Archive for Sunday, July 13, 2014

Kansas, Kentucky took different paths on Affordable Care Act — and got different results

July 13, 2014


Rebecca Esparza is a 41-year-old single mother of three from Lawrence who works part-time at the local homeless shelter and studies social work at Kansas University. And she doesn't have health insurance.

She thought the Affordable Care Act, the 2010 law often called Obamacare, would change that. But when she went to a local clinic to enroll, she found out she didn't make enough money to qualify for tax subsidies to help obtain private insurance. On the other hand, her income put her above the eligibility threshold for KanCare, the state's Medicaid program.

If Esparza lived in another state whose name starts with a K, one, like Kansas, that voted overwhelmingly against President Barack Obama in the last two elections and whose flagship university is famous for its basketball prowess, she would have health insurance.

Kentucky fully participates in the Affordable Care Act, having eased the eligibility requirements for Medicaid and created its own health insurance marketplace, while Kansas does not. In turn, Kentucky has reduced its uninsured population by, according to some estimates, two-thirds, while Kansas has barely made a dent in its number of residents who lack health coverage. The states started out with similar uninsured rates (12 percent in Kansas versus 14 percent in Kentucky).

So how did Kentucky do it?

The answer, largely, resides in the governor's mansion. Democrat Steve Beshear, without the support of his state legislature, expanded Medicaid and set up a state-based marketplace through executive orders. He later called covering the state's uninsured population "a moral issue."

"Over 400,000 people in Kentucky have voted with their feet or pocketbooks in obtaining private insurance and Medicaid," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "It's clear the state has embraced this opportunity to get insurance among families who previously didn't have access."

She said expanding health coverage was imperative in a state whose poor population has abnormally high rates of preventable chronic diseases.

Medicaid expansion drives numbers

Kansas and Kentucky had a similar percentage of their populations enroll in private insurance through the Affordable Care Act — Kansas residents just had to go to, which is operated by the federal government, while Kentuckians used Kynect, which is run by the state. Where Kentucky drastically reduced its uninsured rate was through its Medicaid expansion, which has provided coverage to more than 350,000 people in the state so far.

Kansas Rep. Dave Crum, R-Augusta, who chairs the House Health and Human Services Committee, said the state shouldn't consider expanding Medicaid until the federal government gets the growth of its entitlement spending under control and Kansas works out the kinks in its KanCare program. Under KanCare, three private managed-care organizations last year began operating the state's Medicaid program in the hopes of cutting costs and improving quality of care.

Supporters of Obamacare's Medicaid expansion often point out that the federal government is covering the entirety of the costs for the first three years, then 90 percent after that, and that the state is leaving billions of dollars of federal aid on the table over the next several years. But Crum notes that money has to come from somewhere.

"There's a feeling that when the federal government pays for something it's free," he said. "That thought process is part of the reason our federal government has a $17 trillion debt. Until states are willing to acknowledge the fact that our federal government is in debt and we're borrowing money to fund the Medicaid expansion, there's no way we're going to get the situation in Washington fixed."

Politics not completely similar

Even though Kansas and Kentucky have in recent years voted overwhelmingly for Republicans in national elections, their politics are by no means identical. The Kentucky governor's office and House of Representatives are both run by Democrats, while in Kansas the legislative and executive branches both are controlled by the GOP. In Kentucky all the statewide officeholders but one are Democrats, while in Kansas they're all Republicans.

While the majority of Kentuckians might agree with the Republican party on social issues, they are often more in step with Democrats on economic matters, said Stephen Voss, a political science professor at the University of Kentucky.

"We have a jargon term for it: dual partisanship," said Voss, asserting that Kentuckians are to a considerable degree economic populists. "People can literally identify with one party at the national level and another one at the state and national levels."

He added that this is largely a phenomenon of the South, which supported the Democratic party until the civil rights movement of the mid-20th century.

Not everyone in Kentucky thinks health care reform has been a success. David Adams, a tea party activist from Nicholasville, Ky., believes it will eventually come crashing down, either because a court overrules the governor's decisions, which Adams claims were illegal, or under the weight of its financial obligations.

"Unfortunately, the governor has insisted on running this without legal authority," said Adams, who has filed lawsuits challenging the legality of the state's Medicaid expansion and insurance marketplace. "He's too busy speaking to left-wing groups in Washington, D.C., and accepting congratulations on his 'massive success' without bothering to follow the law back here."

Adams also pointed out that Kentucky hospitals have recently reported an influx of newly insured Medicaid patients showing up in their emergency rooms because of the Affordable Care Act.

A lot left unsettled

Time will ultimately tell how successful health care reform is in Kentucky. While its implementation has been almost entirely funded by the federal government, the law gradually requires states to cover a greater share of the costs of their marketplaces and Medicaid expansions.

