Legislative leaders debate future of Medicaid expansion

"There?s no doubt that health care remains a significant issue for politicians and voters in the commonwealth. While thousands of Kentuckians have health insurance for the first time, Frankfort continues to debate questions about the quality and affordability of medical services provided under the Affordable Care Act and the cost of expanded Medicaid coverage."

That's how Kentucky Educational Television summed up the health-care discussion among the General Assembly's top leaders on the Aug. 24 episode of "Kentucky Tonight," the state network's weekly issue-oriented discussion show:

The biggest health-care question for the legislature and the new governor will be whether to continue or change the state's expansion of eligibility for the federal-state Medicaid program under federal health reform. The federal government is paying the entire cost of the expansion, which covers about 400,000 people, but the state will have to start paying 5 percent of the cost in 2017, rising to the law's limit of 10 percent by 2020.

House Speaker Greg Stumbo, D-Prestonsburg, said on "Kentucky Tonight" that the question will need close scrutiny, especially because many more people enrolled in Medicaid more quickly than expected, but under the current law, the state needs to keep the current system.

?The economy is good in Kentucky right now,? Stumbo said. ?We can afford to provide this insurance, we can afford to continue to make sure that Kentuckians have it, we just have to monitor it and make sure we?re doing it efficiently.?

House Minority Leader Jeff Hoover, R-Jamestown, said he is concerned that the system isn't sustainable because more people are seeking care and providers are facing reductions in Medicaid reimbursements.

?There are a lot of rural hospitals, particularly in my area and I think in other areas of the state, that are struggling financially now as much or more than any time in many, many years,? Hoover said. He said they are ?constantly having to fight for every service that?s provided with the insurance companies [and] the managed-care companies,? which oversee the care of Medicaid clients much like private insurance does.

Senate Minority Leader Ray Jones, D-Pikeville, said he hasn?t heard such concerns, and noted that his wife is a primary-care physician in Pike County. He said he worries about proposals by Matt Bevin, the Republican nominee for governor.

?If you do away with Kynect and you roll back the Medicaid expansion, not only are those people going to be hurt, but the local health-care providers that are going to have to continue to treat these people if they show up in the emergency room and they don?t have a way to pay for it, then . . . you?re going to see an increase in charity care.?

Senate President Robert Stivers, R-Manchester, said a recent visit to Manchester Memorial Hospital "reinforced for him the need to dissuade the newly insured from using emergency rooms as source for primary care," KET reports.

Stivers repeated his suggestion, first made to Kentucky Health News a month earlier, that Kentucky consider a Medicaid system more like that in Indiana, "which provides incentives for Medicaid patients to see their family doctor or go to an urgent care clinic rather than going to an ER for non-emergency concerns," KET reports.

After Stivers made that suggestion, Bevin backed off his earlier statement that he would end the expansion immediately if elected, and said he favors a modified plan based on the experience of other states such as Indiana.