Doctor shortages may undercut Kentucky Medicaid expansion

Flood of patients is a concern

May 21, 2013   |
Written by
Laura Ungar
The Courier-Journal

Dr. Ron Waldridge II sees up to 24 patients a day at a busy family practice in Shelbyville, and says he can’t take on any new ones unless they are family members of people he already treats.

So he wonders how he and other Kentucky doctors will be able to handle the tens of thousands of Kentuckians expected to get Medicaid coverage through health reform.

“On the one hand, you’d love to see universal coverage,” the second-generation family physician said. “But I don’t think there’s a lot of open space for people getting insurance to find a new doctor.”

Gov. Steve Beshear’s recent decision to expand Medicaid opens the program to 308,000 residents earning 138 percent of the federal poverty level or less, and officials estimate that 332,000 more uninsured residents can gain coverage using new insurance marketplaces called exchanges.

But Kentucky’s longstanding physician shortages, combined with refusals by some doctors to take new Medicaid patients because of low reimbursements, threaten to undercut those efforts — particularly in rural areas.

The result might affect not only the newly insured but other patients who potentially face longer waits to see a doctor or specialist.

Data analyzed by The Courier-Journal shows that Kentucky counties that will see the largest portion of nonelderly residents become eligible for Medicaid often have fewer primary care doctors per capita. Casey County, for example, has the highest portion of newly eligible residents at 13.5 percent, but it ranks in the bottom third for doctors per capita.

Experts say expanding community health centers serving low-income patients, and creating more teams of health care workers may help but won’t solve the problem.

Similar issues plague rural states across the nation, said Peter Cunningham, senior fellow at the Center for Studying Health System Change, based in Washington, D.C.

“Rural areas simply don’t attract enough physicians,” he said. “In a lot of places, there’s already strained capacity, and this is going to strain it even more.”

Demand and supply


The federal government lists 192 areas in Kentucky — including 47 counties — with shortages of health professionals. Kentucky Health Facts listed about 10,000 physicians in the state in 2009, including 4,200 in primary care.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” said Susan Zepeda, president and chief executive officer of the Foundation for a Healthy Kentucky.

The state Cabinet for Health and Family Services plans a briefing on the health care work force today, during which officials will discuss results of a study by Deloitte Consulting intended to address the issues.

Officials would not release the study early, but the cabinet and Beshear’s office said in a joint statement that “issues around access to health care and workforce capacity have been a concern for a number of years in Kentucky.”

Shelby County, where Waldridge practices, ranks in the bottom half of counties for primary-care doctors per residents. Waldridge said he and the partners in his practice, which is part of KentuckyOne Health, have about 10,000 patients, about 15 percent of whom are on Medicaid. Waldridge said he personally sees about 1,700 patients.

As a state, he said, “the physician manpower issues we deal with should have been addressed before this.”

Other doctors and nurses shared similar concerns, with some saying patients may turn to emergency rooms because they can’t find primary care doctors.

“I’m not sure who’s going to pick up all those (new) patients into their practices,” said Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives.

The problem is less acute in Louisville, which has one of the state’s highest rates of primary care doctors compared with population, and where hospital systems, such as Norton Healthcare, Baptist Health and KentuckyOne Health have been expanding their primary care networks.

“We think we can absorb a significant number” of new patients, Norton Chief Executive Officer Stephen Williams said.

Waits and crowding are “certainly a potential problem,” Williams said. “But 300,000 (new Medicaid patients) are going to be spread across the entire state. I doubt this will turn into a huge problem — although there may be pockets.”

Patients, payments

Doctors and nurses said another complicating factor is that newly insured patients tend to be sicker because they’ve delayed getting needed care.

Angela Estes, 43, of Columbia, an assistant at a nurse-practioner-only primary care office in her hometown, is uninsured but eligible for Medicaid under the expansion. She gets primary care at her workplace but has been putting off getting a mammogram, updated MRI scans for headaches associated with a neck injury, and recommended sinus treatment that would cost about $7,000.

With Medicaid, she said, “I’ll be able to hopefully get the care for things I need.”

But how quickly will they get it?

Doctors said patients who have put off care may need longer appointments, referrals for specialized care or hospitalizations — pushing up patient loads across the board.

Complicating matters, not all doctors take new Medicaid patients.

According to a 2012 study in the journal Health Affairs, 79 percent of office-based physicians in Kentucky, and 69 percent nationally, accepted new Medicaid patients in 2011.

State statistics show that the portion of Medicaid-registered primary-care providers currently accepting new Medicaid patients ranges from 81 percent to 99 percent, depending on the managed-care company.

Medicaid traditionally has reimbursed providers at lower rates than other types of insurance. Ewen, who said about a third of patients are on Medicaid, said the reimbursement is only $23 for a lower-level visit by an established patient.

The health reform law includes an incentive for more health providers to take Medicaid — an enhanced reimbursement rate for 2013 and 2014 at least equal to Medicare reimbursements. But health care workers said that is only temporary.

Addressing problem

A possible long-term solution includes greater reliance on community health centers, some say.

Family Health Centers in Louisville plans to renovate portions of the Phoenix Health Care for the Homeless site and relocate the East Broadway site to an adjacent building, making room to eventually see 10,000 new patients. Officials there said last May that they received $5.4 million in federal health reform grants for these projects.

At Park DuValle Community Health Center, meanwhile, Chief Executive Officer Anthony Omojasola said “none of our four sites are operating at full capacity right now, so we plan to absorb some of that surge in demand.”

Another solution is to attract more nonphysician health care providers, such as nurse practitioners, to areas lacking doctors. But not everyone agrees on how to do that.

Ewen and Beth Partin, who co-owns the practice where Estes works, said the state’s 2,800 nurse practitioners shouldn’t need “collaborative agreements” with doctors that are now required to prescribe nonscheduled drugs such as blood pressure medications. Partin said such agreements put practices in jeopardy if a doctor dies, moves or charges a large signing fee.

