“I’m waiting with bated breath,” said Audrey Tayse Haynes, the former cabinet secretary who spearheaded Kentucky’s health-care changes under the previous governor, “like others are as well.”
Kynect and the Medicaid expansion are linked: Kynect provides the infrastructure and outreach through which Kentuckians can sign up for qualified health plans or Medicaid. Bevin’s beef with both programs certainly isn’t founded in their unpopularity. To the contrary, the state’s drop in the number of uninsured residents from 2013 to 2014 was the biggest in the country—a credit, health-care researchers say, to the grassroots, in-person network established through Kynect that helped Kentuckians learn about their health-care options.
Bevin’s concerns, rather, focus on what he sees as the two programs’ cost. When asked for specifics about the governor’s plans, his spokeswoman said in a statement that he’s aiming to “improve health outcomes” and “take deliberate and prudent steps to develop a health-care plan that Kentucky can afford.”
But if Bevin’s aim is to save taxpayers money, health-care advocates in Kentucky say he’s going about it all wrong. In terms of its setup, Kynect is already paid for, and dismantling it comes with its own costs. According to a presentation Kynect’s executive director gave in August, the IT work alone to get rid of its website would take nine months and cost roughly $23 million. The state’s coffers could be on the hook for that cost.
Beauregard, executive director of the consumer-advocacy group Kentucky Voices for Health, said even if Kynect is dismantled, the state would still be responsible for managing more than 1 million people on Medicaid, and it would still need the infrastructure in place—including an online enrollment system and employees to help sign up Kentuckians—to do so.
And then there’s the Obama administration variable. In her first interview since leaving her post as secretary of Kentucky’s Cabinet for Health and Family Services, Haynes said she’s “not sure” what the Bevin administration would replace the current system with. She doesn’t anticipate the federal government agreeing to foot the bill after it has already shelled out roughly $280 million to build Kynect.
Kentucky’s rollout of the Affordable Care Act was seen as a victory for President Obama’s signature law. Both were implemented by executive order by the Democratic Governor Steve Beshear. As Jason Bailey, the executive director of the Kentucky Center for Economic Policy, noted in an interview, Kentucky’s reforms were a national model. “And it’s not often that Kentucky is seen as a national leader,” Bailey said.
Kentucky’s model status is rooted in Kentuckians’ swift, close-to-seamless enrollment in Medicaid. After the expansion—which allowed Kentuckians making up to 138 percent of the federal poverty line to enroll—about 400,000 people signed up. That’s twice as many as state officials had estimated, and it brought the total number of Kentuckians on Medicaid to a quarter of the state’s population. Though the federal government is paying for the expansion through 2016, Kentucky does have to kick in funds after that. But according to a Deloitte study commissioned by Beshear’s administration earlier this year, the expansion will pay off. The New York Times has the details:
Kentucky’s cost of covering the new Medicaid enrollees will start at $74 million in 2017 and grow to $363 million by 2021. Like most states, Kentucky already spends more of its budget on Medicaid—about $1.9 billion in the 2014 fiscal year—than almost anything else. But the report found that the expense of covering the new enrollees would be more than offset by the positive economic effects of expanding the program. They include new Medicaid revenue to health care providers—totaling more than $1 billion in 2014 alone, according to the report—and the resulting creation of jobs in health care and other professions.
It’s worth noting that Bevin disputes the findings of that study. But to the former Beshear administration, the financials look even more promising when one considers the total amount the state has made from the expansion: According to a report in The Courier-Journal, that’s roughly $3 billion since 2014.