Kentucky

Last month, the Trump administration gave its blessing for Kentucky Gov. Matt Bevin  to implement work requirements for some Medicaid recipients, and while his critics are predicting this move will result in people needlessly dying, Bevin says it will lead to better health outcomes because more people have a stake in the system.

Bevin’s predecessor, Democratic Gov. Steve Beshear, embraced Medicaid expansion as President Obama’s health law took effect.  However, Bevin says that decision did not result in better health care for the people in Kentucky.

“The whole purpose of having health coverage is to, ultimately, allow people to have better health outcomes.  What we have seen is through the expansion of Medicaid we actually have fewer doctors, not more, that will even see Medicaid patients, which means that we’ve made access to health care less possible, even though more people are covered,” said Bevin.

Bevin says just adding people to Medicaid isn’t even an upgrade for those who had no coverage prior to Obamacare taking effect and Kentucky agreeing to expand Medicaid.

“Studies that have been done have shown that people with Medicaid access in some instances have lesser health outcomes, at best equivalent health outcomes to people with no coverage at all.  That’s a pretty sobering fact,” said Bevin.

And he says the short-term evaluation of health in Kentucky is seeing no improvement.

“Kentucky leads the nation in many health categories that we would not want to: diabetes, lung cancer, premature death, hypertension, cardiac arrest, and cardiovascular disease.  These are things we don’t want to lead the nation on and these numbers have only gone up since we’ve expanded Medicaid.  This tells us something isn’t working,” said Bevin.

As governor, Bevin says it is his job to make sure taxpayer dollars are providing some value for the people in the commonwealth.

“I’m a big believer in spending the money that we have and not more, being good stewards of the taxpayers’ money because it is our own money.  I believe in cutting regulation, simplifying the process.  But above all else as it relates to health care and any other policy that comes from government, we have to look at what the return is that we get on investment,” he said.

“So as it relates to this issue and everything else, my approach to governing is to get a good return for the taxpayers on their money and to get results.  At the end of the day, that’s what wee should be paying for,” said Bevin.

Bevin says it is clearly in the interest of Kentucky to change its approach to Medicaid, and he wants to make it in the interest of each person in the Bluegrass State.

“If people have a vested interest in something, because they have actively participated in it, then they’re more likely to value it and utilize it.  The analogy I’ve often given is for people who have bought their own bicycle.  The odds are pretty high that they didn’t leave that bicycle out in the rain.  In other words, if you care about something, you’re going to pay better attention to it,” said Bevin.

He is also quick to point out that the new policy applies to a fairly small percentage of Medicaid recipients.

“This doesn’t apply to anybody who is a traditional Medicaid patient: the elderly, the frail, someone who’s pregnant, a child, someone who has a disability, who is addicted to drugs.  These are people for whom there is not an expectation.  These are people for whom Medicaid was originally designed.

“What it wasn’t designed for is working-aged, able-bodied men and women, people with no dependents, people who could get engaged but for some reason have not.  That’s not who this system was designed for so this waiver, this expectation that people work, or volunteer or get training or get education only applies to a small subset of the expanded Medicaid population,” said Bevin.

He estimates that 60 percent of those in the expanded Medicaid pool already comply with the requirements, which is to work, volunteer, train, or get education for 20 hours per week – either all in one area or in a combination of two or more categories.

So what impact could this have in Kentucky?

“As we have done projections, and they are only that, we would expect that five years from now there might be as many as 95,000 current recipients who are no longer needing Medicaid for one of two reasons. A, they have moved their way up and out and that should be the bulk of them.  And B, they just don’t want to do anything at all in exchange for something of value,” said Bevin.

Liberal critics are savaging Bevin for pushing work requirements, alleging that people will end up dying because those standards could not be met.  In addition to the statistics comparing Medicaid coverage versus no coverage, Bevin points out that grew up in deep poverty and never had health coverage until he joined the military.

He also says Center for Medicare and Medicaid Services Administrator Seema Verma articulates his approach to the issue perfectly.

“[She] said that to do other than this is to treat those who are poor with the soft bigotry of low expectations.  That is perfectly said.

“I find it offensive that liberals think that poor people can’t do things for themselves and need to be wards of the state.  That’s offensive.  I find that kind of bigotry to be reprehensible, and in Kentucky, we’re not going to tolerate it.  We’re going to give people a better opportunity,” said Bevin.