Physicians, however, have long argued that those agreements are essential. Cory Meadows, director of advocacy and legal affairs with the Kentucky Medical Association, talks about expanding care with nonphysicians in a “physician-led, team-based approach.”

“If we team up together to take care of people, we may not be as short of manpower,” Waldridge said.

Some health care leaders said the growing array of walk-in clinics, such as Baptist Express Care in Walmart stores, provide another avenue for care, at least for minor illnesses.

And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, for example, said her system is looking to open new primary care offices and hire more staff.

Meanwhile, Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from partner KentuckyOne to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agreed that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it.

“The more people we can get into the health care system, the more people get care. It not only saves and improves lives, but it also reduces costs,” said Norton’s Williams. “It’s going to be a positive over the long term. But I think there will be a learning curve and an experience curve.”

Reporter Laura Ungar can be reached at (502)582-7190 or on Twitter @lauraungarcj.


Explaining the Exchanges to Employees Won’t Be Easy

Between the growing number of companies expected to introduce a private exchange later this year and the state-run health insurance exchanges that open for business on Jan. 1, 2014, employee communication will be critical in the coming months, benefits experts say.

By Rita Pyrillis

Published: May 17, 2013 on


As fall benefits enrollment approaches, employers will need to prepare for what one expert calls “the biggest change to occur in employee benefits since managed care”: the introduction of public and privately run health insurance exchanges

Some 44 percent of employers believe that private exchanges, or online marketplaces, will be the preferred way to provide health care benefits in the next three to five years, according to a 2012 survey by Lincolnshire, Illinois-based consultancy Aon Hewitt.

Between the growing number of companies expected to introduce a private exchange later this year and the state-run exchanges that open for business on Jan. 1, 2014, employee communication will be critical in the coming months, benefits experts say.

Recently released federal guidelines require employers to notify their workers of eligibility requirements for their state exchange by Oct. 1, 2013. To the relief of many, the U.S. Labor Department also provided model notices that employers can give to their workers, which eliminates the need to develop their own notifications.

“It’s a huge paradigm shift,” says Alan Cohen, chief strategy officer at Liazon Corp., a private benefits exchange firm based in New York. “Five years ago people thought this idea of an insurance marketplace was outlandish, but now it’s on the tip of everyone’s tongue. On the negative side, this represents a big change, but there’s such big upside as well, and employers need to communicate that.”

He says that the first four months of 2013 have been the company’s busiest. Liazon, which was founded in 2007, caters to small and midsize employers that use the company’s Bright Choices Exchange to offer a variety of different products including health, dental, vision, life and disability products from a number of national and regional providers. The company has about 2,300 clients, Cohen says.

Liazon, along with Bloom Health in Minneapolis, eHealthInsurance, in Mountain View, California, and Aon Hewitt are among the first to jump into the private exchange market. But a number of competitors, including Buck Consultants, Mercer and Towers Watson & Co. have also launched exchanges in recent years.

Eric Grossman, a senior partner at Mercer, which launched the Mercer Marketplace in January, says that employers introducing a private health exchange must tell employees not only how their benefits are changing but also how they are not changing.

“Just because their benefits will be delivered through an insurance exchange, their employer is still sponsoring that plan and providing them with coverage and not washing their hands of benefits,” Grossman says. “One way to reinforce that is to put the company’s name on the exchange. When an employer goes into the Mercer Marketplace portal they will see their employer’s name front and center.”

Decision support tools, like online health plan comparisons and cost estimators, will be key in smoothing the transition to a private exchange model, says Ken Sperling, Aon Hewitt’s national health exchange strategy leader.

“We have invested significantly in decision-support tools,” he says. “Employees are getting more choice than they are typically used to seeing, so it’s very important. People can come online, and just like Amazon and Zappos, they can filter those plans however they want.”

Employees can sort options by price, carrier and/or plan type, Sperling says.

Aon Hewitt, which launched its Corporate Health Exchange last year, enrolled more than 100,000 participants in the fall, including employees at Darden Restaurants Inc. and Sears Holding Corp. According to a post-enrollment analysis, 42 percent bought less coverage, 26 percent bought more and 32 percent chose a plan similar to their current coverage. Sperling points out that two-thirds said they had a good understanding of how the exchange works.

But perhaps the greatest communication challenge lies ahead as employees whose companies are moving to an exchange also start sifting through information on the public exchanges, which expect to enroll between 20 million and 30 million people.

Under the Affordable Care Act, employers will be required to offer health care benefits to employees who work at least 30 hours a week starting in January 2014. Employee contributions are capped at 9.5 percent of their income, which means that some employees may find a better package of benefits on the public exchanges if their employer’s plan is considered unaffordable.

Families with income between 100 percent and 400 percent of the federal poverty level (between $23,550 and $94,200 for a family of four under 2013 guidelines) who purchase health insurance on the public exchanges are eligible for a premium tax subsidy to reduce the cost of coverage. Families offered coverage through their employer are not eligible for a subsidy unless the company plan does meet the minimum actuarial value of 60 percent or unless the family must pay more than 9.5 percent for the premium.

Explaining who is eligible for what won’t be easy, Mercer’s Grossman says.

“The real conundrum for employers, especially for those with large segments at or below two times the federal poverty limit, will be finding themselves in the uncomfortable position of preventing employees from getting a federal subsidy to purchase insurance on the public exchanges. It will require lots of communication requirements and lots of personal counseling and coaching. The problem is that the vast majority of employees will be eligible for an affordable plan, which prevents them from getting a subsidy. It won’t be easy for employees either.”


Rita Pyrillis is Workforce’s senior writer. Comment below or email Follow Pyrillis on Twitter at @RitaPyrillis.


