At top legislative Republican’s invitation, Democrats embrace Obamacare, or at least Kynect and Beshear’s Medicaid expansion

By Melissa Patrick
Kentucky Health News

With a verve for Obamacare most had not publicly demonstrated, state House Democrats passed bills March 22 to preserve the Kynect health insurance exchange and the state’s expansion of the federal-state Medicaid program.

The almost entirely party-line votes were a response to Republican Senate President Robert Stivers, who had challenged the House to act on the bills so the public will know where legislators stand on health reform.

The Senate is not expected to pass House Bills 5 and 6, but may use them as a device for debate of an issue on which Republicans seem to think they have had the upper hand. Democrats appear to think otherwise.

“This is a political issue, we all know that,” House Speaker Greg Stumbo said. “The president of the Senate wanted to challenge us to talk about it, so I think we ought to talk about it because . . . Kynect is working.”

(The debate begins four minutes into the following KET video. The continuation of the debate can be seen here.)

Kynect, where Kentuckians can sign up for Medicaid or buy federally subsidized health insurance, was established under executive order with federal grant money by then-Gov. Steve Beshear, a Democrat. It is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which health reform made unnecessary.

Gov. Matt Bevin and other Republicans say Kynect is not necessary because the federal exchange, used by most states, does the same thing. “We will still be providing Kentuckians with access to care,” said Rep. Addia Wuchner, R-Florence. “It will be as easy as going to a different website.”

Democrats say using the federal exchange will leave Kentuckians without enough of the assistance needed by people who are unfamiliar with health insurance. More than 400,000 Kentuckians have used Kynect to sign up for Medicaid and about 100,000 have used it to get health insurance, many with the help of Kynect-paid “Kynectors.”

Rep. Darryl Owens, D-Louisville, the bills’ sponsor, said many people in Kentucky don’t have access to the Internet and that many who do are not “tech savvy.” He said that a decrease in the number of helpers, who are available to meet clients after hours and at convenient locations, will create additional barriers to access for many Kentuckians.

Rep. Kelly Flood, D-Lexington, told the House about one of her constituents who learned in the middle of a family medical crisis that they had been dropped from Medicaid. Flood said the woman told her she could not “reach that wonderful Kynector who used to tell me what was going on.”

The Kynector later told her that “she had been swamped with others like her who wanted to know what was happening to the stability of their health care that they had just secured,” Flood said. “It is so much more complicated than just going to a new website. I am wanting us to understand the people whose lives are on the line.”

The state, completing a plan put in place by the Beshear administration, recently shifted Medicaid users of Kynect to a new system called Benefind that handles most public-assistance programs.
Emily Beauregard, executive director for Kentucky Voices for Health, told Greg Stotelmyer of Public News Service that the wait times on Benefind are two hours and 6,000 to 7,000 calls are going unanswered each day. Advocates have said that the average wait time on Kynect is two minutes.

Cabinet for Health and Family Services spokesman Doug Hogan told Stotlemyre that there had been “difficulties” with the transition and the cabinet is “working diligently with the contractor to correct problems and make the system perform as was intended.”

The House voted on the bills separately but the main debate touched on both Kynect and Beshear’s expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. The federal government is paying for the expansion until next year, when states will begin paying 5 percent, rising to the law’s limit of 10 percent in 2020.

Bevin and other Republicans say that is not sustainable, and he is negotiating with federal officials to change Medicaid to save money and add more personal responsibility, such as premiums, co-payments and deductibles.

Rep. Joni Jenkins, D-Louisville, chair of the House Budget Subcommittee on Human Services, said most Kentuckians who get insurance through Kynect and expanded Medicaid work in low-income jobs and without the program cannot afford insurance.

“With all of this great news — more people covered, profitable hospitals, more jobs, better health care and wellness — I believe the evidence is overwhelming that Kentucky must keep Kynect and expanded Medicaid,” Jenkins said.

At times the debate was more about federal health reform in general than about the specifics of Kynect or Medicaid expansion.

Rep. Jim Gooch, a Providence insurance agent who recently became a Republican, said many Kentuckians have been helped by Obamacare, others have been hurt. He said many can’t afford their co-payments and deductibles, and he said President Obama lied when he said people could keep their old health plans and doctors if they wanted after the reform law passed in 2010.

Another insurance agent, Rep. Jeff Greer, D-Brandenburg, argued the other side. He said the Patient Protection and Affordable Care Act had brought many people their first affordable health insurance, especially those with pre-existing conditions, and relieved many farmers of the need to to work another job to get insurance.

“What I see is that we have something that is working, and I’m in a field where I see it work and yet we want to dismantle it and go to something that we’re not sure is gong to work or not, Greer said. “I just don’t get it.”
House Minority Leader Jeff Hoover, R-Jamestown, said using the federal exchange “will not cause a single policy to be canceled or a single person to lose coverage.” He said 36 other states now use the federal exchange “seamlessly.”

Hoover and other Republicans said the debate was overdue, referring to Beshear’s executive actions that the legislature was unable to block.

The Kynect bill passed 52-46, followed by a 54-44 vote for the Medicaid expansion, with Republican Reps. Jim DuPlessis of Elizabethtown and Jim Stewart of Flat Lick joining the Democrats. Reps. Gerald Watkins, D-Paducah, and David Floyd, R-Bardstown, did not vote on either bill.

All House seats are on the November ballot. House Democratic Caucus Chair and state party Chair Sannie Overly was asked how a vote for Obamacare might affect the election. “I think that House Bill 5 and 6 are simply a message to others that we stand by our commitment to providing access to healthcare to all Kentuckians,” she said. “We’ve seen that our constituents support making sure that their friends and neighbors and relatives have access to health care.”

To the same question, Rep. Robert Benvenuti, R-Lexington, said, “I think the voters have already thoughtfully evaluated that and cast a strong vote for Gov. Bevin, so I do think it will come up again in these November elections.”

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