Governor-elect Andy Beshear says he will rescind Republican Gov. Matt Bevin's Medicaid plan, which includes, among other things, highly controversial requirements for work and other "community engagement," and key Republicans in the General Assembly seem wary of trying to legislate such requirements over the Democrat's likely veto.
Beshear said in claiming victory, "In my first week in office I am going to rescind this governor's Medicaid waiver," the federal term for such plans. "Health care is a basic human right and my administration will treat it as such."
But the Republican-controlled legislature could pass the plan on its own, and override a Beshear veto. State Sen. Ralph Alvarado, a Winchester physician who was Bevin's running mate for lieutenant governor, didn't completely dismiss the possibility of legislating work requirements.
"All options are on the table, but it has only been three days since the election," Alvarado said in an e-mail Friday. "Legislative intervention would require significant coordination and consensus from legislators. It is also important to remember that Medicaid expansion, itself, was achieved through executive order and not through legislative approval."
Other Republican lawmakers were quicker to say that their super-majorities in the House and Senate shouldn't try to institute the waiver legislatively.
"It's not a matter you want to spend your political capital on," because it wouldn't get that much return for the effort expended, said Sen. Stephen Meredith of Leitchfield, co-chair of the Medicaid Oversight and Advisory Committee and a former hospital administrator.
House Majority Floor Leader John "Bam" Carney of Campbellsville was likewise skeptical, but said GOP legislators would need to discuss it. "Even lots of Republicans have different opinions about Medicaid, with so many of their constituents on it," he said.
Under Bevin's proposal, most able-bodied Medicaid recipients would have had to work, volunteer, attend school or take job training at least 80 hours a month, and make monthly reports, in order to keep their benefits. Those who are primary caregivers or medically frail would be excluded.
The plan was aimed at those who gained coverage through the expansion of Medicaid to households with incomes earn up to 138 percent of the federal poverty line. It was approved through an executive order under then-Gov. Steve Beshear, the governor-elect's father, under the Patient Protection and Affordable Care Act, which will pay 90% of the expanded costs in 2020.
Steve Beshear could expand Medicaid without the involvement of the legislature because of a 1966 state law that requires the state to "take advantage of all federal funds that may be available" for the program, which began in 1965.
The law was the subject of legislation this year that would have given the secretary of the Cabinet for Health and Family Services full control over Medicaid funding, and the ability do do away with the expansion, Jason Dunn, policy analyst for Kentucky Voices for Health, said in an e-mail.
Republican lawmakers proposed to codify the work and community engagement requirements this year in House Bill 3, sponsored by House Speaker David Osborne of Prospect and Speaker Pro Tem David Meade of Stanford. It was introduced late in the session and failed to make it out of the House Health and Family Services committee, chaired by Rep. Kimberly Moser, R-Taylor Mill.
Moser, like Alvarado, did not dismiss the possibility of legislating the work and community engagement requirements. "We are still reviewing the options," she said in an e-mail. "We need to continue to improve health care delivery for the citizens of our Commonwealth."
HB 3 would have also placed restrictions on other public benefits. It spurred creation of a legislative panel called the Public Assistance Reform Task Force, which has been discussing such programs.
Health advocates argue that work and community engagement requirements, along with co-payments and premiums, would create barriers to care that would lead to large reductions in enrollment. Arkansas was the first state to implement such rules; before its plan was vacated by the same federal judge who blocked Bevin's plan, 18,000 people lost coverage, often from failure to report.
The first version of Bevin's plan estimated that after five years, Medicaid would have 95,000 fewer members than it would without it -- largely because of noncompliance, including lack of reporting. "This is paperwork and it is intended to tear health care away from people," Beshear, the state attorney general, said in a debate with Bevin.
The governor argued that "able-bodied" Medicaid beneficiaries need some "skin in the game" and that it is a form of "bigotry" to assume that able-bodied people should be "babied." He claimed that hundreds of thousands of people in the expansion choose not to work.
Studies have indicated that most people who would be affected by the community-engagement rules are already meeting them. One study, based on polling, found that 97% were already meeting the requirements; another, based on claims data, showed that 64% were.
Dustin Pugel, an analyst for the Kentucky Center for Economic Policy, said what this comes down to is that federal law and the courts have said Medicaid is a program that is designed to provide medical assistance, and after Beshear withdraws the waiver, "that is exactly what we'll have."
"We're talking about hundreds of thousands of people who can take a deep sigh of relief after this is over because now they're going to be able to get to a doctor when they need to without barriers," Pugel said.
Bevin is 5,189 votes behind Beshear in unofficial returns. He has refused to concede and has asked for a recanvass of the vote, which is scheduled for Thursday, Nov. 14. A recanvass is a re-tabulation of numbers gleaned from precincts and absentee votes.
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.