The debate comes down to coverage vs. cost.
Proponents of expansion say it would cover millions of vulnerable Americans, saving money in the long run by avoiding more expensive emergency room care and heading off long-term health problems.
According to a report by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute, more than 620,000 Kentuckians and Hoosiers would be newly enrolled in Medicaid in 2019 under the expansion, including more than 460,000 who were previously uninsured.
“It’s pretty obvious this is going to result in significant savings across the system. People getting uncompensated care will have their health care paid for,” said U.S. Rep. John Yarmuth, D-Ky. 3rd District. “Then there’s the moral side of this. We have an opportunity to prevent a lot of sickness, suffering and needless deaths.”
“In the meantime, given Kentucky’s struggles to finance its current Medicaid program and the uncertainty of futurefederal funding, I hope Kentucky’s lawmakers would not expose the commonwealth’s taxpayers to more open-ended expenses they cannot afford,” he said in a statement. “Additionally, a dramatic expansion of Medicaid enrollment would obviously exacerbate the already serious access-to-care problems we face in Kentucky.”
More than 50 of Kentucky’s 120 counties — and almost 100 pockets within counties — are deemed by the federal government to be short on health professionals.
In Kentucky, for example, working parents are eligible if their earnings equal 62
percent or less of the federal poverty level — no more than about $9,000 for a family
of two. Childless adults younger than 65 who aren’t disabled are ineligible in most
According to the Kaiser Family Foundation, about 885,000 Kentuckians and 1.15 million Hoosiers are enrolled in Medicaid.
Under the expansion, Medicaid would effectively cover people who earn up to 138 percent of the federal poverty level — currently $15,415 for one person and $31,809 for a family of four.
Officials in the Kentucky Cabinet for Health and Family Services would not discuss the issues they are weighing as they work with Beshear on the question of expanding Medicaid.
“We are in contact with the appropriate federal agencies, and we are awaiting guidance on how the opinion on the ACA affects Medicaid expansion choices for states,” Beshear said in a statement. “We’re going to take enough time to answer all our questions before we make a determination on expanding the program in Kentucky.”
Yarmuth urged Beshear to expand Medicaid, saying he expects Kentucky will eventually make “the right choice.”
Yarmuth said failing to expand Medicaid would mean turning down $12 billion from the federal government over the first five years. Kentucky’s added cost during 2014-2019 would be $515 million, the Kaiser study said.
Over that same period, the study said, the federal government would spend $9 billion in Indiana; the state, $478 million.
Rudowitz pointed to a July study in the New England Journal of Medicine that compared three states that expanded Medicaid eligibility for adults — New York, Maine and Arizona — with neighboring states that did not.
echoed many others. “Our major concern is cost,” he said. “How’s it going to be paid for year after year? We’re all for health care, but how do you pay for it?”Underwood said he’s concerned that Medicaid costs might eventually require new or higher taxes, and he worries how that might affect small businesses.Noting that states are struggling now to meet their obligations, he said: “If they don’t have any money now, how are they going to have money for this?”A July report from the Congressional Budget Office said the high federal share of expansion costs is an incentive to expand the program, but a “significant disincentive … is that states would ultimately have to bear some costs for an expansion …during a period when their budgets are already under pressure, in part from the rising costs of the existing Medicaid program.”
In 2010, the federal share of Medicaid payments in Kentucky was nearly 80 percent; in Indiana, it was 76 percent.
Experts say federal-state breakdowns for current Medicaid recipients would remain the same under health reform. But all of the money, state or federal, comes from taxpayers.
The congressional budget office and the staff of the Joint Committee on Taxation estimate that the insurance coverage provisions of the health-care law, including the Medicaid expansion, will have a net cost of $1.168 trillion from 2012 through 2022.
That’s a reduction from the $1.252 trillion projected before the Supreme Court decision, which authors say is more the result of spending reductions from lower Medicaid enrollment than offsetting cost increases from greater participation in insurance exchanges.
Rudowitz said if states don’t expand Medicaid, some areas would still see changes.
For example, she said a Medicaid program that provides financial assistance to hospitals serving a large number of low-income patients, called the Disproportionate-Share Hospital program, or DSH, is scheduled to reduce payments
under health reform in the anticipation that more Americans gain coverage.
Regardless of whether the state expands Medicaid, facilities such as University Hospital in Louisville would still see those payments drop.
Also, uninsured people earning 138 percent of the federal poverty level or less, who currently aren’t eligible for Medicaid, are likely to remain uninsured if a state doesn’t expand Medicaid.
That’s because they also aren’t eligible to get insurance through exchanges, since the health law’s authors assumed they’d be covered through expanded Medicaid. Yarmuth said Congress “is going to have to address this.”
Wagner agreed, saying: “It makes no sense for the poorest of the poor not to benefit in any way from the law.”
By the numbers
• 250,704 — Estimated number of previously uninsured Kentuckians newly enrolled in Medicaid, as of 2019, if the state expands Medicaid
• 215,803 — Estimated number of previously uninsured Hoosiers newly enrolled in Medicaid, as of 2019, if the state expands Medicaid
• 57.1 percent — Percentage reduction in uninsured adults in Kentucky with incomes less than 133 percent of the federal poverty level, if the state expands Medicaid
• 44.2 percent — Percentage reduction in uninsured adults in Indiana with incomes less than 133 percent of the federal poverty level, if the state expands Medicaid
• $2 billion — Estimated cost, between 2012 and 2020, of a Medicaid expansion in Indiana
• $1.168 trillion — Estimated net cost of the insurance provisions of the health reform law over the 2012-2022 period
Sources: The Kaiser Commission on Medicaid and the Uninsured; Urban Institute; Congressional Budget Office; Joint Committee on Taxation; Indiana Gov. Mitch Daniels’ office; Milliman