Under Senate Health Bill, A Rural Vs. Urban Divide Is Exacerbated

Kentucky Has the Most to Lose from Senate Health Care Repeal Bill

Kentucky would see its uninsured rate more than triple under the proposed Senate bill to repeal the Affordable Care Act (ACA). According to the Urban Institute, Kentucky’s uninsured population would jump by 541,000 people in 2022 based on the proposed changes to the healthcare system. The primary reason for the coverage losses is a cut in federal funding for Medicaid and premium subsidies on the insurance marketplace of $6.3 billion in 2022, a  58.5 percent reduction. That’s the largest percentage cut of any state.

The coverage losses under the Senate bill come from 704,000 Medicaid enrollees and 17,000 marketplace enrollees losing coverage. The Urban Institute also estimates that 180,000 Kentuckians would gain coverage through their employer, though if Kentucky decides to waive the Essential Health Benefits, these individuals would be enrolled in inferior coverage that would also be subject to annual or lifetime caps.

The percent of Kentuckians under Medicaid who would lose coverage is particularly alarming. In cutting the number of people covered by Medicaid in half, the Senate repeal bill kicks a higher share of Kentuckians off Medicaid than anywhere else. This is such a large share of Kentucky’s population that it essentially strips insurance from 1 in 6 Kentuckians.

The effort to roll back the Affordable Care Act and then permanently squeeze funding for traditional Medicaid does not just take us back to the days before the ACA improved Kentuckians’ health coverage. It sets the commonwealth back even further and jeopardizes the substantial health care gains we’ve made over the past three years. It would also pull billions of federal dollars from our economy, which is still in recovery from the recession. No matter which version of ACA repeal you look at, the results are the same – a catastrophe for Kentuckians’ health and our economy.

Op-Ed: McConnell’s Health Plan Would Wreak Havoc on Kentucky

This column ran in the Courier-Journal on June 28, 2017.

The light of day is revealing why Sen. Mitch McConnell wrote his bill to replace the Affordable Care Act behind closed doors and is now trying to rush it through the Senate.

The bill doesn’t deliver the “better care” its name would suggest. Instead, it throws 22 million Americans off health insurance, makes coverage much more expensive for older, sicker and low-income people and eliminates crucial patient protections — all to deliver massive tax cuts for the wealthy and powerful.

McConnell says his bill will correct the “failed law” that preceded it. But in Kentucky, the ACA has meant major progress in just a few short years. Our rate of uninsured has fallen by more than half. The 475,000 Kentuckians gaining coverage thanks to Medicaid expansion are more likely to get regular care for chronic conditions and less likely to skip medications due to cost, according to a new Harvard study. And Kentucky’s economy benefits from billions in new federal dollars flowing to the state — money that ends up in jobs for nurses and other health providers in every Kentucky community.

That progress and much more is at risk with the Senate bill.

McConnell’s plan would effectively end the Medicaid expansion. And it would go beyond that to radically restructure how Medicaid has been funded since it was created in 1965. The bill would undermine the program through a mechanism that will squeeze federal funding over time. Far from “strengthening” Medicaid, this change will threaten coverage and benefits for the nearly one million Kentucky children, people with disabilities, seniors and pregnant women covered under the traditional Medicaid program.

While ignoring how the bill decimates Medicaid, McConnell argues that it rescues the individual market from Obamacare. But rather than shoring up these marketplaces and filling holes to make coverage more affordable, the Senate bill will mean more people paying higher out of pocket costs for inferior coverage.

The bill allows insurance companies to pass more costs off to consumers in the form of higher deductibles and co-pays, and it eliminates cost sharing subsidies. In addition, insurers will be able to charge older people substantially more for premiums than under the ACA, some middle-income people will lose all assistance buying coverage and, as the Congressional Budget Office notes in their analysis of the bill, “few low-income people will be able to buy any plan.”

McConnell also claims the bill will “preserve access to care for patients with pre-existing conditions.” But the Senate plan gives states the option to waive requirements that plans cover certain health benefits. That will lead to insurers offering plans that fail to cover expensive treatments, leaving people with serious conditions unable to find affordable coverage needed for health and even survival.

And McConnell points to relatively small grants for opioid treatment contained in the bill while leaving out how the plan as a whole pours gasoline on the fire of Kentucky’s drug crisis. Because of Medicaid expansion, Kentucky has seen a 740 percent increase in drug treatment paid for by the program. But by ending expansion, slashing the number of people with health coverage and allowing waiver of requirements that Medicaid and private insurance cover drug treatment, the Senate bill would dramatically roll back access to addiction care.

Far from improving health care in America, the Senate bill would wreak havoc on people’s lives. And the dollars it takes from care for low- and middle-income Americans will be sent to wealthy people, drug companies and insurers in the form of huge tax cuts — an average cut of $50,000 a year for millionaires. No legislation in recent history presents a greater threat to more Kentuckians than the bill now in front of the Senate.

Kentucky’s health depends on what happens next.

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By Advocacy Action Network, Bridgehaven Mental Health Services, Coalition for the Homeless, Community Farm Alliance, Cumberland Family Medical Center, Inc., Fairview Community Health Center, Family Health Centers, Inc., Friedell Committee on Health System Transformation, HealthFirst Bluegrass of Lexington, Homeless & Housing Coalition of Kentucky, Kentucky Association for School Psychologists, Kentucky Association of Regional Programs, Kentucky Center for Economic Policy, Kentucky Coalition Against Domestic Violence, Kentucky Council of Churches, Kentucky Council on Problem Gambling, Kentucky Counseling Association, Kentucky Equal Justice Center, Kentucky Nurses Association

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