Bevin won't say what would happen to 430,000 new Medicaid enrollees if he cancels expansion as planned if elected

By Al Cross
Kentucky Health News

LOUISVILLE, Ky. -- Republican gubernatorial nominee Matt Bevin wouldn't say Thursday what he would do with the 430,000 Kentuckians who would lose their new Medicaid coverage if he is elected governor and cancels the expansion of eligibility for the program.

At a Kentucky Farm Bureau forum in Louisville, Bevin and Democratic Attorney General Jack Conway were asked how they would pay for the expansion of the federal-state program once the state starts paying 5 percent of the bill in 2017, rising to the federal health-reform law?s cap of 10 percent in 2020.

Conway cited a study for the Beshear administration predicting that the expansion would pay for itself through 2020, by creating health-care jobs and tax revenue. It says there would be a net loss in 2021, the last year of the study.

Conway said there are too many people on Medicaid, but said the solution for that is a better economy. ?What I am not going to do is what my opponent will do on day one, which is by executive order kick half a million people off health insurance based on whether we can or can?t afford it in 2021. To me, that?s not courageous, that?s callous. . . . If we can?t afford something, we can potentially scale back.?

Bevin said the ?day one? line was ?an absolute lie,? but when he was asked in February about the expansion, he said ?No question about it, I would reverse that immediately.?

As he has done before, Bevin conflated the Medicaid expansion with Kynect, the state health-insurance exchange where Kentuckians can get subsidized health insurance or, if their household income isn?t more than 138 percent of the federal poverty line, sign up for free Medicaid.

?With respect to the Kynect program, we cannot afford to have 25 percent and fast growing toward 30 percent on Medicaid, period, whether you like it or not, whether you think it?s fair or not, whether there?s supposedly a need or not, truth be told, we can?t afford it.?

He said later, ?We?re gonna dismantle the Kynect program. We?re not gonna have 25 percent of Kentuckians on Medicaid."

At a post-forum press conference, Bevin acknowledged that Kynect and Medicaid are separate programs. But he continued his attack on the study, which during the forum he had called ?nonsense? and ?absolute rubbish.? He said during the forum that if putting 25 percent of Kentucky on Medicaid would create so much economic activity, ?Why not put all of us on Medicaid??

Health reform was designed to help people who couldn?t afford or were denied coverage, and as a result the uninsured population in Kentucky has dropped to less than 10 percent, from above 20 percent. Medicaid enrollment has leveled off and may be declining as the economy improves.

Bevin said the study failed to account for jobs that have been lost because of health reform. In fact, the study was about the effects of Medicaid expansion, which the state controls, not health reform in general, which is a federal issue. And it was done by an internationally respected firm, Deloitte Consulting, that rejected state Health Secretary Audrey Haynes' request to include the expected benefits of a healthier population, which would have been somewhat speculative.

It remains to be seen whether the study?s predictions will pan out. Job creation in health care fell short of the study?s projections last year, but recent monthly figures have shown significant gains, and Haynes says the expansion is still on track to pay for itself through 2020. University of Louisville economist Paul Coomes says annual figures are more reliable.

After the formal press conference, Bevin got more questions about Medicaid, and repeated an argument he has made before, that health coverage doesn?t equal health-care access ? that there aren?t enough health-care providers, as shown by the increased use of many emergency rooms.

As the questioning continued, Bevin said he had explained what would happen to the 430,000 new Medicaid beneficiaries. Told that he hadn?t, he replied, ?They?re Kentuckians. They will continue to live in Kentucky if they choose to.?

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