Article Link:


Kentucky Introduces New Health Insurance Exchange

Reported by: Aaron Adelson



Published: 5/15 3:48 pm


Updated: 5/15 7:20 pm


As part of the Affordable Care Act, Governor Beshear announces Kentucky’s new health insurance exchange program. It’s called Kynect.

Governor Beshear says Kentucky ranks at, or near the bottom in most health statistics.  He says too many people are using the emergency room instead of seeing a primary care physician.

“This lack of early care is one reason Kentucky’s heath picture is so horrendous,” said Governor Beshear.

He says a big part of the problem is a lack of health insurance.  The Governor says about 650,000 Kentuckians are uninsured.  He says this hurts the state in a number of ways.

“A kid is not going to do better in school if they’re sick, if they don’t feel good, if they’ve got bad teeth,” said Beshear.

Last week, the Governor announced half of the uninsured will now be eligible for Medicaid.  The other half will be able to purchase health insurance through Kynect.

“There’s always that fear of the unknown.  I would refer you to Massachusetts in 2006, when then Governor Mitt Romney instituted a program very similar,” said Beshear.

You’ll be hearing a lot about Kynect.

“There will be a full scale advertising campaign,” said Beshear.

The state says 5 insurance companies plan to participate in the exchange.  The state hopes to know how much the plans will cost at the end of the month.

To learn more about Kynect, you can go to:



Who benefits in Louisville? Impact of the Medicaid decision

Written by
Laura Ungar

Bernice Glenn, 55, Shively

Bernice Glenn, shown with her husband, Nelson Glenn Jr., says of Medicaid expansion, ‘I won’t have to worry about how I have to pay’ her bills for medical treatment. / Photos by Kylene White/The Courier-Journal

Family: Husband, Nelson Glenn Jr., 58; three grown children.

Job, income, insurance: Bernice Glenn is unemployed, and her husband has been out of work since being injured in an accident more than a decade ago. He supports the couple with his Social Security disability payments of $1,623 a month. Bernice is uninsured.

Health issues: High blood pressure, diabetes, a nerve condition in her face, arthritis and a bad knee. She uses a cane.

Consequences of being uninsured: Although she sees a primary care doctor at Family Health Centers, she skips some preventive care. For example, she hasn’t gotten a colonoscopy to check for colon cancer, which is recommended for people when they turn 50. She also has medical bills she can’t pay.

Thoughts on expansion: “I won’t have to worry about how I have to pay these bills and how they’re going to come after me about these bills.”

Rosemary Elan, 56, South Louisville

Family: Widow.

Job, income, insurance: Elan does seasonal work for H&R Block, helping people with their taxes, but has no other income and no health insurance. She lives with her 26-year-old daughter, who works at a convenience store, earning $7.35 an hour, and also has no health insurance.

Health issues: Diabetes, high blood pressure, five cardiac stents.

Consequences of being uninsured: She has delayed getting needed care. When her heart bothered her in 2011, “I would just rub it to keep it from acting up.” She eventually needed a fifth stent and incurred $21,000 in medical bills. She said she has no way to pay: “You can’t get blood from a stone.”

Thoughts on expansion: She said she doesn’t like the health care overhaul in general, especially the penalty people would have to pay if they choose not to get health insurance. But she supports Medicaid expansion. “It would help a whole lot,” she said. “It would be a lot less strain on a lot of people.”

Job, income, insurance: She is unemployed because of illness, existing on Supplemental Security Income disability benefits for her children of about $2,000 a month. Her children have Medicaid, but she has no health insurance. She said she’s tried to buy an individual insurance policy but has been turned down because of her health.

Health issues: Jones has severe high blood pressure and a severe form of anemia, both of which have repeatedly put her in the hospital.

Consequences of being uninsured: She has medical bills exceeding $200,000 for hospital stays to treat her blood problems. She gets low-cost primary care at Family Health Centers-Portland, but stopped going to the James Graham Brown Cancer Center when she realized she couldn’t pay the bills. “After a while you get tired of it and throw your hands up,” she said.

Thoughts on expansion: “There’s a lot of people who want to go to work and just can’t because they have conditions like mine. I just think it’ll be better for people who can’t afford (care), and people who actually need it.”

Angela Kildoo, 28, western Louisville

Family: Single with three children, who are in her parents’ custody. She stays at a friend’s house.

Job, income, insurance: A former medical assistant and a temporary warehouse worker who is unemployed, with no income or health insurance.

Health issues: Thyroid problems; high blood pressure; pseudotumor cerebri, which occurs when pressure inside the skull builds up for no obvious reason.

Consequences of being uninsured: Unpaid medical bills, including a $2,000 bill for surgical removal of two teeth and other bills from blood work. She gets low-cost care at Family Health Centers-Portland, but sometimes skips care because of the cost. “I may just stay at home and just suffer with the pain and everything,” she said.

Thoughts on expansion: “I think it would help a lot of people.”

Link to article:

Medicaid health insurance to expand under Obamacare in Kentucky

Beshear touts benefits while others question decision’s costs

Written by
Jessie Halladay
The Courier-Journal
Kentucky Gov. Steve Beshear will expand Medicaid: The Medicaid program will be expanded undervthe federal Affordable Care Act

FRANKFORT, KY. — More than 300,000 uninsured Kentuckians will become eligible for Medicaid after Gov. Steve Beshear announced Thursday that the state will expand the health insurance program — taking advantage of President Barack Obama’s controversial Affordable Care Act.

“This is both the single biggest decision affecting the collective health of Kentuckians in our lifetime, and it was also one of the easiest to make,” Beshear said during a news conference at the Capitol.

He cited a study by the Cabinet for Health and Family Services that said expanding Medicaid would benefit hundreds of thousands of Kentucky families, improve the state’s failing health, create nearly 17,000 jobs, and have a $15.6 billion positive economic impact on the state between fiscal 2014 and 2021.

