90% of public comments opposed Bevin’s Medicaid plan, but some tell feds that Ky. voted for him to get rid of Obamacare

By Melissa Patrick
Kentucky Health News

Nearly 1,750 Kentuckians submitted comments about Gov. Matt Bevin’s plan for Medicaid during the federal public comment period that ended Oct. 8 and the vast majority of them opposed it.

Source of data and chart: Kentucky Center for Economic Policy

The Kentucky Center for Economic Policy, after removing repeated comments submitted over the same names, and the responses that were left blank or were not related to the issue, counted 1,643 individual comments. Of those, they found 90.1 percent were “unfavorable,” 8.4 percent were “favorable” and 1.5 percent were “mixed,” according to KCEP’s KY Policy Blog. These findings were similar to a cursory analysis by Kentucky Health News.

To put this in perspective, Ohio and Arizona, the last two state to have Medicaid waivers considered by the U.S. Department of  Health and Human Services, only drew 103 and 97 comments, respectively.

In response to KCEP’s analysis, Bevin’ spokeswoman Amanda Stamper told Louisville’s WFPL that “Gov. Bevin campaigned on reforming Medicaid expansion and was shown overwhelming support by Kentucky voters who elected him to do just that.” However, a poll taken shortly after the election showed most Kentuckians did not want the expansion scaled back, as Bevin wants to do.

The governor’s plan focuses on able-bodied adults who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty level. The new plan is designed to encourage participants to have what Bevin calls “skin in the game” through premiums and a higher level of involvement in their care.

Bevin has said the state cannot afford to have 1.32 million people, nearly 30 percent of Kentucky’s estimated population, on Medicaid. About 430,000 are covered through the expansion.

The proposal expects to save taxpayers $2.2 billion over the five-year waiver period by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs. The expansion population is paid for through 2016, but next year the state begins paying 5 percent of the costs, rising in annual steps to the reform law’s limit of 10 percent in 2020.

Bevin has said that if federal officials don’t approve this proposal, he would end the expansion, but has said he is willing to negotiate.

The plan is called Kentucky HEALTH, standing for Helping to Engage and Achieve Long-Term Health. It seeks a waiver from federal rules, under a section of law allowing demonstration waivers.

Commenters tell personal stories

Many of the unfavorable comments came from Kentuckians who told personal stories about how Medicaid expansion had benefited them, their loved ones and their neighbors.

“I have never used Medicaid coverage, but I have seen both children and the elderly in my community utilize the services. The residents of Kentucky deserve healthy neighbors and I’m willing to use my taxes to do so,” said one comment. (#224665)

Health-care professionals also chimed in with how Medicaid expansion had helped their patients.

“I’m a physician. It’s greatly reduced the stress of my patients to have comprehensive coverage, which has thus improved their health: lower blood pressures, better medication adherence, better follow up,” said one. (#224169)

Many pleaded with Bevin to not make good on his promise to get rid of the expansion if his plan is not approved.

“Expanded Medicaid is the only reason some of us can see a dentist; it’s the only reason we can get a check up, birth control, an antibiotic for a sickness. The expansion made it so that even male members could be covered. Please don’t take it away!” one commenter said. (#224745)

Other comments suggested that the plan has political motives.

“For many Kentuckians, Medicaid is the difference between life and death. Holding the health of our citizens hostage for purely political reasons is vicious and despicable, since the people on Medicaid for the most part have no other recourse,” said one comment. (#224317)

Many unfavorable comments pointed out specific issues with the plan, including: premiums, other costs, work and volunteer requirements, the lock-out for non-payment, the administrative complexity of the proposed program, removal of automatic renewal, removal of non-emergency medical transportation, the removal of retroactive eligibility, and the loss of dental and vision in the base plan, to name a few.

