2018 MIDTERM ELECTION

Time: D H M S

Kentucky: Bevin gives the HHS Dept. an offer they can't possibly approve.

Long-time readers may have noticed that after a flurry of posts about Matt Bevin's jackassery last fall, I haven't written much of anything about Kentucky lately. In fact, aside from an entry about KY's 2017 rate hike requests (as part of my national project), I haven't said a peep about Kentucky since March. At the time Jeffrey Young of the Huffington Post noted that it looked very much like for all of Bevin's hot air and bluster...

But a funny thing happened on the way to the governor's office: Bevin's anti-Obamacare rhetoric started to tone down as Election Day approached. And in the months since he's been chief executive of Kentucky,instead of ripping up Obamacare out of his state, Bevin is making alterations to how the law works there and leaving its core elements and benefits in place.

A candidate who vowed to completely roll back Kentucky's expansion of Medicaid to more than 300,000 poor residents under the Affordable Care Act now is a governor who plans to put some conservative window dressing on the program, akin to what Gov. Mike Pence (R) did in Indiana.

Well, apparently it really is important to Bevin that he not completely abandon his campaign promises, because as of today, according to Young:

WASHINGTON — Kentucky Gov. Matt Bevin (R) wants to enact a major overhaul of the state’s Medicaid program — and vows to let the Obamacare expansion that covers hundreds of thousands of poor residents to disappear if federal authorities don’t agree to his plan.

At a news conference in Lexington Wednesday, Bevin outlined an ambitious proposal to convert 1.2 million current Medicaid enrollees into a new program called Kentucky HEALTH, which would make them pay monthly premiums and require them to do community service, job training or other activities to retain coverage.

...But Bevin also made clear that the continuation of the Medicaid expansion in Kentucky is contingent on President Barack Obama’s administration, specifically the Centers for Medicare and Medicaid Services, which is part of the Department of Health and Human Services.

“If they do not approve this, there will not be expanded Medicaid in the state of Kentucky,” Bevin said. A Health and Human Services spokesman didn’t immediately respond to a request for comment.

To clarify the numbers a bit: ACA Medicaid expansion totals around 400,000 Kentuckians. An additional 800,000 people are enrolled in "traditional" Medicaid, for Young's 1.2 million total.

The general philosophy behind a work/service requirement is supposedly that it forces recipients to "have some skin in the game", and to "show a work ethic". The problem with this is that it also adds an entire extra layer of bureaucratic red tape to the existing system (something which Republicans supposedly hate) in order to keep track of everyone, which adds more expense and reduces efficiency. In addition, the GOP loves giving wealthy people and large corporations are massive tax breaks and the like without making them show up at a soup kitchen twice a week, so it's pretty obvious what the real goal is here.

Finally, as Judith Soloman of the Center on Budget and Policy Priorites notes:

HHS Secretary Sylvia Mathews Burwell wrote Arkansas’ governor earlier this year that, “Consistent with the purposes of the Medicaid program, we cannot approve a work requirement.” Yet Bevin’s plan would condition Medicaid eligibility on work. Similarly, his plan would impose premiums on all beneficiaries — even those with no income — and delay coverage until they’re paid, though HHS didn’t allow Montana to impose significant cost-sharing and premiums on people with incomes below 50 percent of the poverty line. The governor’s plan would also lock people out of coverage for six months if they fail to renew their coverage in a timely fashion, something no state has proposed doing.

Bevin has cited Indiana’s “HIP 2.0 Plan” as a model for Kentucky, but replicating that plan — which delays coverage until payment of premiums and charges steep co-payments to poor people who don’t pay their premiums — would be unwise. Extensive research shows that premiums significantly reduce low-income people’s participation in health programs, and mounting evidence suggests that Indiana has had trouble implementing HIP 2.0 in a way that’s consistent with its agreement with the federal government. Until state and federal evaluations of Indiana now underway are completed, federal officials shouldn’t allow other states to adopt Indiana’s approach, particularly where beneficiaries would risk losing coverage or access to care due to premiums and cost-sharing.

One other major problem noted by Young:

In both cases, the benefits package is based on the state employees’ health insurance plan. That means it doesn’t include dental or vision coverage. Kentucky HEALTH, however, would retain the current Medicaid program’s level of coverage for mental health and substance-use treatment, which exceeds the employees’ plan.

As Abby Goodnough of the NY Times noted, the removal of dental coverage in particular is a major problem for Kentucky residents.

Anyway, we'll see how this plays out, but obviously Bevin has structured this in such a way that he can have his cake and eat it too: He's given the HHS Dept. an offer he knows damned well that it can't approve; that way, when they reject it, he gets to kill Medicaid for all 400,000 people and try to pin the blame for it on the federal government instead of himself.