The study also said Kentucky would see an $802.4 million positive impact on the state budget for that period because some expenses would be moved to the federal government. Without expansion, the study says Kentucky would see $38.9 million in additional costs because of changes under the Affordable Care Act, also known as “Obamacare.”

Beshear said the Medicaid expansion, when paired with the Health Benefit Exchange the state is setting up under the health act, will provide an opportunity for every Kentuckian to have access to affordable health insurance.

Under the expansion, parents and low-income adults younger than 65 with incomes up to 138 percent of the federal poverty line — $15,856 for an individual or $32,499 for a family of four — will become eligible for Medicaid.

Medicaid enrollment for those newly eligible would start in October, with coverage beginning Jan. 1.

Bill Wagner, executive director of Family Health Centers in Louisville, said that will “significantly change” people’s lives, including 20,000 patients who visit his clinics.

“The impact of expanded access is simply to … improve the health of Kentuckians and to remove what I think is a significant burden of worry about, ‘How I will pay for my family’s health care in the future?’ ” Wagner said.

Terry Brooks, executive director of Kentucky Youth Advocates, which has lobbied for expansion, said it is a “smart investment for Kentucky” because of the health and economic benefits for children and their parents.

“As health outcomes improve due to more people being insured and receiving needed health services, health care costs are likely to decrease and money will be saved,” Brooks said.

But House Republican Leader Jeff Hoover of Jamestown questioned whether Kentucky can afford the change, saying the “expansion has the potential to have a significant impact on other functions of state government” when the state is “inadequately funding our schools at all levels.”

Under the plan, the federal government will pay 100 percent of the costs of expansion for the first three years, and the state will start paying a portion of the costs in 2017, capped at 10 percent in 2020.

Under the current system, Kentucky pays 30 cents of every dollar spent on Medicaid, while the federal government pays the rest. The state now spends about $1.5 billion annually on Medicaid.

Beshear said the newly covered people should expect benefits equal to those received by current Medicaid recipients.

Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said people being added to the Medicaid system will be covered through managed care companies already operating in Kentucky.

Tracey Hayes, 29, a single mother who works full time at a child-care center that does not provide insurance, said she would be the first in line to enroll under the expansion.

While her two girls have health care through the state’s KCHIP program, she pays out of pocket when she has an ailment serious enough for her to seek medical care. “My bills, they pile up because I can only pay a little at a time,” she said. “It’s very stressful.”

The 2010 Affordable Care Act established parameters that required states to expand Medicaid or lose funding, but a June 2012 Supreme Court decision said the federal government couldn’t use existing Medicaid funds as leverage, which made the expansion optional. Kentucky is among 22 states and the District of Columbia that have said they will expand coverage.

Beshear did not need legislative approval to go forward because Kentucky’s rules for Medicaid eligibility are set in regulation, not in statute, and can be revised by the governor. Legislative committees then review the new or amended regulations and may accept or reject them.

But the governor can implement the regulations regardless of any objections.

Political responses

State Sen. Julie Denton — a Louisville Republican who heads the Senate Health and Welfare Committee and proposed a failed bill to prohibit Beshear from expanding Medicaid without legislative approval — said she is concerned that the long-term costs of expansion will outweigh the benefits, particularly if the federal government changes the terms of the deal and requires a bigger contribution from states.

“There’s no certainty” that the contribution will stay the same given the economy, Denton warned. “This isn’t a small measure. … This is too big of an issue for one person’s discretion.”

U.S. Senate Minority Leader Mitch McConnell of Kentucky issued a statement expressing “surprise” with Beshear’s decision, “given Kentucky’s struggles to finance its current Medicaid program.” The action, McConnell said, could exacerbate “the already serious access-to-care problems we face in Kentucky.”

Tom Underwood, Kentucky state director for the National Federation of Independent Business, said his group is concerned about the cost to the state. “Show us the money, is what we’re asking.”

But U.S. Rep. John Yarmuth, a 3rd District Democrat who supported the Affordable Care Act, called Beshear’s decision “historic.”

“There are thousands of Kentuckians whose lives have already been improved — and some saved — because of the Affordable Care Act,” he said.

House Speaker Greg Stumbo, D-Prestonsburg, said he “would challenge any public official opposing this move to surrender his or her own health care coverage.”

“I think it is hypocritical of those with excellent, taxpayer-supported benefits to criticize others who will now have accessible and affordable health care,” he said.

And Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness, said the expansion “is a great step toward achieving equity in access to health care and that, over time, should help to make our citizens healthier and to lower health costs by getting people to the right place, at the right time, for the right care.”

Statistics released by Beshear’s office show that 101,366 Jefferson County residents lack insurance. Under the Medicaid expansion, 47,451 of those will now qualify for the program.

An additional 44,294 will have access to subsidized insurance through the Health Benefits Exchange.

Most providers and advocates also supported Beshear’s decision.

Thomas Johnson, spokesman for Norton Healthcare, said in a statement: “Given the commonwealth’s poor health status — the nation’s highest mortality rate and rankings among the highest in cancer, cardiovascular disease and obesity — expanded coverage will help eliminate barriers to care.”

Sheila Schuster, an advocate with the Kentucky Mental Health Coalition, said expansion is “absolutely the right thing to do.”

But she said many still want to see concerns and problems with the implementation of Medicaid managed care worked out. In the past year, there have been complaints by some providers about delayed payments and from consumers about changing benefits.

Schuster said she hopes the system can be operational by the Oct. 1 enrollment deadline, as Beshear pledged. “It’s a lot of people to get in the system in a short amount of time.”

Reporter Jessie Halladay can be reached at (502) 582-4081 or on Twitter at CJ_JHalladay. Reporters Laura Ungar and Tom Loftus contributed to this report.

Link to article:

Quotes: What local leaders are saying about Medicaid expansions

“The financial impact on the expansion will not hit the state for a couple of years if the federal government picks up the cost for the next three years as promised. This governor will be out of office by that time.”

