Ky. had biggest drop in uninsured low-income people, and in percentage of adults who passed up care because of costHealthy Care

Kentucky had the largest drop in low-income, working-age people without health insurance, and the biggest decline in adults who passed up medical care due to cost, after the state embraced the Patient Protection and Affordable Care Act.

Those two findings were the Kentucky highlights of the latest Commonwealth Fund report on Obamacare, released Dec. 20.

The report found the uninsured rate for low-income adults fell 25 percentage points in Kentucky, from 38 percent in 2013 to 13 percent in 2015, following full implementation of the Patient Protection and Affordable Care Act in 2014. Nationally, the rate for this population dropped from 38 percent to 25 percent during the same time frame.

“I think this proves again what we already knew – that Kentucky has been a national model in getting folks covered,” Emily Beauregard, executive director of Kentucky Voices for Health, told Laura Ungar of the Courier-Journal.

The uninsured rate for all working aged adults in Kentucky dropped from 21 percent in 2013 to 8 percent in 2015.

The report looked at dental visits and out-of-pocket health spending relative to income to measure how states compare on access to health care. Nationally, Kentucky ranked 18th for this measure, moving up 10 spots from last year’s rankings -- the largest gain in the nation.

Kentucky also improved more than any other state on a measure that looked at the numbers of adults who went without health care because of costs, dropping to 12 percent in 2015 from 19 percent in 2013. Low-income Kentuckians also showed a drop in this measure, from 34 percent to 21 percent.

Kentucky is one of the states that expanded Medicaid to allow coverage to those who earn up to 138 percent of the federal poverty level, which has added about 440,000 Kentuckians to the Medicaid rolls. Under the ACA, this population is paid for by the federal government through the end of this year, but the state will have to start paying 5 percent of the cost in 2017, rising to the law's limit of 10 percent by 2020.

Including the expansion population, Medicaid covers more than 1.3 million Kentuckians, or more than one-fourth of the state's population, which comes with a price-tag that Republican Gov. Matt Bevin says is not sustainable.

He has proposed a new Medicaid plan to the federal government that largely targets "able bodied adults" who qualify for Medicaid under the expansion. The plan includes co-pays, premiums, health savings accounts and work and volunteer requirements for those who aren't primary caregivers. Critics of the plan say it is too complicated and creates barriers to health care.

Doug Hogan, a spokesman for Kentucky's Cabinet for Health and Family Services, told Ungar that it’s misleading to look at the uninsured rate without additional context, noting that the number of people who had private health insurance is about the same as it was before the ACA.

“What we saw was an unsustainable growth of 68 percent in the state’s Medicaid program,” he said.

Beauregard argued that scaling back the Medicaid expansion and repealing the ACA, as President-elect Donald Trump and other Republicans have vowed to do, is a bad decision for Kentucky, noting that Kentucky is one of the poorest and unhealthiest states in the country.

“The gains that we’ve made are at risk,” she told Ungar, adding that charity and uncompensated care at hospitals will go up if people lose their health insurance. “There will be real consequences for the entire state of Kentucky.”

Hogan pointed out that simply having Medicaid doesn't improve health outcomes and said Bevin's new plan is sustainable and "will improve the health of our citizens and encourage self-sufficiency." He added, "We owe it to our citizens to do more than simply enroll people in social welfare."


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