by Ricki Barker
by Tom Loftus
by Ryland Barton
by Daniel Desrochers
The latest attempt to repeal the Affordable Care Act (ACA), known as the Cassidy-Graham bill, would cut Kentucky’s funding for low-income health care by $3.1 billion by 2026. That would be the 8th largest cut in the country, even though Kentucky ranks only 26th in the size of its population.
The bill would undermine health care coverage for millions of Americans in three main ways.
A block grant that squeezes funding for 10 years and then runs out
Perhaps the most devastating of the bill’s cuts would result from turning funding for both the Medicaid expansion and the marketplace subsidies into a block grant. This block grant would increase annually in the short term, but at a rate well below what is needed to pay for the rising cost of care, and would not adjust based on changes in population or health care emergencies.
Compounding this funding cut is the fact that under this bill, states that expanded Medicaid under the ACA would no longer be able to simply offer Medicaid coverage to people earning up to 138 percent of the poverty level, as they can under current law. Instead, they would have to start from the beginning and ask the federal government for permission, and continue to do so every five years. Under any expansion request under Cassidy-Graham, however, the restricted funding would force states to set up a far inferior program that either restricted benefits or limited eligibility.
In 2027, this funding would completely go away, leaving states with 100 percent of the cost for the people covered under these programs; which means in Kentucky would need to find a way to make up $6.9 billion every year. This cut would almost certainly leave states no choice but to discontinue offering affordable coverage options to low-income individuals.
In Kentucky, over 475,000 are covered by Medicaid expansion and 63,700 receive financial assistance for purchasing or using their marketplace coverage.
A permanent and ongoing cut to traditional Medicaid
For people covered under traditional Medicaid – primarily children, pregnant women, those with disabilities and very low-income seniors – the funding structure would change fundamentally from a flexible state-federal match to what is known as a per capita cap. A per capita cap would limit the amount a state receives from the federal government to a fixed amount per person enrolled in Medicaid coverage that is then adjusted more slowly than the actual cost of care. In doing so, this formula would put more burden on the state to pay for an increasing share of costs – ultimately leading to removing people from coverage, reducing benefits, cutting payments to health care providers or some combination of the three.
There are currently 945,500 Kentuckians covered under traditional Medicaid.
Changes to individual insurance that will make it more expensive or unavailable
The Cassidy-Graham bill would immediately eliminate the individual mandate requiring everyone to have some kind insurance coverage or else pay a fine, which the Congressional Budget Office estimated would result in 15 million more uninsured in the following year. These coverage losses stem from some healthy people deciding not to buy insurance but also from people who would no longer be able to afford coverage or find options as insurance companies either raise premiums or no longer offer individual policies. With the bill reducing funds for premium subsidies and cost sharing assistance until 2026 (when it would run out), insurers would find it difficult to justify continued participation in the marketplace. Ultimately, the market for individual insurance would be destabilized and purchasing insurance on and off the exchanges would become difficult or impossible, particularly in rural states like Kentucky.
Updated September 20, 2017.
New American Community Survey (ACS) data for 2016 released today by the U.S. Census shows poverty didn’t budge and income only increased slightly in Kentucky from 2015. The poverty rate was unchanged at 18.5 percent statewide and still elevated over the pre-recession 17.3 percent. Median household income grew an inflation-adjusted $871 since 2015 to $46,659, essentially the same as it was pre-recession.
“Along with stagnant unemployment, the new Census data shows Kentucky’s economy is not fully recovered,” Anna Baumann, research and policy associate for the Kentucky Center for Economic Policy, said. “Too many Kentucky families still struggle to make ends meet.”
Poverty remains exceptionally high for black Kentuckians at 30.2 percent and Hispanic Kentuckians at 30.6 percent, compared to white Kentuckians at 16.8 percent. There was no statistically significant change in the poverty rate for these racial groups in 2016.
Geographic as well as racial disparities illustrate the barriers to economic vitality that different communities in Kentucky face. 29.3 percent of people in the 5th Congressional District of eastern Kentucky lived in poverty in 2016, compared to 12.9 percent in the 4th district of northern Kentucky. For children, poverty was even more prevalent at 36.3 percent in the 5th district and 17.8 percent in the 4th (the highest and lowest in the state). No district saw a statistically significant change in poverty or child poverty since 2015.
“There are real barriers that contribute to stubbornly high poverty rates for communities in the commonwealth,” said Baumann. “Outright discrimination hurts black and Hispanic Kentuckians, but so do policy choices such as the failure to pass comprehensive criminal justice reform, a higher minimum wage and stronger pathways to legal status for immigrants. And we still haven’t adequately reinvested in eastern Kentucky communities facing the decline of coal.”
Despite two years of growth, median household income in 2016 was not statistically higher than in 2007 before the recession. For black and Hispanic Kentuckians, median household income in 2016 was statistically lower than for white Kentuckians at $32,231, $39,043 and $48,770, respectively.
“At a time when Kentucky so clearly needs policies that support broadly shared prosperity, it’s very concerning that federal and state lawmakers are considering ideas that would pull the rug out from under Kentuckians,” Baumann said. “Instead, we should be pursuing policies that help communities thrive like strengthening improvements made through the ACA, paid family leave, a higher minimum wage and child care support.”
by Adam Beam
U.S. Census data released today shows Kentucky continued its historic progress in reducing the share of Kentuckians without health insurance coverage in 2016, down to only 5.1 percent compared to 6.0 percent in 2015 – a statistically significant drop over the past year.
The new American Community Survey data (ACS) shows Kentucky has also experienced a statistically significant 9.2 percentage point drop in the uninsured rate since Kentucky created Kynect and expanded Medicaid coverage under the Affordable Care Act in 2013 (when the uninsured rate was 14.3 percent). In fact, Kentucky is one of only 4 states that have seen a decline in the uninsured rate of more than 9 percentage points since 2013, and we lead the nation for the percent decrease in the number of people without coverage (-63.8 percent).
“It’s clear beyond a shadow of a doubt the Affordable Care Act is working. It has helped Kentuckians get the care they need to improve their health, work and take care of their families. It has created jobs in our state and kept many more Kentuckians from being an illness or accident away from financial ruin,” Kenny Colston, communications director for the Kentucky Center for Economic Policy, said.
But recent and pending changes at the state level and attempts to repeal and sabotage the ACA at the federal level threaten the important health coverage gains Kentucky has made.
- Fewer Kentuckians signed up on the federal exchange after the shuttering of Kynect and after reductions in federal spending on marketing health insurance exchanges, meaning our coverage gains could have been even larger if not thwarted.
- Proposed changes to Kentucky’s Medicaid expansion through Gov. Matt Bevin’s pending 1115 waiver would result in nearly 100,000 fewer people being covered by Medicaid.
- Federal attempts to repeal the ACA, replace it with weaker laws, and destabilize the marketplace by denying cost-sharing payments and reducing resources for consumer assistance all threaten coverage in Kentucky.
Though several federal efforts to take coverage from hundreds of thousands of Kentuckians and give tax breaks to the wealthy have been rejected, there are more big threats on the horizon. The Cassidy-Graham repeal and replace bill, as well as recent federal budget proposals, all pose deep cuts to traditional and expanded Medicaid.
“Our elected officials – in Frankfort and Washington D.C. – need to build on our historic gains in health rather than roll them back through the kinds of harmful changes that have been proposed over the past year,” Colston said.