Jeff Hoover, Kentucky House Republican Leader

“I would challenge any public official opposing this move to surrender his or her own … excellent, taxpayer-supported benefits.”

Greg Stumbo, Kentucky House Speaker

” This is a great step toward achieving equity in access to health care and that over time should help to make our citizens healthier and to lower health costs by getting people to the right place, at the right time, for the right care.”

Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness

“I continue to believe this should not be a unilateral decision by the executive branch.”

Robert Stivers, Kentucky Senate President

” It would really help relieve some of the burden families feel that are currently uninsured and worry about having some unexpected medical condition that could lead their family to bankruptcy.”

Bill Wagner, executive director, Family Health Centers

“My (medical) bills, they pile up because I can only pay a little at a time. It’s very stressful. I have a full-time job and it just isn’t enough.”

Tracey Hayes, 29-year-old uninsured single mom and daycare employee

“We believe that health care is a basic human right. … We measure governmental policies by asking this primary question: How will this policy affect poor persons? Today, the governor answered correctly.”

The Rev. Patrick Delahanty, executive director of the Catholic Conference of Kentucky

“Our Kentucky Health Issues Poll shows that a vast majority of Kentuckians — more than 80 percent — favor providing access to affordable, quality health care for all Americans. We applaud the governor’s decision.”

Susan Zepeda, president and chief executive officer of Foundation for a Healthy Kentucky

“The long-term financial impact of this expansion — coupled with other growing pressures on hospitals — remains to be seen.”

Carl Herde, chief financial officer, Baptist Health

“It is the right thing to do for our most vulnerable citizens.”

Ruth Brinkley, chief executive officer, KentuckyOne Health

“Adding more people to the Medicaid rolls will put a squeeze on the program’s core mission, which is children, pregnant women, the disabled and vulnerable seniors.”

Brett Guthrie, U.S. representative, R-Bowling Green

Link to:

Gov. Beshear Expands Health Coverage to over 300,000 Kentuckians

Thursday, 05 09, 2013

Kerri Richardson
Terry Sebastian


Decision means every Kentuckian will have opportunity to obtain affordable health insurance;
Expansion will create nearly 17,000 jobs and $15.6 billion in economic impact

FRANKFORT, Ky. – Calling it “the single-most important decision in our lifetime for improving the health of Kentuckians,” Gov. Steve Beshear today announced the inclusion of 308,000 more Kentuckians in the federal Medicaid health insurance program. The expansion, together with the creation of the Health Benefit Exchange, will ensure that every Kentuckian will have access to affordable health insurance.

The expansion – made in accordance with the federal Affordable Care Act (ACA) – will help hundreds of thousands of Kentucky families, dramatically improve the state’s health, create nearly 17,000 new jobs and have a $15.6 billion positive economic impact on the state between its beginning in Fiscal Year 2014 and full implementation in Fiscal Year 2021, he said.

“I have repeatedly said that I believe it is in the best interest of the Commonwealth and its citizens to provide better access to health care for our people. My only concern was the cost,” said Gov. Beshear. “We have now done the exhaustive research – and our conclusion matched what most other states have found: by expanding Medicaid, Kentucky will come out ahead in terms of both health outcomes and finances. In fact, if we don’t expand Medicaid, we will lose money.”

Several months of internal analysis – as well as outside studies conducted by the University of Louisville and the Price Waterhouse Coopers accounting and actuarial firm – determined that the expansion was a good deal for those families and for taxpayers. The reviews gathered information about possible impacts to citizen health, the state budget, workforce and economic development.

Medicaid currently provides health care for low-income or disabled citizens. After the U.S. Supreme Court upheld the ACA last year, states have the option to expand Medicaid eligibility to individuals who earn up to 138 percent of the Federal Poverty Level (FPL), with the guarantee that the federal government will cover the entire cost for the first three years.

The expansion will be effective January 1, 2014. By expanding, every Kentucky citizen will have access to affordable health care, either through Medicaid or through the Health Benefits Exchange – no one will fall into a coverage gap.

The Governor cited several key reasons for expanding the program, including:

  • drastic improvements to Kentucky’s abysmal health rankings;
  • millions in savings to the state budget and Kentucky taxpayers;
  • billions in economic impact to the state, including nearly 17,000 new jobs;
  • preventing costly penalties to businesses and protecting hospital funding; and
  • broad support from health care advocates, county officials, and medical providers.

Access to Health Care Improves Kentuckians’ Health

About 640,000 Kentuckians are uninsured. By expanding Medicaid eligibility, an estimated 308,000 Kentuckians will qualify for health care coverage –– a population greater than the size of Lexington and Fayette County.

Gov. Beshear pointed to Kentucky’s dismal rankings in multiple health outcomes as one of the reasons to give lower-income Kentucky families access to reliable, quality health care. In 2012, Kentucky’s overall health ranking was 44th. Kentucky is at the bottom of many national health rankings, including 50th in smoking, 40th in obesity, 41st in diabetes, 50th in cancer deaths, 49th in heart disease, 43rd in high cholesterol, 44th in annual dental visits and 48th in heart attacks.

“I, for one, am tired of being at the bottom,” Gov. Beshear said. “Giving every Kentuckian access to affordable health care coverage will help us tackle these abysmal health outcomes. Our poor health has contributed to us being a poor state. Improved health will help improve our education levels and job opportunities.”

Multiple state and national reports show that when someone has or gains health coverage, there are measurable improvements in health status, including a decrease in delayed care and reduction of mortality rate. When larger groups gain health coverage, the workforce improves.

Conversely, if Kentucky chose not to expand eligibility, the state would create a coverage gap for hundreds of thousands of citizens. The Supreme Court ruling on ACA making expansion optional created a coverage gap for those who are not eligible for a state’s existing Medicaid program, but whose income is too low to qualify for premium subsidies through the Health Benefit Exchange. In Kentucky, up to 206,000 citizens would fall into this gap – not eligible for Medicaid benefits, but also unable to get subsidized coverage through the exchange.

