would have incrementally increased Kentucky’s minimum wage to $15 by 2021 from the current $7.25 an hour. Women make up a disproportionate share of Kentucky’s low-wage workers, meaning that they would also especially benefit from an increase in the minimum wage: 42 percent of all female workers in Kentucky would get a raise from an increase in the federal minimum to $15, compared to 34 percent of men. And though black workers make up 8 percent of Kentucky’s workforce, they comprise 13 percent of the total workforce that would benefit from an increase to $15 an hour, suggesting African American moms would especially benefit.
  • Overtime: The federal overtime threshold fails to protect many low-income workers from being required to work more than 40 hours a week without being paid. Clawing back the ground that has been lost over decades of erosion in the rule – with an increase in the threshold to $913 from $455 a week (as proposed in HB 456) – would improve job quality for 25 percent of salaried women compared to 22 percent of salaried men. It would also cover the parents of more than 7 million additional children, nationwide.

Kentucky moms are working hard to support their families and contribute to our economy. Kentucky legislators can and should improve supports and remove barriers to work and economic security for these women and their families.

Proposed Health Care Changes Would Hurt Kentucky’s Moms

Women, and mothers in particular, are especially at risk of losing access to healthcare if the American Health Care Act (AHCA) becomes law. While millions of Americans stand to lose coverage, the AHCA is especially harmful to mothers who rely on coverage offered and protected by the Affordable Care Act (ACA) for pregnancy, birth, family planning and other needs, as recently reported by the Center on Budget and Policy Priorities.

Medicaid works for mothers

One core part of the AHCA that has nothing to do with the ACA at all permanently cuts the original Medicaid program through a mechanism called a per-capita-cap. By slowly squeezing the federal dollars for the Medicaid program over time, a per-capita-cap would threaten coverage for the most vulnerable, including pregnant women and children, threatening groups of people covered by Medicaid for over 50 years. Nearly 55 percent of all Medicaid enrollees in Kentucky are women, and 44 percent of all births in Kentucky are paid for by Medicaid.

The AHCA’s effective elimination of the Medicaid expansion further reduces access for women who gained coverage when eligibility was extended through the ACA to Kentuckians at or below 138 percent of the federal poverty level, or $35,218 for a family of three. Low-income women who did not previously qualify for Medicaid have been able to get to the doctor thanks to the expansion — and most state Medicaid programs offer services like pap smears, contraceptives and sexually transmitted disease testing. Moreover, women and their newborn children are healthier when mothers are getting regular care for conditions like diabetes and hypertension prior to pregnancies, and between giving birth and getting pregnant again. Taking away Medicaid coverage for women who are eligible under the expansion would make pregnancy and infancy riskier.

Allowing states to waive insurer requirements would risk coverage for women and mothers

The version of the AHCA passed by the House would allow states to waive two important patient protections known as Essential Health Benefits (EHBs) and Community Rating. EHBs require that insurance policies include healthcare services that are critical to women, especially maternity care and mental health treatment; between 5 and 25 percent of women who are pregnant, post-partum and parenting have some type of depression, and between 40 and 60 percent of low-income mothers have depressive symptoms. If the AHCA becomes law, insurers could decide to not include those benefits as part of the plans they offer, or return to placing annual or lifetime caps on specific kinds of benefits.  This applies to coverage women receive through work, as well as to people who purchase insurance on the exchanges.

The option to waive Community Rating means insurers could go back to basing insurance premiums on health history or status such as cervical or breast cancer, having had a C-section and others. By one estimate, annual premiums in Kentucky for pregnant women could rise by $15,660 and premiums for people with major depression (including post-partum) could rise $7,680. In many of these cases, while insurers would not deny someone coverage based on a pre-existing condition, the premiums would be so prohibitively high that they would effectively shut these women out.

As lawmakers move forward with decisions about how to transform America’s healthcare system, it is critical to the health and wellbeing of millions of Kentucky women and their families that the vital care afforded them by the ACA is protected. To do otherwise would be a giant step back for the women of our commonwealth.

Tax Shortfall Signals Need For Reform

Tax Shortfall Signals Need For Reform

by Lexington Herald-Leader

Kentucky Tonight: Tax Reform

Kentucky Tonight: Tax Reform

by Renee Shaw

Kentucky Has A History With High-Risk Health Insurance Pools. It Isn’t Good.

How Kentucky’s Advocacy Groups are Reacting to U.S. House Passage of AHCA

Job Recovery for Some Kentucky Counties, Second Recession for Others

When the Great Recession came at the end of 2007, all of Kentucky lost jobs. The U.S. economy hit bottom a couple of years later before starting to improve. Now the nation’s lost jobs as a whole are restored and the economy is strengthening, with some arguing the country is at or near full employment.

But when you dig down to the local level, the picture becomes less rosy — as the map below shows.

In Kentucky from 2009 to 2017, 32 counties experienced modest to strong job growth, with the number of people employed rising in those counties between 11 percent and 31 percent. Most of the growing areas are in central and northern Kentucky or are located along interstate corridors.

But in 32 other Kentucky counties — many of which are in eastern Kentucky — the number of people employed fell between 2009 and 2017 from 10 percent to 32 percent. While the economy overall was recovering, those counties felt what you might call a second recession (a shift in population to more prosperous areas in response to economic conditions plays a role in these numbers.)

Responding to Transition

This drop in employment stems in part from the loss of coal jobs (and factory jobs in northeastern Kentucky) plus the ripple effects in communities. Already, most of the counties experiencing the biggest employment losses had high poverty rates.

These counties were experiencing a second recession at the same time Recovery Act dollars that helped rescue the U.S. economy were drying up, and as the federal and state government enacted additional budget cuts that reduced investments in local schools, roads, human services and more.

The federal government was initially slow to react to the loss of coal jobs. But a few years ago, the Obama administration announced the POWER Initiative and coordinated the funneling of federal grant dollars to transitioning communities, of which Kentucky has received about $20 million. Other initiatives were announced, and Congressman Rogers filed the RECLAIM Act to release abandoned mine land monies for land reconstruction, though the bill has not passed through Congress.

Also helping in a major way was the Affordable Care Act. Kentucky expanded Medicaid, and eastern Kentucky counties gained more than any other part of the state. That resulted in hundreds of millions more dollars flowing per year to health care providers in the region, as well as greater opportunities for preventive services that improve health.

Aid Now at Risk

The region clearly needs much more that builds on those investments and improves the jobs picture. But instead of considering ways to spur greater job growth, we are now at risk of major cuts to the investments that are helping.

The American Health Care Act (AHCA), which passed the House yesterday, unwinds the Medicaid expansion and makes other cuts that will drastically reduce federal health funding to the region. The 5th Congressional District in eastern Kentucky could lose an estimated 20,000 jobs if the AHCA is passed and fully implemented, according to one estimate. That would make it the hardest-hit congressional district in the country by the AHCA.

And the President’s budget for 2018 proposed completely eliminating funding for 7 of the 12 programs that were part of the POWER Initiative — along with other investments that benefit the region. The budget proposed complete elimination of the Appalachian Regional Commission.

Now the AHCA heads to the Senate, and we expect the President’s full budget proposal later this month. Both could severely worsen an already dark jobs picture for one of America’s most economically distressed regions.