Election results increase concerns among supporters of Medicaid expansion in Kentucky

The election of Donald Trump and continued Republican control of Congress have compounded worries about the future of health care for the 440,000 Kentuckians who gained it from the expansion of Medicaid, especially those in depressed rural areas, Phil Galewitz reports for Kaiser Health News and NPR.

Gov. Bevin and President-elect Trump (Courier-Journal montage)

On top of Gov. Matt Bevin’s request for changes in Medicaid, Trump and a Republican Congress are poised to repeal the health-reform law that allowed the expansion and perhaps give states much more leeway in running the program.

“The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state’s uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier,” Galewitz notes. “Bevin has threatened to roll back the expansion if the Obama administration doesn’t allow him to make major changes, such as requiring Kentucky’s beneficiaries to pay monthly premiums of $1 to $37.50 and require non-disabled recipients to work or do community service for free dental and vision care.”

Bevin has said the state can’t afford to have 30 percent of its population on Medicaid after Jan. 1, when Kentucky taxpayers will start footing part of the bill for the expansion: 5 percent in 2017, rising in annual steps to the law’s limit of 10 percent in 2020.

“Trump’s unexpected victory may help Bevin’s chances of winning approval,” Galewitz writes. “Before the election, many analysts expected federal officials to reject the governor’s plan by the end of the year on the grounds that it would roll back gains in expected coverage.”

The outgoing Obama administration may be willing to approve changes it wouldn’t have otherwise, in order to maintain the expansion in a state it has often cited as a health-reform success story. But the administration could also leave the decision to Trump appointees, who would be more likely to approve the waiver.

“I think it’s much more likely that a waiver could be approved under the Trump administration,” said Emily Beauregard, executive director of Kentucky Voices for Health, a collection of advocacy groups that oppose most of Bevin’s proposals on grounds that they could reduce access to care. “On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [law] are repealed,” she told Galewitz.

Medicaid helps Freida Lockaby. (Photo by Phil Galewitz)

Galewitz’s object example is Freida Lockaby, “an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester” and got her first health insurance in 11 years from expanded Medicaid. “It’s been a godsend to me,” she told Galewitz. “I am worried to death about it.”

“Lockaby finally got treated for a thyroid disorder that had left her so exhausted she’d almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal-tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control,” Galewitz writes. “But Lockaby is worried her good fortune could soon end.”

So is Ramiro Salazar, 47, another unemployed resident of Manchester. “With Medicaid, he sees a doctor for his foot and ankle pain, meets regularly with a psychologist for anxiety and gets medications — all free to him,” Galewitz writes. “Medicaid even covers his transportation costs to doctors, vital because a specialist can be 40 miles away. Salazar is worried about Bevin’s plans, especially the additional costs.”

“I probably couldn’t afford it,” he told Galewitz. “It would hurt me pretty bad.”

Dr. Jeffrey Newswanger, the chief medical officer at Manchester Memorial Hospital, “sees both sides to the debate over Medicaid,” Galewitz writes.

“Just because they have a Medicaid card doesn’t mean they have doctors,” so they are using the hospital’s emergency room, which saw its rate of uninsured patents drop to 2 percent from 10 percent in 2013, the year before the expansion, he told Galewitz.

“Eliminating the expansion altogether would be painful for the hospital and a disaster for the community,” Newswanger said. But he added that he appreciates some of Bevin’s proposals, which he said should encourage people to get care in less expensive places: “No one values something that they get for free.”