“When people don’t have insurance, they skip regular checkups. They go without medicine. They delay examinations for early symptoms. When they do end up in an emergency room, their health problems can be much more advanced, and more difficult and expensive to treat,” said Audrey Tayse Haynes, Secretary of the Cabinet for Health and Family Services. “Expanding Medicaid offers hardworking Kentuckians the security of reliable medical care to keep them on the job and catch serious health threats before they become debilitating or fatal.”

Expanding Health Care Saves Kentucky Taxpayers Millions

The administration’s review of health care expansion included heavy emphasis on both its immediate and long-term financial impact for the state. The following issues emerged: 1) the costs the state will incur from other mandates of ACA; 2) savings the state will realize through shifting current state budget burdens to the federal government; and 3) generation of new state and local revenues.

Regardless of whether or not Kentucky expanded Medicaid, the federal law adds costs to state Medicaid programs, including substance abuse treatment coverage for existing Medicaid recipients, additional administrative costs and a loss of federal Disproportionate Share Hospital (DSH) payments that pay for indigent care.

Adding newly eligible citizens to Medicaid rolls creates an increase in tax receipts and state revenue, and allows the state to move some current state spending to federal spending. Those revenue-generating and cost-shifting steps add up.

However, with the other requirements of the ACA, upon full implementation of the federal law, it would cost the state more if we did not expand Medicaid. Without expansion, analysts estimate Kentucky would see a negative state budget impact of nearly $40 million by full implementation in FY21.

“When we examined expansion purely from a financial standpoint, there was no question that expanding offered much more benefit for our budget,” said state budget director Jane Driskell. “With the federal government covering the full cost of expansion for the first three years, combined with the ability to shift some of our current cost burden to the federal government, expansion will be a very large net positive to our taxpayers’ bottom line – an estimated $802.4 million.”

The federal government will fund 100 percent of the expansion costs for three years starting in 2014, and then will gradually decrease funding to 90 percent in 2020. Additionally, states can change their expansion plan at any time; if circumstances change and expansion is no longer a benefit to Kentucky, the state can pull back the expansion.

Expansion Generates Millions in Recurring Revenue; Creates Nearly 17,000 Jobs

Expanding Medicaid coverage to families at or below 138 percent of the poverty line will have an economic impact of $15.6 billion between FY14 and FY21, the first year of full implementation. Those funds will come from an increase in health care spending, increases in state and local tax receipts, and savings created by moving certain expenditures from the state to the federal government.

The increase in jobs will occur quickly. Kentucky is expected to create about 7,600 new jobs in the first year of Medicaid expansion alone, due largely to the additional $608 million in health care spending generated as a result of expansion. By 2021, expansion is estimated to be responsible for the employment of nearly 17,000 Kentuckians annually, with an annual average salary of more than $43,000.

Expansion Saves Money for Businesses, Maintains Funds for Hospitals

Expanding Medicaid avoids costly penalties for businesses with employees that would have met the 138 percent FPL threshold for Medicaid coverage. Expansion also provides reliable reimbursement for hospitals after the required reduction of DSH payments.

If Medicaid is expanded, companies whose employees qualify for coverage through Medicaid and are between 100 and 138 percent of FPL, face no penalties. However, if Medicaid is not expanded, those employers would be responsible for $3,000 in fines for every employee who instead receives a premium subsidy to purchase insurance elsewhere. These penalties would cost Kentucky employers an estimated $32 million to $48 million every year.

Hospitals use federal DSH payments to help cover the cost of treating low-income, uninsured patients. Because the Affordable Care Act assumed all low-income individuals would have access to coverage either through Medicaid expansion or a Health Benefit Exchange, the law reduces federal DSH payments to the states. For Kentucky, the reduction is an estimated $287.5 million through FY21. If a state expands Medicaid, many of the previously uninsured will be Medicaid-eligible and hospitals will receive reimbursement for their care. Without expansion and with the reductions in DSH payments, hospitals would be forced to find alternative ways to address the sudden drop in their budgets.

Broad Spectrum of Support for Expansion

Dozens of health care organizations, advocacy groups, county and local officials and private citizens have expressed their strong preference for Kentucky to expand Medicaid. These groups also see the financial and health benefits of providing access to health care to every Kentuckian. A list of those groups is attached.

“Expanding Medicaid is a major policy decision with significant long-term economic and health consequences,” said Susan Zepeda, president and CEO of Foundation for a Healthy Kentucky. “Our Kentucky Health Issues Poll shows that a vast majority of Kentuckians – more than 80 percent — favor providing access to affordable, quality health care for all Americans. We applaud the Governor’s decision.”

“Uninsured individuals often utilize emergency rooms for conditions which could be more appropriately and inexpensively treated by a primary care provider,” said Dr. Michael Karpf, executive vice president for health affairs at the University of Kentucky. “Expanding Medicaid coverage will create opportunities to improve access to care and improve the ability of organizations such as UK HealthCare to more effectively manage both acute and chronic conditions for our most vulnerable patient populations.”

“The Governor’s decision to expand Medicaid coverage to uninsured Kentuckians is significant for county governments. Fiscal courts pay a tremendous amount for the medical coverage of jail inmates. This coverage for catastrophic medical needs of inmates will greatly reduce jail medical costs for counties,” said Vince Lange, executive director of the Kentucky County Judge/Executive Association.

“Today, the Governor of Kentucky is making a decision that will provide the largest benefit to low-income Kentuckians in over 40 years,” said Natalie Harris, executive director of the Coalition for the Homeless. “The Coalition for the Homeless strongly supports this decision which will insure health care for over 95 percent of homeless Kentuckians from the present coverage rate of 15 percent.”

