Urban Llama

Former Kentucky Gov. Steve Beshear announced the formation last week of a tax-exempt organization to raise awareness about the impending demise of kynect, Kentucky’s locally-grown outlet of Obamacare, by new Republican Gov. Matt Bevin.

The bipartisan organization, “Save Kentucky Healthcare,” has an online presence that includes a petition, and is intended to educate voters about the proposed changes to the kynect marketplace.

kynect was widely hailed as a national model for Obamacare since its inception in 2014. Under the guidance of Gov. Beshear, a Democrat, Kentucky became the only state in the South to create a state-based insurance exchange and expand Medicaid under the Affordable Care Act (ACA).

Some 500,000 Kentuckians have enrolled in the exchange plans as a result, dropping the state’s uninsured rate from 20.4 percent in 2013 to a low of 7 percent, beating the U.S. average of 10.6 percent.

While I applaud the former governor’s compassion, and share the dismay felt by the organizers of kynect over its dismantling, I fail to see an avenue where stakeholders can impact the sitting governor’s decision to carry out one of his primary campaign promises.

The major vulnerability for the program is that the authorization allowing for kynect and expanded Medicaid were achieved through the use of executive orders.

It was impossible given the political climate in Kentucky and the polarization surrounding President Obama, for Gov. Beshear to get a bill through the KY General Assembly that would allow for the establishment of a state-based exchange and Medicaid expansion.

An executive order is only as binding as the incoming governor chooses to make it once the issuing governor has left office.

In this instance Gov. Bevin reports that after looking at budget numbers he finds kynect duplicative and seeks to shift the state over to the federal exchange, Healthcare.gov. The necessary paperwork was filed to make that happen, which in turn has rendered kynect obsolete.

Of the half-million Kentuckians enrolled through kynect, 400,000 are on Medicaid. This is a godsend to the working poor – those with full-time jobs earning minimum wage that are not offered benefits and can’t afford private insurance.

Under the ACA, the wages an individual can earn were expanded to 138 percent of the poverty level, allowing those that qualify to receive comprehensive medical coverage, plus dental, for basically free.

The rub is this coverage has to be paid for somehow. From 2014 through 2016, federal funds have covered the entire bill for those enrolled in Medicaid. Beginning in 2017 through 2020, Kentucky will have to begin paying a percentage of its Medicaid costs, up to 10 percent.

In a cash strapped state facing budget shortfalls and more than $30 billion in unfunded liabilities for state employee and teacher retirement funds, it’s a problem having an unknown amount of Medicaid reimbursements dangling.

Secondarily, there is a growing national debate about the private insurance side of Obamacare. Those not qualifying for Medicaid can receive subsidies and special discounts that help offset the costs of private Obamacare plans.

Those policy options are far from affordable for the people needing help the most. The deductibles are astronomical, making it impossible for middle class families to meet them, plus the monthly premiums average $585 in Kentucky.

The cost of these private plans is being attributed to why Obamacare enrollments in 2016 were 40 percent lower than forecasted, a deficit of 7 million sign-ups below last year’s projection.

Regardless, the ACA has been a great starting point to the conversation of how America intends to provide health coverage to its population. This is an ongoing discussion, and one receiving significant attention in the current presidential nominating contests.

What adds to the intrigue of the Kentucky discussion is that kynect has gone through what could be considered two statewide referendums already; during the re-election bid of Sen. Mitch McConnell in 2014; and in the recent governors race between Bevin and Democrat Jack Conway.

In both instances the dismantling of kynect was a prominent platform item for both Republican candidates, while neither Democrat adequately embraced the defense of this transformational program.

Individuals benefiting from improved health, lower costs and potentially better, longer lives, could have locked down access to kynect, and in both elections voters overwhelming rejected the Democratic candidates who aligned with the former governor’s signature accomplishment.

In Bevin’s case he won 106 of 120 counties. Even in a low turnout election that represents a mandate. The people of Kentucky spoke loud and clear.

As things sit currently, enrollees will stay on the exchange plans through 2016, then will transition to the federal website, Healthcare.gov, and enroll there for 2017.

There shouldn’t be any huge difference in the enrollment process. The major sticking point is whether Gov. Bevin decides to decrease the Medicaid qualification percentage.

If the waiver Gov. Bevin has applied for, that would allow flexibility in qualification levels and possible co-pays from recipients, is not approved in a timely fashion, the governor has floated getting rid of the Medicaid expansion.

That is an entirely different political animal, as hundreds of thousands could be denied healthcare access.

Again, these are real-life ramifications that should have been thoroughly considered by kynect recipients when the polls were open in November of the past two years, but those folks never showed.

Beshear had a study done in 2015 that indicated the expansion would pay for itself through job creation, tax revenue and an increase in the healthcare system.

That job number has come up short, and the Bevin administration has declared kynect a financially unsustainable boondoggle that has cost $330 million.

Perhaps better explaining the political ramifications surrounding kynect to the public would have been helpful, instead of organizers putting their collective heads down and only illustrating how the program worked for consumers.

Having served as a program coordinator with the exchange from 2013 into 2015, and being responsible for kynect’s social media, I repeatedly submitted story ideas that looked at the swirling criticism around the ACA and kynect, and what was at stake in election outcomes.

My thought was that by opening social media channels to discussions of a substantive nature, an informative and fruitful dialog could be established.

Those types of conversations were never allowed to take place. Neither was it permissible to make reference to President Obama or the term Obamacare.

By not joining in this discourse it allowed the Republicans to frame the argument and it facilitated the public’s misconception that kynect was not associated with Obamacare and not subject to the vulnerabilities it now faces.

It’s ironic that the ex-governor now wants to have this conversation through his “Save Kentucky Healthcare” website.

Check it out at:  www.saveKYhealthcare.org

Estimates are that it will cost Kentucky taxpayers $23 million to disband kynect and transition enrollees to the federal exchange.

Issues do matter, voting matters, and now Kentucky will again be a national example – but this time it will be for the consequences of complacency.

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[For additional background on the issues surrounding kynect, and the political races impacting it also see:

kynect Poised for Winds of Change | December 4, 2015]