Bevin asks Congress to get rid of Obamacare and, if Medicaid expansion continues, limit it to those who are in poverty

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has taken a stronger stance against Obamacare than his fellow Republican governors, urging Congress to repeal it “in its entirety” and saying that if Medicaid expansion under the reform law must continue, then only those under the federal poverty line (FPL) should get it.

Gov. Matt Bevin

“Medicaid was always intended to be a poverty program, and anyone above FPL should be eligible for gradually decreasing subsidies to the extent Congress decides to keep premium subsidies and cost-sharing reductions,” Bevin wrote House Republicans in a letter dated Jan. 6.

The FPL is $11,880 for an individual and $24,300 for a family of four. The Medicaid expansion is for those who earn up to 138 percent of the FPL: $16,394 for an individual and $33,534 for a family of four. Before the expansion of Medicaid, only people in households with incomes of 69 percent or less of the FPL were eligible for Medicaid in Kentucky.

Kentucky is one of the states that has benefited most from the expansion, with its uninsured rate dropping by more than half from 2013 to 2015, from 14.3 percent to 6 percent respectively. The state has about 1.3 million Kentuckians on Medicaid, with about 430,000 qualifying through the expansion.

Bevin said the expansion is “unaffordable and harmful, threatening to eat up the state’s budget and undermine Kentucky’s ability to provide care for the poorest residents.” The federal government paid the full expansion cost through last year; this year states are paying 5 percent of it, an amount that would rise in annual steps to the law’s limit of 10 percent if that provision is not repealed. Bevin estimates Kentucky’s cost at $1.2 billion over the next five years.

“We need a more sustainable solution, focused less on mere enrollment and more on actually improving health outcomes,” Bevin wrote. “At a minimum, the Medicaid expansion population should be converted to a block grant program, possibly encompassing the Children’s Health Insurance Program “in order to promote family coverage across those who are at or below the poverty line.”

As a candidate in the 2015 primary, Bevin pledged to end the expansion and other elements of Obamacare, but backed off that as the Republican nominee, and as governor has only asked for a waiver from federal rules that would allow the state to charge income-based premiums and require able-bodied recipients who aren’t primary caregivers to work or prepare for work. The Lexington Herald-Leader said in an editorial that “emails to Bevin’s spokespeople, asking whether he still supports his Medicaid plan . . . or again wants to repeal the expansion produced no replies Wednesday,” Jan. 25.

Bevin’s comments contrasted with those of other GOP governors, such as Ohio’s John Kasich, who said Congress should preserve Medicaid expansion, as well as several consumer protections in the law, Deirdre Shesgreen reports for USA Today. Bevin also asked for “maximum flexibility” for states to create their own plans.

Several governors urged simultaneous repeal and replacement of the law, but Bevin did not, Shesgreen notes. The letters came in response to House Majority Leader Kevin McCarthy’s request for governors to offer input about the ACA and their suggestions for replacement.

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