The ‘Arkansas Option’ is More Expensive, Costs Outpace Benefits

Arkansas plans to provide health insurance to individuals at 138 percent of FPL or below, but instead of enrolling them in Medicaid, Arkansas plans to purchase private insurance through their Health Benefits Exchange (HBE). While HBE rates are not yet available, preliminary information from the Congressional Budget Office and Massachusetts indicates that this option could be 50 percent to 66 percent more expensive than traditional Medicaid.

If that plan were applied to Kentucky, not only would costs exceed benefits by 2021, but we would likely never make up the loss. Beyond 2021, costs are expected to grow at nearly 4 percent annually, while the combined benefits would only increase at 2 percent, meaning that the gap would continue to expand over time.

Who is Eligible for Kentucky Medicaid

In Kentucky, Medicaid or Kentucky Children’s Health Insurance Program (KCHIP) benefits are currently available to:

  • Adults if they have disability, serve as the caretaker relative for a child who is eligible for Medicaid and on average has income below 43 percent of (FPL), or are pregnant; and
  • Children with family income up to 200 percent of FPL.

Expansion will allow more than 308,000 Kentuckians to access reliable, quality health care. The new threshold of 138 percent of FPL means a single person with no children earning less than $15,856 per year is eligible to sign up for Medicaid. A family of four with an annual income of less than $32,499 is also eligible.

Most of the Kentuckians who will be eligible are the working poor. This includes people who work at minimum wage jobs for fewer than 40 hours per week; individuals who are self-employed; or single parents whose children are covered through KCHIP.

Jana Bailey of Berea is one of the hundreds of thousands of Kentuckians who will have health insurance thanks to the expansion. She and her husband have four children, and while her husband has health coverage through his job, Jana does not. “I work part time, but we cannot afford health care coverage for me,” said Bailey. “I will no longer have the added stress of hoping nothing happens to me because I don’t have health care coverage. This program will greatly benefit my family as well as many others throughout our state who are in the same situation.”

Where to find more information:

A new state website houses information about the expansion, including the CHFS white paper and letters from supporters. Visitors can also explore county-by-county data such as how many citizens will be newly eligible for Medicaid, or how much county jails spent on medical care last year. Visit to learn more.


Link to Press Release

Beshear expected to announce Medicaid expansion

by Associated Press

Posted on May 9, 2013 at 1:24 PM

Updated today at 1:27 PM

FRANKFORT, Ky. (AP) — Gov. Steve Beshear is expected to announce Thursday that Kentucky will expand its Medicaid program to cover hundreds of thousands of additional people, a move that drew both praise and criticism ahead of a scheduled afternoon press conference.

Kentucky’s Medicaid program already provides medical coverage to some 800,000 low-income residents. The Affordable Care Act allows states to expand coverage to some 300,000 additional Kentuckians with incomes up to 138 percent of the federal poverty level, or nearly $15,860 for individuals.

“Despite decades of hard work, too many Kentuckians are one illness or one accident away from financial ruin because they lack access to affordable, adequate health care coverage,” said Cathy Allgood Murphy, a lobbyist for AARP Kentucky. “By accepting federal funds for health care expansion, Kentucky can make a real difference in the lives of thousands of people.”

Tea party activist David Adams predicted the move will result in additional government waste.

“Medicaid provides little more than large opportunities in health care fraud and inefficiency for politicians who can’t do math,” Adams said in a statement.

Nationally, about 15 million people — mostly adults with no children living at home — could eventually be covered if all states expand. But the Supreme Court last year gave states the right to reject the expansion without jeopardizing the rest of their federal Medicaid funds.

Expanded Medicaid will be available starting Jan. 1, and uninsured people can start signing up this fall. So far, 21 states plus Washington, D.C., have accepted the expansion, while 14 states have turned it down. Another 15 states are still weighing options.

Nearly all the states refusing are led by Republicans. Several of the states accepting have Republican governors, but most are led by Democrats. Washington will pick up the entire cost of the expansion for the first three years, and 90 percent over the longer haul. It’s estimated that less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade.


Beshear says Kentucky will join Obamacare plan to expand Medicaid

By Beth Musgrave —

FRANKFORT — Gov. Steve Beshear announced Thursday that Kentucky will expand the federal and state Medicaid program to provide coverage to an estimated 308,000 Kentuckians currently without health insurance.

At a news conference at the Capitol, Beshear called the decision to expand Medicaid for the poor and disabled “the single most important decision in our lifetime” to improve the health of Kentuckians — who traditionally rank near the bottom nationally in nearly every health indicator.

Expanding Medicaid could add 17,000 jobs and pump more than $15.6 billion into the state’s economy in the next six years by putting more money into the state’s medical infrastructure, Beshear said.

That data came from analysis conducted by University of Louisville and Price Waterhouse Coopers on the potential financial impact of expanding the program that accounts for roughly 14.8 percent of the state’s current two-year budget.

With Beshear’s announcement, Kentucky becomes the 21st state to expand Medicaid, a key provision of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare.

A 2012 U.S. Supreme Court decision left the expansion of Medicaid up to states.Twenty states — mostly with Democratic governors — and the District of Columbia had already opted to expand.

The expansion of Medicaid will now include people whose income is at or below 138 percent of the poverty level. That means someone who makes $15,415 a year or less, or a couple making $20,879 a year or less, would be eligible for Medicaid beginning Jan. 1.

Health care advocates, many hospitals and medical associations have pushed for the expansion, saying it will help the state’s finances and its overall health rankings.

But Kentucky Republicans have repeatedly tried to block key portions of the Affordable Care Act, including the creation of a health benefits exchange, an online insurance marketplace for people who don’t have health insurance.

The Republican-controlled Senate also passed legislation in the most recent legislative session that would have required Beshear to get legislative approval before an expansion could occur. That bill died in the Democratic-controlled House.

Kentucky Republicans have questioned how much the Affordable Care Act will eventually cost the state, which already spends $6 billion in federal and state money on the program.

