Tuesday, August 9, 2016

Ky. still has 300,000 without health coverage; they're more likely to be working, and younger and less educated, than the insured

By Al Cross
Kentucky Health News

The 300,000 Kentuckians who still lacked health coverage at the end of 2015 were more likely to be working but earning low pay. They were also more likely to be young adults, lack any college education, and be of Hispanic or Latino heritage.

So says the latest report on the impact of the Affordable Care Act and Medicaid expansion in Kentucky, done for the Foundation for a Healthy Kentucky.

"We need to understand who the remaining uninsured are to make certain they can get essential health services moving forward, and this report gives us some critical insight," said Susan Zepeda, president and CEO of the foundation. "While traditional and expanded Medicaid programs are providing more than 600,000 working-age Kentucky adults with access to health-care services that will help them lead healthier and more productive lives, there remain 300,000 Kentuckians who . . . likely cannot afford to pay for even basic health care."

The fact that seven of 10 uninsured Kentuckians are working suggests that many of them are unwilling or unable to buy health insurance or sign up for Medicaid, even though 46 percent of them have incomes that qualify for the program. Those with household incomes above 138 percent of the federal poverty threshold can't get Medicaid but are eligible for federally subsidized insurance. However, they may feel they still can't afford the monthly premiums or the high deductibles of policies that have the lowest premiums. Many work for employers that don't offer health insurance.

The higher percentage of uninsured among young adults is one of the pitfalls of the reform law. To make a profit, insurers need a substantial enrollment of healthy people paying premiums and not making many claims to create a balanced enrollment with older, less healthy people.

Of Kentucky's non-elderly adults who had health coverage in the first quarter of 2016, nearly 611,000 were covered by traditional or expansion Medicaid. More than 515,000 Kentucky children were covered by traditional Medicaid and the Kentucky Child Health Insurance Program. "While the Affordable Care Act's coverage expansions primarily target adults, children are more likely to be covered when their parents have health insurance," Zepeda said.

The report said Medicaid covered tens of thousands of screenings and other health services for Kentucky adults aged 19-64 during the first quarter of  this year, including 6,304 colorectal cancer screenings, 5,451 hepatitis C screenings, 9,567 breast cancer screenings, 12,837 substance-use services, 46,668 dental services; and 6,660 births.

"More than three-fourths of those who received dental services were able to get coverage because of Medicaid expansion, pointing out the great need for dental coverage," Zepeda said. Gov. Matt Bevin has proposed removing dental coverage from the basic coverage but creating a rewards program through which Medicaid members could earn access to it.

The report was prepared for the foundation by the State Health Access Data Assistance Center at the University of Minnesota. It is the fifth quarterly snapshot of a study of the impact of the Patient Protection and Affordable Care Act in Kentucky.

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