National reporting on Bevin's health-care plans is generally good, but sometimes off the mark; here's an important example

By Al Cross
Editor and publisher, Kentucky Health News
Director, Institute for Rural Journalism and Community Issues
Associate extension professor of journalism, University of Kentucky

Kentuckians' election of Matt Bevin, who has vowed to shut down the Kynect health-insurance exchange and scale back the Medicaid expansion created under federal health reform, is already prompting much national reporting because Kentucky has been more successful in embracing "Obamacare" than any other state.

Some of that reporting is very good, but some of it is has been incomplete. The latest example is an otherwise fine story by Amy Goldstein of The Washington Post, who went to Pikeville and got a great quote from Dennis Blackburn, a 56-year-old mechanic who was laid off from a tire company that supplies coal mines. (At this writing, the story is the most-read on the Post site.)

Goldstein writes that Blackburn voted for Bevin "because he is tired of career politicians and thought a businessman would be more apt to create the jobs that Pike County so needs. Yet when it comes to the state’s expansion of health insurance, 'It doesn’t look to me as if he understands,' Blackburn said two days later. 'Without this little bit of help these people are giving me, I could probably die. . . . It’s not right to not understand something but want to stamp it out.'"

Blackburn may have believed what Democrats said in TV ads, mailings and debates, that Bevin would end the expansion of Medicaid to people in households with incomes up to 138 percent of the federal poverty level. But since July, Bevin has denied ever saying that (he did) and said he would seek a federal waiver to adopt a plan like that in Indiana, which has four plans that charges premiums and co-payments, require health savings accounts and/or require "healthy behaviors," according to the Kaiser Family Foundation.

The story fails to mention that Robert Stivers of Manchester, the president of the Republican-controlled state Senate, says the legislature will decide what the Medicaid expansion looks like going forward -- with the concurrence of the Centers for Medicare and Medicaid Services, which would have to approve the waiver that Bevin has been talking about since July. He started saying that the day after Stivers spoke.

Stivers and many of his colleagues have tens of thousands of constituents on expanded Medicaid, so it would be bad politics for them to make huge changes in it. Blackburn and his neighbors didn't vote for Democrats because they gave them health care, but they might well vote against Republicans in the 2016 legislative elections is they took away their health care.

So, the expansion will survive, but the debate will be about whether premiums, co-payments, deductibles or health savings accounts keep people from getting needed care, or make them use the health-care system more responsibly. Other topics are likely to be debated, perhaps in private as the waiver is negotiated by the Bevin administration, the legislature and federal officials.

When it comes to Kynect, Bevin has consistently vowed to close it, saying it is redundant. That is not entirely true, because the state would lose 75 percent of its funding for "Kynectors" who help people navigate the health-insurance system and would no longer run ads like the one Goldstein saw: "Along Route 23 through Pike County, a billboard for Kynect touts 'Happy teeth. Healthy bodies.' If Bevin carries out his intentions, the billboard will be gone."

Kynect is funded by a 1 percent fee on all health-insurance policies sold in Kentucky, so closing it wouldn't save the state any money, but at least theoretically could save those policyholders a little, $27 million spread around a state of 4.4 million people. But the fee on the federal exchange is 3.5 percent, so current Kynect customers would pay more. And state officials have estimated that at least $23 million in state funds will be needed to tear down Kynect, which was built with federal funds.