Four years into Obamacare, Kentucky's uninsured rate leveled out, and probably rose. Why? It depends on whom you ask

By Melissa Patrick
Kentucky Health News

In the fourth full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance remained about the same, and probably increased. 2017 was the first year the percentage hasn't dropped since the program's inception in 2014, according to a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

In 2017, 5.4 percent or 235,000 Kentuckians had no health insurance, up slightly from 5.1 percent in 2016, a change that is statistically insignificant, because the poll's error margin was 0.3 percentage points. But chances are that the uninsured rate rose slightly.

Kentucky's uninsured rate was once relatively high, and the drop in it has been by some measures the greatest in the nation.

Before 2014, when Kentucky used the Patient Protection and Affordable Care Act to expand Medicaid to residents with incomes up to 138 percent of the federal poverty level, 14.3 percent of Kentuckians, about 616,000, didn't have health insurance. The expansion has added nearly 500,000 people to the Medicaid rolls.

Click on chart to view a larger version

“Medicaid expansion has been a game changer in the commonwealth. Because so many more Kentuckians now have coverage, people are getting healthier, hospitals are thriving and our economy is moving ahead,” Dustin Pugel, policy analyst for the left-leaning Kentucky Center for Economic Policy, said in a news release.

In general, the Census report shows that there is a clear divide in the uninsured rate among states that expanded Medicaid and those that haven't. In the 32 expansion states as of Jan. 1, 2017, the average uninsured rate was 6.5 percent, about half the 12.2 percent rate in states that haven't expanded.

Between 2016 and 2017, the rate did not significantly change in expansion states as a whole, and increased by 0.4 percentage points in non-expansion states.

Nationally, the share of Americans without health insurance remained the same in 2017, at 8.8 percent, or 28.5 million people.

The survey also found that 96.2 percent of Kentucky's children had health insurance in 2017, up from 93.6 percent in 2013. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program KCHIP.

“Having health insurance means children are able to visit the doctor and the dentist to get the care they need to stay healthy," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. "It means parents can take care of their health needs, so they can stay healthy and provide for their family. And, we know there is an undeniable link between parent’s coverage and their child’s coverage. As more parents receive coverage and care, so will their kids."

CommonWealth Magazine image

What the plateau in coverage numbers means depends on whom you ask.

Obamacare opponents blame the stalled progress in reducing the uninsured rate on rising premiums in the individual market, Rachel Roubein reports for Politico.

Supporters of the Affordable Care Act continue to be concerned about the Trump administration's ongoing attempts to repeal and "sabotage" the ACA, noting the shortened window to sign up for subsidized health insurance, huge cuts to the advertising budget and "navigators" who help people find an insurance plan, the removal of the individual mandate to have health insurance, and pending lawsuits to remove the requirement for coverage of pre-existing conditions.

Meanwhile, proponents are closely watching what will happen if Gov. Matt Bevin's new Medicaid plan is approved, after being vacated by a federal judge in Washington, D.C., just days before it was set to start on July 1.

The judge said federal officials had not sufficiently considered public comments about then plan, which were overwhelmingly against it, or the state's estimate that in five years its Medicaid rolls would have 95,000 fewer people with the plan than without it, partly due to noncompliance. The judge sent it back to the U.S. Department of Health and Human Services for more review.

The plan would require "able-bodied" Kentuckians who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lockout periods for noncompliance, among other things.

The Bevin administration is proceeding as if the plan will be approved, recently holding a hearing to discuss its regulations and continuing to hold stakeholder meetings to discuss it. At the Sept. 6 stakeholder meeting in Frankfort, asked how long the state expects the approval process to take, Kristi Putnam, deputy secretary of the health cabinet, said, "We don't think it will take a long time."

Bevin has said he will end the expansion if courts block his new Medicaid plan, and has issued an executive order putting the termination into effect six months after a final court judgment.

Health Secretary Adam Meier told lawmakers in August that the state is considering eliminating the expansion because Medicaid is facing a nearly $300 million shortfall. The new plan estimates that it would save $300 million over the next five years if it is allowed to proceed, with most of the savings a result of covering 95,000 fewer people.