The state will start paying for Kynect next year using funds from a now-defunct high risk insurance pool, said Gwenda Bond, spokeswoman for the Kentucky Cabinet for Health and Family Services. Meanwhile, the federal government covers 100 percent of the Medicaid expansion through 2016.

In Kentucky, people continue to sign up for Medicaid under the state's eased eligibility requirements. But that's cold comfort for Esparza, the Lawrence single mother, who believes she's being penalized by the government for working. If she quit her job, she says, she would likely qualify for KanCare and even disability insurance.

And while she freely admits she hasn't always been a health-conscious person, she says that in recent years she has quit smoking and started exercising more. But she still often puts off needed care because of her lack of coverage.

"I could either completely mooch off the government and they'll cover my health issues, or I could go to work and do the best I can and continue to be sick," she said. "I'm not asking for a handout; I'm asking for a hand up."


Fred Whitehead Jr. 3 years, 7 months ago

The real problem here is two fold. The Kansas government belongs to the Koch billions. As such, these two billionaires rule the state through their bought-and-paid-for politicians that the Kansas voters have elected. Nothing reasonable and workable will ever be done as long as the Kochs pull the strings. The governor is complicit in this fraud and a majority of the state legislature has bought the hatred, bigotry and prejudice against the current President of the United States. Therefore, Kansas finds itself in the situation where a large part of the population is not insured under the Affordable Care Act and other states that have participated have ehjoyed the benefits of the President's health care program.

We are Kansas. To hell with the citizens, we must continue to rail on about the black, Nigerian President of the United States.

Richard Heckler 3 years, 7 months ago

The Brownback Plan will eventually be in the ownership of the Koch bothers complete with tax dollar funding.

Philipp Wannemaker 3 years, 7 months ago

Nothing eventual about it, the koch's own both the "governor" and the GOTeaParty legislators completely.

Dick Sengpiehl 3 years, 7 months ago

Tea Partiers loved to lie about what they called "death panels" in Obamacare. In Kansas we have a Governor who is so callous about his constituents that he is creating his own possible deaths among the uninsured. And this from a self proclaimed Christian.

Philipp Wannemaker 3 years, 7 months ago

And that is the problem, this so called "christian" who can only do what Koch brothers tell him to do. If he is the definition of a "christian', no wonder so many, including me, hate anyone who identifies themselves as "christian".

Leslie Swearingen 3 years, 7 months ago

The young man asked Jesus what he should do to be his disciple and Jesus told his to sell his belongings and follow him. The young man could not do that. Later, Jesus was asked what the first and most commandant was and he answered, love one another as your father loves you. Remember the parable of the young man who left and later returned home and was welcomed with a big supper? His brother who had stayed at home was angry and wanted to see his brother punished. The lesson of this parable that no matter when you return you are forgiven and loved.

I am a Catholic Christian and I full well understand your hate and disgust with those who would defy the words of Jesus and turn the young man away, who would not only refuse to actually follow Jesus but would accumulate still more, and never share it with anyone.

No one person, not even the Pope, is THE definition of christian, and it is an ongoing process that each of us who calls ourselves that must redefine and live every moment. I would like to add that those of all faiths have equal right to call themselves blessed and holy.

Leslie Swearingen

Phillip Chappuie 3 years, 7 months ago

So Ms. Esparza works and goes to school and does the best she knows how. A hard working person trying to get ahead. The problem is this. Mr. Brownback and all the tea party, AFP funded lackeys don't give a flying flip about these people. These people are merely an inconvenience to them. The face of everything they choose to ignore. And they struggle. Brownback is not a Christian. Nor is any of the other elected AFP boys. Liars. Liars to a man. Their mothers should be ashamed at what they do.

Philipp Wannemaker 3 years, 7 months ago

If you are paid by the Koch's, you have to be constantly lying, otherwise checks stop coming.

Lynn R. Smith 3 years, 7 months ago

This link goes to a letter-to-the editor in the Butler County Times-Gazette that was addressed to Rep. David Crum (R-Augusta) who is mentioned in the above story questioning the decision to not allow Medicaid expansion. March 1, 2013, Butler County Times-Gazette.

Lynn R. Smith 3 years, 7 months ago

Then this is Rep. David Crum's (R-Augusta) response to the previous letter to editor link I posted above. This was back in March of 2013. Crum was mentioned in the Journal-World's article. Butler County Times-Gazette, March 5, 2913. One can see the contrast to the two approaches.

3 years, 7 months ago

Just because Kentucky's health care systems works doesn't mean that it works ideologically. Sure you could make things work using the wrong ideology. "But it doesn't matter if it works". ( I was actually told that by a fellow employee whose a fundamentalist & a joke.)

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