IE 11 is not supported. For an optimal experience visit our site on another browser.

Fight over Medicaid expansion reaches a crossroads

Voters in Kentucky elected a right-wing governor because of abortion and gay rights. They may have "voted away their health insurance" in the process.
U.S. Senate candidate Matt Bevin (R-Ky), speaks to a gathering at FreePAC Kentucky, Saturday, April 5, 2014, at the Kentucky International Convention Center in Louisville, Ky.
U.S. Senate candidate Matt Bevin (R-Ky), speaks to a gathering at FreePAC Kentucky, Saturday, April 5, 2014, at the Kentucky International Convention Center in Louisville, Ky.
Earlier this year, Louisiana Gov. John Bel Edwards (D) delivered on a key campaign promise and made his state the 31st in the nation to adopt Medicaid expansion through the Affordable Care Act. So far, the rollout process has been a great success, and hundreds of thousands of low-income Louisianans have been able to receive affordable coverage.
The question now is whether the number of Medicaid-expansion states will grow or shrink.
South Dakota was one of a handful of states considering the policy, but Gov. Dennis Daugaard (R) couldn't overcome opposition from his own party.
And then there's Kentucky, which was celebrated as a national model for ACA success, right up until Gov. Matt Bevin (R) was elected. The far-right governor ran on a platform of eliminating Medicaid expansion altogether, though he backed off soon after taking office. Last week, however, as the Courier-Journal in Louisville reported, Bevin laid out some "reforms" that he says are non-negotiable.

A thunderstorm rumbled through Frankfort Wednesday as Kentucky Gov. Matt Bevin laid out his sweeping proposal to reshape the state's Medicaid plan into one he predicts will encourage responsible health choices and teach Kentuckians the basics of paying for health care. As he spoke in the crowded Capitol Rotunda, a crack of lightning and boom of thunder reverberated through the marble corridors, prompting Bevin to pause. "God's weighing in on this," the governor, a conservative Christian, joked. "He agrees with everything I just said."

Well, that's certainly one way of interpreting things, but given the details of his pitch, there's an alternative worth considering.
Medicaid expansion in the Bluegrass State, which has brought coverage to 440,000 people, has been extremely effective, which Bevin is eager to change. The governor's plan includes premium hikes on people who can least afford it and new work requirements.
Bevin's proposal would need approval from the Obama administration, and the governor has already said it's a take-it-or-leave-it proposition: if federal officials balk at his "reforms," Bevin says he's prepared to scrap Medicaid expansion altogether, leaving 440,000 of his constituents with nothing.
It's worth noting the electoral irony of all of this: as we discussed after the governor was elected, a local political scientist who crunched the numbers found that the Kentucky counties most reliant on Medicaid expansion were also the most likely to vote for the candidate who vowed to tear down Medicaid expansion.
Owsley County Judge-Executive Cale Turner said at the time, "To be honest with you, a lot of folks in Owsley County went to the polls and voted against gay marriage and abortion, and as a result, I'm afraid they voted away their health insurance."
For what it's worth, locals are starting to get engaged. The Courier-Journal reported last night:

Gov. Matt Bevin's proposal to reshape the state's Medicaid program ran into a buzz saw of criticism at its first public hearing since the governor announced it last week. Of the parade of people who spoke at the two-hour hearing at Western Kentucky University, almost no one spoke in favor of the plan aimed largely at those added to the state's Medicaid program since 2014 under an expansion authorized by the federal Affordable Care Act.

Watch this space.