From Phil Galewitz Via NPR:

In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.

...But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.

More last-minute shuffling... (h/t commenter "M E"):

Baptist Health Plan to stop selling insurance in Ky.

FRANKFORT (AP) — Baptist Health Plan says it will not sell policies in Kentucky next year, meaning about 7,000 people will have to find a new insurance provider.

Kentucky’s fourth-largest insurer notified state officials in a letter. In a news release, state officials say company President James S. Fritz said Baptist Health Plan had enrolled more people than it planned and said federal risk assessments imposed by the federal Affordable Care Act are “unsustainable.”

The company’s insurance plans sold on the state’s health exchange will be good through Dec. 31. Plans sold off the exchange will expire March 31, 2017.

The news means next year people in 59 counties will have one insurance provider selling plans on the state health exchange. Off the exchange, most counties will have two options, state officials said.

When I ran Kentucky's average requested rate hike numbers for the individual market back in May, I came up with a weighted average of 23.8%, but also cautioned that the weighting was likely based on less than 50% of the total ACA-compliant individual market state-wide.

Since then, it looks like a couple of the carriers resubmitted their filings with slightly different average requests, although nothing major. In fact, even Aetna dropping off the exchange doesn't change much, since it looks like they only have around 400 enrollees there anyway (plus, Aetna says they're sticking around the off-exchange market in "most" of the regions they're bailing on next year). Finally, as far as I can tell, Kentucky is among the states that Humana is not abandoning (though they might be reducing their footprint there?).

Anyway, just moments ago, according to SHADAC, the Kentucky DOI has posted their approved rates for the individual market:

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.

Not much to say about the bluegrass state...taken together, the 6 carriers offering individual policies in Kentucky appear to be requesting an average rate hike of 23.8%, ranging from Aetna's single-digits for a few hundred people up to Golden Rule's stroke-inducing 65% hike. One thing to note is that KY's total individual market was around 163,000 people in 2015, and is likely around 25% higher today (around 203,000), so over half of the market is likely missing from this table:

I wrote a lot about Matt Bevin during the Kentucky gubernatorial campaign last fall, as well as after he won the election, was sworn in as governor, and started doing his best to screw up stuff which wasn't broken. As you'll recall, when it came to the Affordable Care Act and the state ACA exchange (kynect), Bevin originally promised that he was going to kill the kynect exchange completely (even though there's no reason to do so, it's been operating smoothly for years and has excellent branding in the state) as well as killing the ACA Medicaid expansion (even though, again, it's been a huge success in the state at no cost to them so far and only pennies on the dollar going forward).

Well, as Jeffrey Young notes over at the Huffington Post, it turns out that Bevin can't even screw over hundreds of thousands of people properly:

Kentucky has turned into the place where Obamacare repeal rhetoric meets Obamacare repeal reality. Reality is winning.

No sooner had I posted my big "wrap-up" reports when Rachel Karas of Inside Health Policy gives me the following heads up:

.@kynectky 2016 enrollment numbers as of today: QHP: 93,687; total Medicaid: ~1.3M; Total in expanded Medicaid: 437,091 cc: @acasignups

— Rachel S. Karas (@rachelkaras) February 5, 2016

Hmmm...OK, I guess "as of today" means I need to make the "thru date" 2/04/16 instead of 1/31 or 2/01, but whatever; the point is that this is Kentucky's final official total.

Kynect's total was 81,121 as of 12/26, so they only added about 12,500 more since Christmas. 93,687 is only around 75% of the 125K I was expecting, and is over 12,600 fewer private enrollees than they had last year, making them one of only 8 states to drop their open enrollment total.

In fact, each of the other 7 are special cases:

OK, there's a lot of confusion (including some by myself) about the whole "saving money" issue with regard to Matt Bevin shutting down Kentucky's kynect exchange. I've discussed it with Louise Norris, and I think the situation is as follows:

  • Currently, kynect's $28 million annual budget is covered by a 1% fee charged to all premiums for everyone on individual policies (on or off exchange), small group policies and large group policies.
  • In other words, right now, as far as I can tell, around 1.8 million Kentuckians are paying roughly $16 per year to pay for Kynect.

Not that it'll save the state any money or anything (and in fact could end up costing them more, both in terms of the cost of winding down the organization/transitioning to the federal exchange as well as the higher fees which will apparently be required), but doing something sensible doesn't seem to be part of Matt Bevin's DNA:

FRANKFORT, Ky. - Following through on a campaign pledge, Gov. Matt Bevin has notified federal authorities he plans to dismantle kynect, Kentucky's health insurance exchange created as part of the Affordable Care Act.

In a Dec. 30 letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, Bevin said he plans to wind down the state health exchange and transition Kentuckians to the federal site,, to shop for insurance under the law also known as Obamacare.

If you look at the State-By-State OE3 enrollment breakdown, you'll notice that there are still 4 blank fields all the way down at the bottom, plus a special note regarding California:

When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

"Sometimes I park in handicapped spaces
While handicapped people make handicapped faces."

--Denis Leary, "Asshole"

A couple of weeks ago I noted that newly inaugurated Republican Governor of Kentucky Matt Bevin was, true to his word during the campaign, making the destruction of kynect, the Bluegrass State's ACA healthcare exchange, one of his first and highest priorities.

Never mind that the exchange has (unlike most of the other ACA exchange sites) operated pretty much flawlessly since day one.

Never mind that thanks to the ACA and kynect, the uninsured rate in Kentucky has been slashed by more than half over the past two years, from over 20% down to 9%.

Never mind that the "kynect" branding has been an unprecedented and award-winning success.

As I noted last week, as of Monday, December 7th, here's the sort of information which could be found on outgoing Democratic Governor Steve Beshear's "Healthier Kentucky" webpage:

Open Enrollment stats as of Thursday 2/19/2015:

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.