But Beshear said Thursday that after months of study, he thinks state coffers and Kentucky businesses and hospitals would be hurt if the state does not expand Medicaid.

“We have now done the exhaustive research, and our conclusion matched what most other states have found: By expanding Medicaid, Kentucky will come out ahead in terms of both health outcomes and finances. In fact, if we don’t expand Medicaid, we will lose money.”

Without expansion, the cost to the state could be an estimated $40 million by full implementation in 2021, Beshear said.

Under the Affordable Care Act, the federal government will pick up 100 percent of the tab for the additional 300,000 people for three years beginning in 2014.

The federal contribution rate will be reduced gradually beginning in 2017, eventually dropping to 90 percent in 2020. The state then will pick up the remaining 10 percent.

Currently, the federal government picks up 70 percent of the Medicaid costs, and the state pays for 30 percent.

Beshear said that if Kentucky did not expand Medicaid so more people would have coverage, there would be more than 206,000 people in Kentucky who would not be eligible for subsides to buy health insurance on the health benefit exchanges. That means many people — mostly the working poor, who work minimum-wage jobs but have no insurance benefits — would continue to be without health insurance.

Kentucky companies also could face fines totaling between $32 million and $48 million a year if they employ people who qualify for the Medicaid expansion but don’t offer health insurance, Beshear said Thursday. Kentucky hospitals could lose substantial amounts of money if Medicaid is not expanded, Beshear said.

Hospitals receive payments under the current Medicaid system to care for the uninsured. Those payments will gradually decrease as more people are insured.

If some of Kentucky’s 604,000 uninsured seek treatment at the state’s hospitals, those hospitals will not be able to recover that cost, Beshear said.

“With the federal government covering the full cost of expansion for the first three years, combined with the ability to shift some of our current cost burden to the federal government, expansion will be a very large net positive to our taxpayers’ bottom line — an estimated $606 million,” said Jane Driskell, the state budget director.

To control spiraling costs in the Medicaid program, Kentucky moved roughly 500,000 people to three private managed-care companies in November 2011. Those contracts will have to be amended to include the additional 300,000 people on the state’s Medicaid rolls.

Beshear said that if the cost becomes a burden, the state can opt out of the expansion at any time.

Many social justice groups and health care advocates applauded Beshear’s decision.

“Expanding Medicaid for adults without health insurance is a smart investment for Kentucky,” said Terry Brooks, executive director of Kentucky Youth Advocates. “It creates an opportunity to address the health needs of Kentucky citizens without adding too great a burden on the state budget.”

Dr. Michael Karpf, executive vice president of health affairs at the University of Kentucky, said uninsured patients delay treatment or use emergency rooms for primary care. Expanding Medicaid will improve treatment and decrease costs, he said.

“Uninsured individuals often utilize emergency rooms for conditions which could be more appropriately and inexpensively treated by a primary care provider,” Karpf said. “Expanding Medicaid coverage will create opportunities to improve access to care and improve the ability of organizations such as UK Health Care to more effectively manage both acute and chronic conditions of our most vulnerable patient populations.”

Beth Musgrave: (502) 875-3793. Twitter: @BGPolitics. Blog: ­


Lawsuit challenges Beshear’s online marketplace for health insurance plans

Published: April 8, 2013

By Jack Brammer — | Lexington Herald-Leader |


FRANKFORT — Central Kentucky Tea Party activist David Adams filed a lawsuit Monday challenging the legality of the Kentucky Health Benefit Exchange, which Gov. Steve Beshear created last year by executive order.

Beshear on July 17 authorized the online marketplace, which will offer health insurance plans for Kentuckians as called for by the federal Patient Protection and Affordable Care Act.

Adams, of Nicholasville, claims in his lawsuit that Beshear did not receive “proper approval” from the Kentucky General Assembly to create the exchange. Adams is seeking an injunction against Beshear’s executive order until the governor receives legislative approval.

Beshear spokeswoman Kerri Richardson said the governor acted appropriately.

“The governor exercised the constitutional authority afforded the office to meet the requirements of federal law,” she said.

In signing the executive order last year, Adams said, Beshear cited one statute giving him the authority to do so — Kentucky Revised Statute 12.028. But the governor failed to receive approval of the General Assembly during this year’s legislative session as required by the statute, Adams said.

Kentucky is one of 17 states that the U.S. Department of Health and Human Services approved to build their own exchanges to provide one-stop shopping for health insurance. Open enrollment begins Oct. 1, and the exchanges start operating Jan. 1.

Allowing the Beshear administration to operate the health exchange without legislative approval “sets a terrible precedent for ignoring legal limits on executive branch authority to protect Kentuckians’ rights in seeking and pursuing their safety and happiness as explicitly guaranteed by the Kentucky Constitution,” Adams said.

He also said costs of creating a state-run exchange cannot be easily avoided unless the state quickly informs federal authorities of its inability to agree to properly establish an exchange.

In addition to helping more than 600,000 uninsured Kentuckians arrange health coverage, the exchange will assist employers with enrolling workers in health plans, help individuals receive tax credits and subsidies for their insurance premiums, and qualify small businesses for tax credits.

It will be operated by the Cabinet for Health and Family Services and housed in a building in Frankfort.

Twenty-one states have declined to set up exchanges, which means federal authorities will set up and operate the insurance marketplaces for them. Three other states have gotten the go-ahead for federal-state partnerships.

The federal government is proposing a 3.5 percent fee on insurance premiums to operate exchanges for states that opted not to create their own. Kentucky plans to use an existing 1 percent fee on insurance premiums to operate its exchange, a potential savings to insurance customers in the state of more than $50 million a year.

Startup costs for the Kentucky exchange are being covered by federal grants, but the state will be responsible for all funding beginning in 2015.

Kentucky has received $252 million from the federal government to set up the exchange.

Jack Brammer: (502) 227-1198. Twitter: @BGPolitics. Blog:

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