The Republican leader of the state House said today that Kentucky should not take advantage of an expansion of Medicaid under federal health reform because it would cost too much once the state starts paying 10 percent of the cost. The U.S. Supreme Court last week said the states could refuse to expand the program without risking loss of their current Medicaid money, as the reform law prescribed.
For adding people with incomes up to 133 or 138 percent of the federal poverty threshold, the federal government would pay the entire cost in 2014-16. For other recipients, the feds would continue to pay 70 percent of the cost.
House Minority Floor Leader Jeff Hoover of Jamestown said that would be "financially devastating" because nearly 400,000 uninsured Kentuckians have incomes under 138 percent of the poverty line. "Other estimates put the number of people eligible for Medicaid under the new rules at fewer than 350,000," reports Beth Musgrave of the Lexington Herald-Leader. More than 700,000 are already on Medicaid.
Hoover's comments were directed at Democratic Gov. Steve Beshear, who has equivocated on the question. A Beshear spokeswoman told Musgrave, “We will continue to work with our federal partners and the [Cabinet for Health and Family Services] to get a fuller picture of this policy and determine the best course for the state after we have gathered the facts.” In his re-election campaign against state Senate President David Williams, Beshear voiced misgivings about the costs.
Mugsrave notes that Williams, R-Burkesville, "said in a statement late Thursday that he is concerned about the growing costs of the program, but he stopped short of calling on Beshear to opt out of the expansion." (Read more) However, U.S. Senate Republican Leader Mitch McConnell, who has vowed to repeal the reform law, has called on Beshear to reject the expansion.
House Speaker Greg Stumbo, D-Prestonsburg, endorsed the expansion, saying, “I think that Americans have a right to accessible and affordable healthcare, and the more we expand coverage to meet that goal, the lower healthcare costs will be for all of us.” For coverage from Tom Loftus of The Courier-Journal, click here.
Hospitals could lobby for the expansion. "Hospital associations agreed to help fund the law by accepting various cuts to their reimbursement rates with the expectation that they would be more than compensated by money from patients newly insured through Medicaid," The Washington Post reports. "Now they worry that they will be stuck with only the downside of that bargain."
Robert Laszewski, a health-care consultant and former insurance executive, told the Post that governors wary of the expansion's cost "could push Obama for permission to privatize parts of their Medicaid programs or to open eligibility only to those with incomes up to 100 percent of the poverty level instead of 133 percent. They also could request that the federal contribution to Medicaid be sent to them as a block grant without strings attached, Post reporters N.C. Aizenman and Sandhya Somashekhar write. Are those the sorts of things Beshear has in mind to limit costs?