Gov. Steve Beshear said today that he would expand Kentucky's Medicaid program under the federal health-reform law if the state can afford the cost. "If there is a way that we can afford that will get more coverage for more Kentuckians, I'm for it, because if we've got a healthier Kentucky, we're all better off. Our economy's better off, and of course the individuals are better off," Beshear told Jack Pattie of WVLK Radio in an interview on Pattie's mid-morning show.
That may have been Beshear's first public statement from his own mouth on the issue. State House Republican Leader Jeff Hoover has said Beshear should not expand Medicaid because it would cost the state hundreds of millions of dollars once it has to start paying part of the cost of covering the new patients, beginning in 2017 and rising to 10 percent in 2020.
The first caller to the show asked the Democratic governor, "How much is this going to cost us?"
Beshear did not reply with a number. He said, "We're gonna analyze that part of the law to see how much it will cost us, how many people we're talking about. I do know the profile of the people we're talking about; they're working adults, they're working families that just can't afford health care because they don't make enough money to be able to pay premiums" for health insurance.
Beshear said he would make "a reasoned and fiscally responsible decision, and there is "no timetable on making it at this point." Republicans are expected to make it an issue in the fall elections, raising the prospect of reduced state services or higher taxes.
Pattie asked the governor, "Is it possible to do all this without a tax increase?" Beshear answered, "I've got to look out into the future, see how our revenues are growing, see how our economy is doing, to make sure we don't put a burden on ourselves that we can't afford."
The 2010 law specified that if states did not expand Medicaid to cover those with incomes up to 133 percent of the federal poverty level, they could lose all their federal Medicaid funds, which in Kentucky covers 70 percent of the program's current cost. The U.S. Supreme Court ruled that threat was unconstitutional, giving the states the option.
Several Republican governors have said they would not expand Medicaid, while Democrats are generally in favor of it, but governors of both parties have said they are undecided. It is possible that federal officials would allow the program to be adjusted in ways that would reduce the cost of the expansion.
Beshear also defended his decision to create a state exchange for health insurance, saying the state's business interests, hospitals, insurance companies and other interests wanted the state to run its own exchange rather than let federal officials do it. "We know better about Kentuckians than the federal government does," he said. He told the first caller that the exchange "would not cost us anything," and explained later that insurance companies would pay the cost.
Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.