Kentucky’s Medicaid expansion is building a strong foundation for a healthier state, and this is showing up in the research. When considering changes laid out in the recently proposed Medicaid demonstration waiver, it is important to keep in mind the evidence that backs the state’s current approach.
Kentucky’s current approach to Medicaid expansion is resulting in progress
A new study led by researchers at Harvard’s School of Public Health shows progress on a number of measures in Kentucky and Arkansas, another state that expanded Medicaid, compared to Texas, a state that did not expand Medicaid. Low-income adults in the two expansion states are:
- More likely to have a personal physician.
- More likely to have a usual source of care.
- Less likely to delay getting care due to cost.
- Less likely to skip medication because of cost.
- Less likely to use the ER as a usual source of care, or use the ER at all.
- Less likely to report trouble paying medical bills and report spending less out of pocket.
- More likely to get a check-up.
- More likely to get glucose testing, especially when they already have diabetes.
- More likely to get regular care for a chronic condition.
- Less likely to report receiving poor quality care.
- More likely to report having excellent health.
The Foundation for a Healthy Kentucky has been conducting quarterly snapshots of the impact of the Affordable Care Act since the beginning of 2015. Their most recent report estimated that 478,848 Kentuckians between 19 and 64 have coverage because of the Medicaid expansion. They also found that from January through March of this year Medicaid beneficiaries received:
- 6,304 colorectal cancer screenings
- 5,451 Hepatitis C screenings
- 9,567 breast cancer screenings
- 12,837 substance use treatments
- 46,668 dental treatments, 76 percent of which were people covered under the Medicaid expansion (as opposed to traditional Medicaid)
States that chose to expand Medicaid see budget savings and economic gains
The Robert Wood Johnson Foundation looked at 11 states including Kentucky and found that:
- Spending on Medicaid grew more slowly in expansion states than non-expansion states between FY 2014 and FY 2015 (3.4 percent compared to 6.9 percent).
- In 2014, health sector jobs grew 2.4 percent in expansion states, whereas they grew 1.8 percent in non-expansion states.
- Uncompensated care for hospitals dropped far more in expansion states (26 percent) than in non-expansion states (16 percent) during 2014, and rural hospitals were twice as likely to be at risk of closure in non-expansion states compared with their counterparts in expansion states.
The Kaiser Family Foundation found hospitals in states that expanded Medicaid saw an even greater decrease of 35 percent in uncompensated care.
Indiana’s waiver model — which influenced Kentucky’s waiver proposal — is coming under scrutiny
Kentucky’s Medicaid waiver design is heavily influenced by Indiana’s waiver program, but according to the Center on Budget and Policy Priorities initial data is showing:
- The premiums in Indiana’s program are resulting in a drop in Medicaid enrollment, partially due to cost, and largely because the complexity of the plan itself is keeping some people away.
- Few people are participating in preventive care incentives because they are not clearly understood.
- Although a central part of Indiana’s plan is to charge premiums that rise with income, the number of people being charged the lowest amount is likely overstated, hiding the full impact that premiums have on enrollment levels. The state is claiming an improbably large population at or below 5 percent of the federal poverty level, making them eligible for $1 premiums, rather than more expensive premiums owed under the parameters of the program.
A work requirement tied to Medicaid would be a barrier to coverage without boosting employment
While the Centers for Medicare and Medicaid Services have never allowed a state to create a work or community service requirement for Medicaid eligibility, experience with other safety net programs provides a warning for their use in Medicaid. According to the Center on Budget and Policy Priorities, previous work requirements haven’t resulted in increasing long-term employment, and in some cases have worsened deep poverty (people living at or below half the federal poverty line). While programs that provide voluntary access to training and other work supports can help increase employment, requirements can make people less likely to be employed by forcing them to lose coverage and see their health deteriorate as a result. The report notes that most Medicaid beneficiaries who can work already do so.
The evidence is heavily stacked in favor of the state’s current approach to the Medicaid expansion and its impact on Kentucky’s economy and health. People have been able to engage their health, in some cases for the first time, exactly because they have coverage. Without insurance, low-income Kentuckians would be back where they were prior to expansion – uninsured and getting sicker. It is imperative that we build on the successes of our recent health policy, rather than create barriers that would move us backward.