Reaction to Medicaid plan is predictably mixed; critics predict federal officials won't approve work-oriented requirements

By Melissa Patrick and Al Cross
Kentucky Health News

Reactions to Gov. Matt Bevin's plan to change Medicaid were predictably mixed, from health-reform advocates saying it is "paternalistic," too complex, removes benefits and adds costs that will create barriers to care, while leading Republicans and the Kentucky Hospital Association sang its praises.

Critics predicted that the Obama administration will reject the plan's requirements that Medicaid recipients have a job, look for one, take job training or do volunteer work.

"You just simply cannot have work requirements in the Medicaid program. It is a safety-net program," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of groups that favor federal health reform and the embrace of it.

Judith Solomon, health-policy vice president at the liberal-leaning Center for Budget and Policy Priorities in Washington, D.C., noted that Health and Human Services Secretary Sylvia Burwell told Arkansas this year, “We cannot approve a work requirement.”

Joe Sonka of Insider Louisville wrote that an unnamed HHS official told him "the agency has been clear that states may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities."

The plan has several elements modeled after private insurance, and Mark Birdwhistell, Bevin's special adviser for Medicaid, said it is "commercial insurance on training wheels." That didn't set well with some critics.

"Training wheels are for kids. Right there, that struck me as an inappropriate analysis,"said Rich Seckel, executive director of the Kentucky Equal Justice Center.

"I have heard words like condescending, patronizing. Even if one doesn't use those kinds of adjectives, I do think there is perhaps an inappropriate model of envisioning people as welfare dependents when that's not really who they are and it's a little unfair to them to act on a stereotype," Seckel said. "A theory of welfare dependency kind of pervades this, and yet we know that more than more than half of the people who qualify and got covered were working people."

Seckel and others said the plan, which would seek a waiver of various federal rules, is too complex.

"People on Medicaid have a lot of responsibilities. They have a lot of things they are dealing with on a daily basis," Beauregard said. It is going to be more difficult to navigate, more difficult to keep up with all of the requirements. And it really is just going to place additional burdens on low-income working Kentuckians and their families."

She added, "Navigating the healthcare system is difficult for anyone, but certainly for people who may not be familiar with commercial insurance. I don't think that our goal should be for that people know how to use commercial insurance. I think our goal should be that people use their coverage to improve their health."

The plan removes dental care from the basic Medicaid program but allows members to qualify for it by engaging in a range of activities that could help them improve their health.

"That is the heartbreaker as far as the benefits that are in jeopardy," Seckel said. "We know how closely related that is to the rest of physical health. We know that people have seized upon that opportunity and used that benefit by the thousands. It is something that does affect your confidence in looking for jobs and acting in the workplace and maybe your hire-ability, and yet we've moved that further away and given you a bunch of things that you have to do to get it back."

KVH Chair Sheila Schuster said, "We're talking about a Medicaid expansion population that has been without coverage for years and years and years and just got it for two years, and now you are saying, 'No, you don't get to have oral health,' which is huge. We have one of the worst toothlessness problems in the country and it is very correlated with physical health."

The sharpest criticism came from Democrat Steve Beshear, who as governor expanded eligibility for Medicaid under health reform, adding more than 400,000 people to the rolls.

In a statement issued under the name of Save Kentucky Healthcare, a group he formed, Beshear said Bevin had "declared war on Kentucky’s working families" and "threatened to kick hundreds of thousands of working Kentuckians off of health care. Gov. Bevin seems woefully unaware of what Kentuckians on expanded Medicaid -- and that's construction workers, substitute teachers, nurses’ aides, farmers, our neighbors, friends and family -- do every day to support their families while still being able to take their children to the doctor."

Perhaps anticipating such criticism, Bevin's office had ready a string of quotes praising the plan.

“The Kentucky Hospital Association applauds Governor Bevin for his leadership in presenting a comprehensive plan to transform Kentucky's Medicaid program to achieve better health outcomes for Kentuckians, while also focusing on its financial sustainability," President and CEO Michael Rust was quoted as saying. “We look forward to working with the Bevin administration in helping to implement this innovative plan.”

Bevin's office also quoted several leading Republicans, including state Senate President Robert Stivers of Manchester, whose district has a large Medicaid population: "I am glad to see Governor Bevin and his administration putting an emphasis on personal responsibility with regard to Medicaid expansion. These are some ideas we have been talking about in the Senate for several years. I agree that the idea of making individuals have some 'skin in the game' will make for a more sustainable and better health-care system for Kentucky."

The Foundation for a Healthy Kentucky issued a statement from President and CEO Susan Zepeda, which said in part: "There are areas to applaud in the proposal, including aligning Managed Care Organization practices for greater efficiency, incentives for evidence-based healthy behaviors such as quitting smoking and obtaining a health risk assessment, expansion of presumptive eligibility sites (including local health departments), and commitment to drug use disorder and mental health services."

"The proposal also raises concerns, including the exclusion of dental and vision benefits in the standard benefits package, anticipated significant drops in Medicaid enrollment, elimination of retroactive eligibility and re-enrollment requirements and penalties for those who fail to pay mandated premiums."