Bevin touts Medicaid proposal, claims ‘hundreds of thousands’ in Kentucky ‘should be going to work and choose not to go to work’

By Al Cross Published July 15, 2019 FEATURED, HEALTH POLICY

Bevin spoke to reporters after his Chamber interview. (Photo by Jack Brammer, Lexington Herald-Leader)
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By Al Cross
Kentucky Health News

Gov. Matt Bevin gave a vigorous defense of his plan to require work or other activities by “able-bodied” adults without dependents who are on Medicaid, in an interview at the Kentucky Chamber of Commerce‘s Business Summit and Annual Meeting in Louisville on Friday, July 12.

“Is there anyone in this room that thinks it is a good idea for able-bodied, working-age men and women between the ages of 19 and 64 who have no dependents – and they’re able-bodied, they’re healthy – and they choose not to work?” Bevin asked. “How many of you think it’s a good idea for you to subsidize them and allow them not to work? Anybody? That’s what Andy Beshear believes. I don’t. That’s what his father believed. I don’t. We’re not helping people by that.”

Attorney General Andy Beshear, the Democratic nominee challenging the Republican incumbent, is the son of Steve Beshear, who as governor in 2014 used the Patient Protection and Affordable Care Act to expand Medicaid to people with household incomes up to 138 percent of the federal poverty level: $16,753 for individuals, $22,715 for a couple and $34,638 for a family of four.

As a candidate in 2015, Bevin initially said he would abolish the expansion, then said he would request a waiver of federal Medicaid rules so the program’s beneficiaries would have “skin in the game” through premiums, co-payments, deductibles or health savings accounts. After he was elected, he added “community engagement” requirements including work, but those have been blocked in federal court.

“They should do one of five things I have proposed for 20 hours a week, four hours a day, five days a week,” Bevin said. “Work, go to school, volunteer, be in training for a specific job, take care of somebody that the state would otherwise be paying for to be taken care of.” The fifth option, which Bevin didn’t mention, would be enrollment in treatment for substance-use disorder.

“One or more of those things is possible in every community in Kentucky,” he said. “And it is, I think, morally irresponsible if we don’t expect people to do what other people are paying to give them something that they themselves may or may not even have.” Earlier, he said, “Many of your companies don’t even offer the same benefits Medicaid does.”

Bevin said the lack of community-engagement rules “sets a bad precedent. It creates a sense of entitlement and expectation, and it sets a bad example for next generations of children who see their parents not going to work, and working the system. There are hundreds of thousands of people in this state that could be going to work, should be going to work, and choose not to go to work. That is their prerogative; they can choose that, but you should not be expected to subsidize that choice if they could choose otherwise.”

Afterward, Bevin refused three times to give a source for his “hundreds of thousands” figure, but later in the day his office cited the Census Bureau‘s 2017 American Community Survey, a poll that estimated 443,723 Kentuckians “do not have a disability and are not in the labor force.”

Those numbers apparently include people who retired before 65, attend college, or work at taking care of others without pay. Mike Randle, publisher of Southern Business & Development Magazine, told the Chamber members the day before Bevin spoke that of the 95 million Americans “outside the workforce,” 44 million are retirees, 20.5 million are college students, 13 million are caretakers and “unknown millions” are mentally ill and/or addicted to drugs.

In May, the last month for which figures are available, more than 1.35 million Kentuckians were on Medicaid, including 446,639 covered by the expansion. Estimates vary, but somewhere around half of the expansion members appear likely to be covered by the community-engagement requirements. Nationally, most Medicaid beneficiaries work; no other state has work requirements, though several are trying to implement them.

Bevin said he grew up in poverty, without health care, and his body still shows it. “I’m empathetic to that world, not sympathetic. But I know for a fact that if you give people something when they don’t need it, in the case of these able-bodied people, you don’t have it to provide to the people who do need it.” (For a transcript of his remarks, go here.)

The state has estimated that if the waiver is allowed, in five years Kentucky Medicaid would have 95,000 more members than without the waiver, in large measure because they would fail to comply with work or reporting requirements. Bevin repeated his vow that if the U.S. Supreme Court ultimately blocks the waiver and he is still governor, he will abolish the Medicaid expansion.

The chamber’s Jacqueline Pitts also asked Bevin about the economic impact of the expansion, more than 90 percent of which is paid for by the federal government, but that question was tacked on to a broader question on the topic and he did not answer it.

Beshear called earlier in the week for “a legitimate, non-political study” of the impact of the expansion on the state’s economy and tax revenues.

Beshear declined to appear at the Chamber meeting, saying the group supports Bevin and his agenda. The Chamber said it has a history of working with officials of both parties.