“The complexity of the program creates unnecessary barriers for individuals to maintain health insurance coverage and manage the benefits. The waiver includes maintenance of a health savings account, health rewards accounts in addition to work, volunteer and health education requirements. This creates a very confusing system with multiple barriers to keeping coverage. that needs to be navigated. The purpose of an 1115 Waiver is to improve access to health care, not create roadblocks,” said one comment. (#219253)

Many of the comments also voiced concerns about the removal of dental benefits. The new plan requires participants to earn dental benefits through a rewards program.

M. Raynor Mullins, professor emeritus at the University of Kentucky College of Dentistry, noted in his personal comments that it is well-documented that Kentuckians’ access to dental care has improved since the implementation of Medicaid expansion. He said the plan “includes no supporting dental science or detailed dental or cost information or a solid rationale for the dental design and benefit changes,” though such information is “readily available.”

Mullins questions whether HHS should approve a plan that, in his words, would increase state dental expenses, remove an important health benefit from more than 400,000 Kentuckians, negatively affect rural economies, reduce dental access and ignores the inter-relationship between oral health, diabetes, obesity and heart disease.

Many national and state organizations submitted detailed comments opposing the proposal, including Save Kentucky Healthcare, founded by former Gov. Steve Beshear, who expanded Medicaid. It said that despite Bevin’s claims that the expansion is not affordable, “numerous studies show that Medicaid expansion is financially sustainable, and is in fact beneficial both for the state budget and the Kentucky economy as a whole.” It also pointed out that most of the savings in the new plan will come from a reduction in enrollment.

HHS’s consideration of this waiver is also important to other states.

The policy director of Alabama Arise, a health-advocacy group, wrote that Southern states look to Kentucky as a “beacon for the region,” considering it “one of the great hopes of the South for its highly successful Medicaid expansion.” And said that if HHS approves this waiver it “would be a backward step not only for Kentuckians but for all Southerners . . . and would send a clear message to reluctant but interested states not to move boldly and affirmatively but to hedge and whittle away the most meaningful provisions of expansion.” (#225401)

Fewer than 10 percent of the comments supported the plan

Many of the 8.4 percent of comments in favor of the plan reiterated the governor’s stance that the state cannot afford Medicaid as it currently exist; that “able-bodied” Kentuckians need some some “skin in the game,” that the plan would promotes self-sufficiency by “helping those who help themselves;” that it would discourage people from taking advantage of the system, and increase a person’s dignity by allowing them to pay something for their health care.

“I support Governor Bevin’s plan to replace the expensive and one-size-fits-all Obamacare expansion with a plan that requires personal responsibility and meets the unique needs of Kentucky,” one commenter said. “I, as a Kentucky taxpayer, expect able-bodied adults to work or volunteer in order to receive taxpayer funded health care and that it should be transitional coverage, not permanent.” (#222221)

At least one person told HHS that Bevin was elected to get rid of Obamacare. “Please pass Gov. Bevin’s plan and do away with Obama’s
plan. Plain and simple, this is one of the things we elected you for,” they wrote. (#222785)

KCEP noted that only three organizations wrote in support of the waiver, including: Health Management Systems, Inc.; St. Elizabeth Healthcare; and the Kentucky Chapter of the Association of American Physicians and Surgeons, which is skeptical of government involvement in health care.

KCEP said, “The waiver would not likely save the money it claims, would cover fewer people, and would roll back the historic health care gains we’ve made as a commonwealth. As negotiations begin between officials from Kentucky and Washington, the outpouring of concern should be a key factor to consider.”

One comment suggested that Kentucky’s current Medicaid plan should be allowed to develop for five years before any changes are made, just like the five year demonstration waiver will require if approved.

“Shouldn’t the massive change we made to our Medicaid program in January 2014 be allowed to be evaluated for effectiveness, efficiencies, and health outcomes for at least as long as CMS would consider allowing Governor Bevin’s proposal?” said one comment, in part. (#222385) CMS stands for the Centers for Medicare and Medicaid Services.

Information for this story was also gathered by Traci Thomas of the University of Kentucky. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in UK’s School of Journalism and Media, with support from the Foundation for a Healthy Kentucky.

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