Kynectors tell why they're important to keeping Kentuckians signed up for coverage; Stivers says they're making assumptions

L-R: Kynectors Kathy Oller, Cara Stewart, Mike Wynn, Laken
Daniels, Jennifer Gates, Miranda Brown, Ashley Shoemaker

By Melissa Patrick
Kentucky Health News

Kynectors, who help Kentuckians sign up for health coverage through Kynect, the health-insurance exchange that Gov. Matt Bevin plans to dismantle, gathered in Frankfort Feb. 23 to argue that Kynect is much more than a website and to ask the governor to reconsider.

Five Kynectors shared stories of how they not only help Kentuckians sign up for health insurance or Medicaid, but do so at times and locations that are convenient to their clients. They said they answer questions about health insurance, help clients find providers, keep them informed about changes in their plans and also help them navigate the system throughout the year, helping them change their plans if their income levels fluctuate.

"A Kynector wears many hats: case manager, outreach worker, advocate and entrepreneur for the language of health insurance," said Ashley Shoemaker, a Kynector for Family Health Centers Inc. in Louisville. "We reach the hardest to reach groups to ensure that all Kentuckians have access to affordable health care coverage without barriers."

Bill Wagner, head of Family Health Centers, has said that the number of people offering the help that the 500 Kynectors now give would be cut to about 125 if Kynect is closed and the state uses the federal exchange.

Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of pro-reform interest groups, estimated afterward that under the federal exchange, there will be one-third of the funding for navigators, which is what the federal exchange calls those who are paid to help others sign up for health insurance.

Cara Stewart of the Kentucky Equal Justice Center said federally funded navigators have more restrictions than Kynectors. For example, they can't go to people's homes and have less ability to follow up with their clients. She also said Kynectors actively interact with Kynect to find ways to improve the system to best suit the needs of Kentuckians.

The news conference was held by Keep Kentucky Covered, a coalition focused on sustaining access to affordable health care in Kentucky through Kynect and the expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level.

Shoemaker, who works with the homeless, noted some of the barriers that make it hard for her clients to sign up for health insurance without a Kynector: lack of transportation, no access to the Internet, poor health literacy and health concerns such as depression or substance abuse.

"Without the assistance of Kynectors, many of our most vulnerable neighbors would not be able to access or maintain their healthcare coverage," she said.

Mike Wynn, Kynector for Grace Community Health Center in Knox County, said, "We meet people daily who come to us in tears, in frustration because they just don't understand the system or they just can't make it work and they don't know who to call or where to go."

Miranda Brown, Kynector with the Kentucky Equal Justice Center, expressed concerns that loosing Kynectors would cause Medicaid recipients to drop out or that those on federally subsidized health plans would have trouble finding providers and would give up.

Mary Volkerding of Caresource said it has built its business model around Kynectors, instead of agents and brokers, to promote its products and this is what has allowed them to have some of the lowest premiums in the areas that it serves. She noted that the loss of Kynectors would likely cause them to have to raise their rates.

Are Kynectors and their allies tilting at a windmill?

Bevin notified federal officials Dec. 30 that Kentucky plans to shut down Kynect, which he says is redundant because the federal exchange serves the same purpose. He has also said that it isn't fair that all Kentuckians with health insurance pay a 1 percent fee on their policies for something that relatively few use. The federal exchange charges a 3.5 percent fee on policies it sells.

It was also announced Feb. 16 that after Feb. 29, Kentuckians will sign up for Medicaid through an online-only program called Benefind.

Beauregard said after the meeting that it is not too late to save Kynect. "We haven't gotten so far along that we can't change our minds," she said. She also noted that just because Kynect was established by an executive order doesn't mean legislators can't weigh in on it and said, "We think they should."

"It is important that legislators hear from the more than 500,000 Kentuckians who have gotten coverage through Kynect because that is when we will see some pressure put on this situation," she said. However, she said, "We only have so much time for this to happen."

Beauregard said that if the governor goes through with his plan to shut Kynect, then the state will need two systems, one for subsidized health plans and another for Medicaid.

As for Bevin's claim that it is not fair for all Kentuckians to pay for something only a few use, she said, "I don't know that 30 percent of Kentuckians is a small percentage. I think that is a good portion of our state." She is including Medicaid recipients in her figure; Bevin does not.

Beauregard said Kynect is a public benefit to all Kentuckians because it maximizes the number of them who enrolled in coverage.

Stivers says Kynectors are making assumptions about their work

In an interview, Senate President Robert Stivers said the Kynectors' belief that they play a vital role in helping decrease barriers to health care for Kentuckians is an "assumption" on their part.

"It seems like the people who have been involved with the assumptions related to Kynect have generally been wrong in all of their numbers and in all of their assumptions," he said.

He then fired off some statistics not directly related to Kynect, including: 51,000 people lost their health insurance when the Kentucky Health Cooperative folded, and it was estimated that 200,000 would sign up for Medicaid expansion by now, but the number is over 400,000.

"I truly appreciate the direction that Gov. Beshear was trying to go, but ... we are far in excess of the numbers they initially provided to us, except for jobs," Stivers said. "So, I don't know how you can argue numbers or facts when they are so wildly disproportionate to what they have told us would happen and it hasn't."

Meanwhile, Stivers said Bevin, Chief of Staff Blake Brickman, Health Secretary Vickie Yates Brown Glisson and Mark Birdwhistell, who has been charged with changing the Medicaid program, met this week with U.S. Health and Human Services Secretary Sylvia Burwell about this issue and Brickman had told him they "thought it was a very, very beneficial meeting and very productive."