Medicaid hearings in Bowling Green and Frankfort elicit nearly incessant criticism; third and final hearing in Hazard next Wed.

Supporters of the current Medicaid expansion sat on the front row of a packed hearing room in Frankfort.

By Al Cross
Kentucky Health News

Supporters were few and far between at the first two public hearings on Gov. Matt Bevin's plan for changes in the Medicaid program.

In Bowling Green on Tuesday and in Frankfort on Wednesday, critics of the plan said it would put too many obstacles between the poor and health care. A third and final hearing will be held in Hazard next Wednesday.

"What you're proposing to do here is more cumbersome than average folks find the insurance process now," said A.J. Jones of Louisville, identifying himself as a former Medicaid enrollee now on private insurance. He said in Frankfort that fiscal responsibility, a stated reason for the plan, is "important, but not when you're talking about people's health."

The plan would require enrollees to pay premiums of $1 to $15 a month, based on income. It would also require able-bodied adults without jobs to take job training or counseling, or do community service for nonprofit organizations.

Miranda Brown of Lexington, who helps the poor navigate the health-insurance system, said a homeless person she helped get on Medicaid told her that she would probably drop out of the program if she had to pay premiums.

Bevin and other Republicans say Medicaid enrollees need to have "skin in the game," but Harriet Seiler of Louisville said, "It's a concept that will scrape a pound of flesh from Kentuckians. . . . The sick, the poor and the unemployed are not naughty children who need to be incentivized, scolded or humiliated."

K.J. Owens of Louisville won applause from the overflow crowd in Frankfort when he said the plan "seems motivated by the concern that poor people are defective morally . . . that poor people just aren't trying hard enough. The people on Medicaid are in no more need of moral guidance than the governor and the people on the governor's staff."

Emotions peaked when Molly Shaw of Louisvile-based Parents for Social Justice predicted, "More people will be sick and more people will die. This waiver will kill people."

The plan is a request to the federal government for a waiver of normal Medicaid rules. Asked afterward to reply to Shaw's comment, Health Secretary Vickie Glisson said, "We're trying to maintain the expansion."

Bevin has said if federal officials don't approve his plan, he would end the expansion of Medicaid under federal health reform by his predecessor, Democrat Steve Beshear, that added to the rolls more than 400,000 Kentuckians earning up to 138 percent of the federal poverty level.

Emily Parento, who was Beshear's chief health-policy adviser, predicted that federal officials would not approve the work-oriented requirements or the plan's increase in premiums for enrollees between 100 and 138 percent of the poverty line. "This amounts to a penalty for poverty," she said, adding that the plan has "minimal detail" on the projected cost savings, other than reduced enrollment.

The only unequivocal endorsements of the whole plan, other than written statements from Republican legislators, came from the Kentucky Hospital Association and the state's largest hospital system, Baptist Health. KHA official Nancy Galvagni said the plan improves on those in other states "by using more carrots than sticks" to influence enrollees' behavior, and "does inject some personal responsibility into the system."

In Bowling Green, Diane Amos said her elderly mother couldn't
afford premiums. (Daily News photo by Miranda Pederson)

In Bowling Green, "A few speakers expressed support for smoking cessation programs or a pilot substance abuse treatment plan included in the proposal. But most of the about 20 people who spoke appeared passionately opposed to the changes, with comments that prompted frequent applause from the about 60 people at the hearing," reports Deborah Yetter of The Courier-Journal.

"Cara Stewart, a legal-aid lawyer who represents people on Medicaid, said Bevin’s application for a waiver conflicts with the federal government’s requirements for waivers," Yetter reports. "The goal generally, she said, is to enhance or expand coverage." Stewart said, “I don’t see anywhere in here where we’re increasing coverage I only see cuts in service and taking away access to care.”

The Frankfort hearing was part of a meeting of the state advisory council for Medicaid, chaired by nurse practitioner Elizabeth Partin of Columbia. She was among the speakers who questioned the removal of annual vision and dental exams from regular Medicaid coverage. "That's how you catch problems before they become huge problems," she said. Given the small cost, "It's not gonna break the bank either way, and it may help improve people's health."

The issue was also big in Bowling Green. “We’re No. 1 in toothlessness; so we’re not going to provide dental care for those who need it the most?” asked Chris Keyser, executive director of Fairview Community Health Center.

Franklin optometrist Steve Compton said optometrists often are the first to identify other health problems, such as high blood pressure or diabetes, during a routine eye exam. In Frankfort, Richmond optometrist Matt Burchett said optometrists discovered 15 percent of diabetics insured by United Health.

Under the plan, enrollees could earn coverage for vision and dental exams, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.

Speakers at both hearings questioned the proposed six-month suspension of enrollment for failure to pay premiums. "It seems rather harsh," said council member Barry Whaley of Louisville, executive director of Community Employment Inc.

Bevin's deputy chief of staff, Adam Meier, noted that suspended enrollees could re-enroll sooner by paying premiums and taking a health-literacy or financial-literacy course. "We want to mirror commercial insurance coverage," he said, "to teach people how to be engaged in their health insurance plan."